回收钩贴壁的疑难性下腔静脉滤器取出技巧及应用

目的探讨回收钩贴壁的疑难性下腔静脉滤器取出技巧及应用价值。方法近3年置入172例可回收下腔静脉滤器,在取出滤器的111例患者中,对回收钩贴壁的18例患者,采用鹅颈抓捕器-单个或多个加硬导丝辅助圈套加常规套取法。结果 18例常规取出法失败的病例,均成功取出。结论对回收钩贴壁的疑难性下腔静脉滤器,采用鹅颈抓捕器-单个或多个加硬导丝辅助圈套加常规套取法取出,损伤小,操作简单易行,值得推广应用。     

伞形滤器回收钩包埋和支柱断裂成功回收1例并导丝成襻技术要点总结

<正>1临床资料患者女,56岁。3个月前因右膝关节术后右下肢深静脉血栓形成,为预防肺栓塞行下腔静脉滤器（IVCF）置入术（伞形）,手术顺利,术后恢复良好。1周前于外院2次行下腔静脉滤器取出术,均未获成功,最近一次术中造影发现滤器一支柱变形,随呼吸运动上下摆动（见图1(1)）。     

导丝成襻切割技术辅助回收嵌顿的下腔静脉滤器

【摘要】 目的 探讨导丝成襻切割技术辅助回收嵌顿的下腔静脉滤器操作技巧与应用价值。 方法 2015年1月2018年1月北部战区总医院对接受下腔静脉滤器回收术患者,先采用常规标准取出技术,再以目前常用的改良回收技术进行回收,滤器发生嵌顿并与血管壁严重黏连无法取出时,遂辅助以导丝成襻切割技术尝试取出。 结果 168例下腔静脉滤器取出术中共有7例患者经常规标准技术和改良技术均失败,辅助以导丝成襻切割技术后均成功取出滤器。结论 导丝成襻切割技术可行有效,有助于提高嵌顿且与严重血管壁严重黏连的下腔静脉滤器回收率。     

超期可回收下腔静脉滤器的回收

目的探讨超期的可回收滤器是否仍可回收以及回收的技术要点和安全性。方法自2009年1月至2012年6月,共实施6例超期可回收下腔静脉滤器回收手术,其中Günther Tulip(CookMedical,Bloomington,IN)2例,OptEase(Cordis Corporation,Bridgewater,NJ)4例。Günther Tulip 2例分别植入了120 d和140 d,OptEase 4例平均植入时间为56 d。结果 2例Günther Tulip均顺利回收,患者术中无不适主诉,术后造影下腔静脉无充盈缺损、无对比剂外漏。4例OptEase中3例取出,1例放弃。结论超期的可回收下腔静脉滤器多数仍是可以被顺利回收的,回收的成功率与植入的时间和滤器的结构有关,细致小心的术中操作可避免严重并发症的发生。因此,对多数因各种原因错过了最佳回收时间的可回收下腔静脉滤器植入患者来说,回收手术仍是值得尝试的。     

LOOP技术在腔静脉滤器回收困难病例中的临床应用

目的 总结Loop技术在腔静脉滤器回收困难病例中的临床应用经验与技巧.方法 回顾性分析肇庆市第一人民医院及中山大学附属第三医院自2015年1月至2020年6月期间采用LOOP技术处理腔静脉滤器回收困难患者27例,滤器留置时长为7～120 d,平均45 d.结果 17例患者的滤器被整体取出,造影显示下腔静脉通畅,无对比剂...     

腔内技术回收倾斜贴壁下腔静脉滤器31例分析

【摘要】 目的 探讨球囊移位和导丝成襻Loop技术取出倾斜贴壁的可回收下腔静脉滤器(IVCF)的技巧和临床经验。 方法 回顾性分析2017年3月至2020年9月在重庆医科大学附属第二医院接受处理的31例IVCF倾斜贴壁回收困难患者临床资料。其中男15例, 女16例,年龄为(57.9±16.4)岁。滤器留置( 7～693) d,术中采用球囊辅助移位、导丝成襻Loop技术解除回收钩贴壁状态,取出滤器。记录患者围术期并发症和随访期下腔静脉(IVC)通畅性。结果 31例倾斜贴壁IVCF均成功取出,其中应用Denali滤器3例,OptEase滤器20例,Celect滤器6例,Günther Tulip滤器2例。采用球囊辅助移位技术12例,导丝成襻Loop技术19例(单Loop 6例,同向双Loop 9例,双向双Loop 4例)。手术时间为35～157 min。回收相关并发症发生率为9.68%(3/31),未发生严重并发症。术后随访4～48个月,1例因颅内胶质瘤死亡,IVC通畅率为100%。结论 采用球囊移位、导丝成襻Loop技术可有效解除滤器倾斜,提高倾斜贴壁所致取出困难的可回收IVCF回收率,值得临床推广应用。     

