可转换型腔静脉滤器的临床应用观察

目的评价可转换型腔静脉滤器临床应用的近期疗效、安全性和并发症。方法回顾性分析2017年5月至2018年5月安置可转换型滤器患者的临床及随访资料。结果 103例滤器均成功置入。27例行滤器转换, 26例转换成功(置入后5～145 d转换), 所有转换滤器均无血栓形成、移位、倾斜、断裂或穿透静脉壁造成血肿等并发症。未转换原因主要包括年龄(18.4%, 19/103)、高危人群的预防(12.6%, 13/103)、有限的器官功能(9.7%, 10/103)等。94例患者在术后6个月获得随访(91.3%), 发现1例滤器内血栓形成, 3例下肢静脉血栓加重但无下腔静脉闭塞, 全部患者未再出现症状性肺栓塞。结论可转换型腔静脉滤器可减少围手术期肺栓塞的发生率。年龄、有限的器官功能及高危人群的预防是低转换率的主要原因。     

OptEase可回收型滤器在DVT介入治疗中的应用

目的评价Optease可回收型滤器防止肺栓塞作用及其安全性、可回收性。方法42例下肢深静脉血栓患者(合并肺栓塞17例),男25例,女17例,年龄22~60岁(平均44岁)。40例经股静脉路径置入Optease滤器于肾下水平下腔静脉,2例因血栓累及下腔静脉近肾静脉开口,经右颈静脉路径置入到肾静脉以上段下腔静脉。置入后,行下肢静脉及肺动脉导管溶栓治疗。术后6例患者取出滤器。结果Optease滤器释放时均无明显前跳和回缩现象发生,定位良好。介入治疗及造影复查过程中,滤器均无移位。患者均无肺动脉栓塞症状加重及新的肺动脉栓塞发生。6例下肢静脉血栓完全消失及年龄较轻患者(22~40岁),于滤器置入后7~12天内,经股静脉路径,采用Gooseneck捕捉器将滤器取出。回收的滤器均完整,无血栓附着。结论Optease可回收型滤器可有效地防止肺栓塞的发生;Optease滤器置入安全、定位准确,可经股静脉路径完好地进行回收。     

腹腔镜下腔静脉滤器取出术安全性与可行性分析

背景与目的：笔者所在医院自2016年率先在国内开展腹腔镜下腔静脉取滤器手术以来,已进行了多例该项手术。本文通过分析10例行该手术患者的临床资料,总结两种腹腔镜下腔静脉滤器取出的手术途径（经腹腔途径、经腹膜后途径）的手术经验,为开展及推广该手术提供参考。 方法：回顾性分析2016年12月—2018年11月10例行腹腔镜下腔静脉滤器取出术的患者临床资料。其中男7例,女3例;年龄24~66岁,平均（47±12.5）岁;经CT分型：滤器头端位于肾静脉水平以上1例,位于肾静脉水平4例,位于肾静脉水平以下5例;滤器头端贴近下腔静脉前壁或前侧壁者5例,贴近后外侧壁者4例,位于下腔静脉腔内者1例。9例患者置入Cook Celect滤器,1例患者置入Denali滤器。所有滤器均为可回收滤器。患者均在当地医院置入,因髂静脉及下肢静脉血栓形成而预防性置入滤器7例,因肋骨及骨盆多发骨折而预防性置入滤器1例,因下肢静脉血栓致肺栓塞而置入滤器2例,患者既往均在当地医院腔内取滤器失败次数1~3次失败后转入我院。10例患者均行下腔静脉滤器取出术,包括经腹腔途径6例,经腹膜后途径4例。手术通常放置3~4个Trocar,游离下腔静脉,根据CT检查,找到滤器头端的具体位置,纵行切开下腔静脉,取出滤器。术后注意观察引流情况,24 h经腹腔途径引流量50 mL以下,经腹膜后途径引流20 mL以下即可拔出引流管。根据引流情况,术后24~48 h皮下注射低分子量肝素钠注射液,防止下肢深静脉血栓形成。患者第2天开始进流质饮食,并逐渐过渡至普通饮食,鼓励患者适度下床活动。 结果：10例患者中9例腹腔镜下腔静脉滤器取出成功,1例未成功。下腔静脉阻断1例,阻断时间20 min,其余未阻断。手术时间150~420 min,平均（253.5±86.7）min;术中出血量10~500 mL,平均（67.0±152.6）mL;9例出血量较少（10~50 mL）,未输血,1例患者出血500 mL,输悬浮红细胞4单位。住院时间7~15 d,平均（12.3±2.4）d。所有患者术后均未出现相关并发症。术后随访至今,所有患者均未见血栓复发。 结论：腹腔镜滤器取出手术难度大、技术复杂,充分的术前准备,熟练的手术技巧可以提高手术的安全性和成功率。对于每位患者,都要仔细观察CT片,根据滤器头端的不同位置,采用不同的手术方法,才能提高成功率。     