DSA导引下经左颈内静脉为永存左上腔静脉患者植入静脉输液港1例

<正>1临床资料患者女,56岁,因“右乳腺癌改良根治术后1个月余”收治入院。既往有原发性高血压Ⅰ级3年余。体格检查：右乳房缺失,右胸壁可见长约15 cm陈旧性手术瘢痕,愈合佳,右胸壁及腋窝未扪及包块,未扪及皮下积液,双侧腋下未扪及肿大淋巴结。入院诊断：乳腺恶性肿瘤（右乳浸润性导管癌（p T2N3M0）。患者右乳房癌改良根治术前已通过右颈内静脉入路置入经外周穿刺中心静脉导管（peripherally inserted central catheter,PICC）,     

Denali和Celect下腔静脉滤器回收单中心经验

目的 对比分析Denali和Celect可回收下腔静脉滤器回收的难易程度和手术相关并发症.方法 收集2015年6月至2019年6月在北京世纪坛医院接受Denali或Celect可回收下腔静脉滤器置入的196例患者临床资料,其中Denali组101例,Celect组95例.分析两组一般资料、回收过程及相关并发症情况.结果...     

旋转肾动脉DSA的临床应用

目的　探讨旋转肾动脉DSA临床应用的可行性。方法　回顾性分析 48例肾肿瘤患者腹主动脉DSA检查中肾动脉的解剖情况。测量 5 0例腹部CT增强扫描肾动脉开口的位置、方向。观察 16例旋转肾动脉DSA的效果。结果　 48例常规腹主动脉DSA中 ,右肾动脉开口、主干及分支显示不清分别为 12例、5例及 10例。左肾动脉开口、主干及分支显示不清分别为 8例、4例及 6例。 5 0例腹部CT增强扫描显示 :右肾动脉开口位于腹主动脉侧壁、侧前壁以及侧后壁分别为 4例、2 4例及 3例。左肾动脉开口位于腹主动脉侧壁、侧前壁以及侧后壁分别为 13例、2例及 13例。两肾动脉开口位于腹主动脉同一水平面 11例。 16例旋转肾动脉DSA中 ,两侧肾动脉旋转 6例 ,单侧肾动脉旋转 10例。肾动脉开口狭窄 3例 ,主干狭窄 2例 ,肾肿瘤供血动脉 7例 ,排除肾动脉狭窄 4例。结论　旋转肾动脉DSA有助于详细显示肾动脉的解剖细节。     

Fibrin cap disruption: an adjunctive technique for inferior vena cava filter retrieval

Various adjunctive techniques have been reported for challenging inferior vena cava (IVC) filter retrievals (1-4). One particularly challenging obstacle to successful IVC filter retrieval is the formation of a radiolucent fibrin cap over the embedded apex of the IVC filter. This obstacle is a result of filter tilting that creates turbulent blood flow, which promotes fibrin cap formation. The aim of this brief report is to depict a novel technique for IVC filter retrieval: guide wire-manipulated disruption of the fibrin cap.     

Loop-snare technique for difficult inferior vena cava filter retrievals

Retrievable inferior vena cava (IVC) filters are generally retrieved without difficulties. However, when filters are tilted against the IVC wall, engaging the tip or hook of the filter can be difficult with the use of standard techniques. This report describes an alternative method of successful IVC filter retrieval by creating a wire loop between the filter legs, including the tip of the filter. This loop snare was successfully applied in eight cases after filter retrieval failed with the Recovery Cone or simple snare technique.     

Suprarenal inferior vena cava filter implantation

Purpose

This study evaluated the feasibility, safety, and efficacy of the suprarenal implantation of a retrievable filter in patients with renal cell carcinoma (RCC) and renal vein thrombosis (RVT) [extending or not extending to the inferior vena cava (IVC)] undergoing surgery.

Materials and methods

Between March 2005 and May 2010, 13 patients (eight men and five women; mean age 67.08 years, range 38?C95) with RCC and RVT associated or not with IVC thrombosis underwent implantation of a retrievable suprarenal IVC filter. All patients underwent computed tomography angiography (CTA), which documented RVT and in some cases its extension to the IVC. The level of IVC involvement by the neoplastic thrombus was evaluated on the basis of the Oto classification. Cavography was performed before and after filter implantation. Surgical resection of RCC was performed in all patients. A CTA scan was performed 1 week before filter removal.

Results

The procedure had 100% feasibility. All filters were correctly deployed in the suprarenal tract of the IVC. There was no evidence of peri-or postprocedural complications. All patients were monitored for clinical symptoms of pulmonary embolism (PE). There was no evidence of PE in the 30 days after the procedure. All suprarenal IVC filters were removed from 30 to 60 days after surgery.

Conclusions

Implantation of a temporary suprarenal IVC filter is an additional and feasible procedure that can prevent immediate and perioperative PE.     

Incidence and management of inferior vena cava filter thrombus detected at time of filter retrieval

Purpose

To evaluate inferior vena cava (IVC) venograms (ie, cavograms) before filter retrieval to determine the incidence and volume of filter thrombus relative to filter dwell time and evaluate subsequent changes in thrombus volume with additional anticoagulation.