下腔静脉滤器开放手术取出的安全性与可行性分析

背景和目的：下腔静脉滤器（IVCF）在预防致死性肺栓塞（PE）中广泛应用,通常经过腔内介入手段取出。对于腔内取出失败或超回收时间窗的滤器,可考虑手术取出。本研究目的是评价开放手术取出IVCF的安全性及可行性。方法 回顾性分析2019年2月—2022年8月在北京积水潭医院血管外科收治的27例IVCF置入后行开放手术取出的患者临床资料。所有患者开放手术前行介入尝试取出的中位次数为1（1~2）次。结果 所有滤器均全部取出,技术成功率为100%,滤器置入中位时间为20（5~48）个月。其中,Aegisy滤器8例（29.6%）,Denali滤器1例（3.7%）,Cordis滤器10例（37.0%）,Simon滤器1例（3.7%）,Celect滤器3例（11.1%）,Tulip滤器4例（14.8%）。1例（3.7%）滤器位于肾静脉上下腔静脉,1例（3.7%）位于肝后下腔静脉,25例（92.6%）滤器位于肾静脉下下腔静脉。术中,2例（7.4%）于滤器回收钩处留置荷包缝合线,未阻断下腔静脉血流,通过直接钳夹回收钩取出,取出后进行荷包缝合;2例（7.4%）未阻断下腔静脉血流,将滤器直接回收至血管鞘后行荷包缝合;1例（3.7%）阻断双肾静脉及滤器远近端下腔静脉血流,1例（3.7%）分别阻断滤器远端下腔静脉、第一肝门及第二肝门血流,21例（77.8%）阻断滤器远近端下腔静脉血流,然后通过切开下腔静脉前壁进行滤器取出,取出后进行血管壁连续缝合。手术平均时间为（224.15±23.85）min。围手术期无下肢深静脉血栓或症状性PE发生,无心肺系统并发症,无伤口感染。1例（3.7%）出现腹痛伴血性胃液,1例（3.7%）出现血尿,均保守对症治疗后缓解。术前血红蛋白平均为（128.59±15.05）g/L,术后为（110.56±22.15）g/L,6例（22.2%）术后输入悬浮红细胞400 mL,未见致命性大出血及休克。中位术后住院时间9（8~12）d。结论 尽管开放手术滤器取出手术难度较大、技术十分复杂,但滤器取出是安全可行的。术前充分利用CT判断滤器及其回收钩的位置,采用合适的手术方式,通过熟练的手术技巧可以极大地提高开腹手术的安全性和成功率。     

导管溶栓及置入下腔静脉滤器预防肺栓塞的临床应用

目的评价导管溶栓治疗下肢深静脉血栓形成的效果及置入下腔静脉滤器预防下肢深静脉血栓脱落引起肺栓塞的价值。方法48例下肢深静脉血栓患者分别经股静脉（40例）、右颈静脉（8例）置入下腔静脉滤器，滤器位于双。肾静脉水平以下的下腔静脉内，下腔静脉滤器植入后将溶栓导管插入血栓之髂股静脉进行溶栓。药物：尿激酶80-100万u，肝素1mg／kg。结果下腔静脉滤器置入全部成功，术中导管溶栓32例完全再通及部分再通，余16例术后溶栓成功。结论经导管术中溶栓成功率高，效果好，置入下腔静脉滤器防止肺栓塞是安全有效的方法。     

临时滤器捕捉血栓预防肺栓塞的临床观察

目的　观察下肢深静脉血栓形成患者置入的腔静脉临时滤器后捕捉血栓和预防肺栓塞的效果。方法　对确诊单侧下肢深静脉血栓形成的 5 8例患者 ,治疗前经健侧肢体置入腔静脉临时滤器 (antheortemporaryfilter,ATF)并实施手术腔内治疗和 或抗凝溶栓治疗 ,临床观察有无出现肺栓塞症状和体征。治疗后拨除临时滤器观察血栓的捕捉。结果　下腔静脉滤器置入全部成功 ,下肢深静脉血栓形成患者治疗后效果良好 ,无症状性肺栓塞发生。置入滤器平均 (1 2 . 0± 2 . 0 )d取出。临时滤器捕捉血栓患者 4 6例 ,占 79. 3%,其中 2例捕捉到大于 1cm血栓 ,经切开股静脉将滤器和血栓一并取出。结论　临时滤器预防肺栓塞安全有效 ,无远期并发症之忧 ,下肢深静脉血栓形成患者为预防肺栓塞措施置入临时滤器是有必要的。     