Materials and Methods

IVC filter retrieval attempts between December 2002 and June 2010 were retrospectively reviewed to determine the incidence of filter thrombus and estimate thrombus volume on a preretrieval cavogram. Correlation between filter dwell times (assessed at 30-d intervals) and incidence and volume of thrombus was assessed. Follow-up images and management of filters with thrombus that were not initially removed were analyzed.

Results

A total of 463 retrieval attempts were performed in 440 patients, with a mean filter dwell time of 95 days ± 145 (SD; range, 0–1,762 d). Thirty (6.5%) had filter thrombus on initial cavograms, with a mean thrombus volume of 2.8 cm³ ± 7.3 (range, 0.04–40.02 cm³). Incidence rate and estimated thrombus volume were highest in the 0–30-day dwell interval (8.0% and 6.3 cm³, respectively) and decreased at subsequent time intervals. On linear regression analysis, incidence of filter thrombus was inversely related to dwell time (P < .05; correlation coefficient, −0.86). Seven patients with thrombus underwent additional anticoagulation for a mean of 48 days ± 25 (range, 14–90 d); thrombus resolved completely in five (71%) and partially in one (14%), and increased in one (14%).

Conclusions

The incidence of filter thrombus at the time of filter retrieval appears to decrease with dwell time. If thrombus is detected, an additional period of anticoagulation is likely to reduce the thrombus burden and facilitate later retrieval.     

Comparative efficacy and safety of the Captus device for inferior vena cava filter retrieval

PurposeRetrievable inferior vena cava filters (IVCF) have been increasingly used for mechanical pulmonary embolism prophylaxis since their development. The Captus Vascular Retrieval System (Avantec Vascular, Sunnyvale, California) is a new device developed for retrieval of IVCF. This study compared the safety and efficacy of the new Captus device against the existing EnSnare Endovascular Snare System (Merit Medical, South Jordan, Utah) for IVCF retrieval.MethodsPatients undergoing IVCF retrieval at a single institution between July 2015 and July 2020 were retrospectively identified. All adult patients (>18 years) undergoing filter retrieval with either Captus or Ensnare were included. Technical success and complications were compared by device. A complexity score was assigned to each case to adjust for selection bias. Logistic regression was used to model the association between device type and primary technical success.Results99 IVCF retrievals met inclusion criteria, 59 with Captus and 40 with Ensnare. The majority of the cohort consisted of low complexity cases (n = 51, 86% Captus versus n = 31, 78% Ensnare; p = 0.28). Technical success for low and medium complexity retrievals was 88% and 62% with Captus and 96% and 33% with Ensnare. There was no significant association between device type and technical success, adjusting for case complexity (Captus OR 0.55, 95% CI 0.08–2.72, p = 0.49). There were no device-related complications.ConclusionNo statistically significant difference in device technical success or complications between the Ensnare and Captus devices for uncomplicated IVCF retrieval.PrecisThe Captus Vascular Retrieval System is a new device for IVC filter retrieval which has similar technical success to the existing EnSnare.     

Percutaneous retrieval of a Mobin-Uddin inferior vena cava filter 42 years following implantation

Inferior vena cava filters (IVCFs) are an established alternative for protection from thromboembolism when anticoagulation fails or is contraindicated. Before the creation of retrievable IVCFs, patients received filters that were permanent or designed without standardized retrieval options. Although these filters were implanted for prolonged protection, chronic vena caval occlusion and post-thrombotic syndrome are potential sequelae. We present a 53-year-old patient with a Mobin-Uddin permanent IVCF placed 42 years prior, complicated by acute iliocaval thrombosis following more than 40 years of filter dwell time. She was successfully treated with thrombolysis, thrombectomy, endobronchial forceps assisted IVCF removal, and iliocaval stent reconstruction.

Pulmonary embolism (PE) is a devastating consequence of venous thromboembolism and contributes to a significant portion of preventable hospital death. Standard medical management of venous thromboembolism includes anticoagulation. Under circumstances where anticoagulant therapy is contraindicated or fails, clinicians have relied upon procedural interventions such as inferior vena cava filters (IVCFs) to block the migration of deadly emboli to the lungs. One of the earliest accounts of IVCF clinical data originated from placement of the umbrella filter by Kazi Mobin-Uddin in 1969 (1).The Mobin-Uddin (MU) filter was designed to provide lifetime prophylaxis for patients; however, it is not devoid of thrombotic and filter-related postplacement complications. Thrombotic manifestations include acute caval thrombosis, chronic vena cava occlusion, and increased risk of subsequent deep vein thrombosis (DVT), which may further necessitate concurrent anticoagulation. Filter-related complications include penetration into adjacent viscera, migration, fracture, and embolization. The recovery process for retrievable vena cava filters is well documented in medical literature. In comparison, there seems to be a scarcity of insight regarding the removal of permanent inferior vena cava filters (pIVCFs). In this case report, we describe the retrieval tactics implemented in removing a MU filter in a patient who developed acute obstruction 42 years post filter placement.