TempofilterⅡ型下腔静脉临时滤器的临床应用

目的 总结TempofilterⅡ型下腔静脉临时滤器应用的临床经验。方法 对2002年4月～2006年8月间的24例需要置入下腔静脉临时滤器的患者,应用彩超了解血栓范围,下腔静脉、肾静脉和入路静脉（右颈内静脉）的情况,在彩超和X线透视下（免造影剂）,应用Seldinger穿刺技术,通过导丝导管将临时滤器放在肾静脉开口远端的下腔静脉内。结果 24例均成功置入和拔除。置入时间5 d～6周,平均16.8 d。其中滤器处下腔静脉血栓形成4例,发生在3 d～2周。捕获血栓8例,血栓均〈0.5 cm。随访23例,平均23个月（7～57个月）,无再次发生肺栓塞病例,1例下肢深静脉血栓复发,经抗凝治疗后好转。结论 TempofilterⅡ型下腔静脉临时滤器是安全和有效的;超声结合X线透视免去造影剂的置入操作是安全和可行的;多数可以在3周时拔除,如果滤器血栓形成应及时处理。     

下腔静脉滤器在治疗下肢深静脉血栓中的应用

目的探讨下腔静脉滤器在治疗下肢深静脉血栓中的应用价值。方法46例下肢深静脉血栓患者在其他治疗前先置入下腔静脉滤器,然后其中20例采用抗凝、溶栓等药物治疗＋气压梯度治疗,另26例实施手术治疗,并同时采取抗凝、溶栓及气压梯度治疗。观察本组患者有无出现肺栓塞的症状及体症,定期透视滤器的形态与位置。结果下腔静脉滤器置入全部成功,其中置入永久性下腔静脉滤器38例,置入临时性下腔静脉滤器8例。经治疗46例患者中44例的下肢深静脉血栓症状及体征消失或缓解,无肺栓塞发生。对置入永久性下腔静脉滤器者中的36例进行2～24个月的随访（平均13个月）,滤器无移位,未发生肺栓塞。结论下腔静脉滤器置入方法简单、安全,可有效防止肺动脉栓塞的发生,可为下肢深静脉血栓治疗提供有效保障。     

腰椎椎旁大血管走行及其与腰椎位置关系的CT观测

【摘要】 目的：观察腰椎椎旁大血管走行情况及其与腰椎的位置关系,为腰椎后路手术提供指导。方法：选取50例在我院行腹部CT增强扫描患者的影像资料,其中男性34例,平均年龄53岁,平均身高174cm,平均体重68kg;女性16例,平均年龄54岁,平均身高167cm,平均体重63kg。采用PACS 11.0软件系统分别测量L1/2～L5/S1椎间盘水平椎旁大血管（腹主动脉、下腔静脉、髂动静脉及其分支）与椎体前、后面的相对位置关系,及其与椎体前、后面之间的距离。结果：男性椎旁动脉距椎体前、后面的距离分别为35.86±7.84mm、46.48±8.51mm;女性分别为32.15±6.03mm、41.57±6.72mm;男性椎旁动脉位于椎体前、后面的范围分别为10.87°±27.54°、7.61°±19.12°;女性分别为15.16°±31.85°、10.87°±22.48°;男性椎旁静脉距椎体前、后面的距离分别为35.86±7.84mm、46.48±8.51mm;女性分别为32.15±6.03mm、41.57±6.72mm;男性椎旁静脉位于椎体前、后面的范围分别为10.87°±27.54°、7.61°±19.12°;女性分别为15.16°±31.85°、10.87°±22.48°。男性椎旁动静脉距椎体前面和后面的距离均大于女性,差异均有显著性（P＜0.05）,而椎旁动静脉与椎体前、后面的相对位置关系男女之间无显著性差异（P>0.05）。腹主动脉分叉位置12例（24%）在L4椎体下半部,32例（64%）在L4/5椎间隙;髂总动脉分叉位置29例（58%）在L5/S1椎间隙,12例（24%）在S1椎体的上半部;髂总静脉汇合位置42例（84%）在L5椎体上半部;髂内外静脉汇合位置16例（33%）在L5/S1椎间隙,27例（53%）在L5椎体的下半部。结论：腰椎椎旁血管的分叉位置变异较大,女性椎旁动静脉距椎体前、后面距离更小,腰椎后路手术中咬除腰椎间盘时应该注意把握腰椎与椎旁血管的角度与距离,谨防误伤椎旁血管。     

下腔静脉滤器置入术预防肺栓塞的临床观察

目的：探讨下腔静脉滤器置入术对下肢深静脉血栓形成后引起肺栓塞的预防效果。方法：14例下肢静脉血栓形成患者采用Seldinger技术施行下腔静脉滤器置入术。结果：滤器全部安全置入肾静脉下方的下腔静脉内。随访1月～40月，10例无肺栓塞的患者，无肺栓塞发生，滤器无移位，4例已有肺栓塞者无加重。结论：下腔静脉滤器用于预防肺动脉栓塞是一种安全有效的方法。     

全腹腔镜辅助下透壁锥形滤器取出的临床分析

背景与目的:锥形滤器是近些年较为常用的可取出下腔静脉滤器,但其容易发生倾斜及回收钩嵌入或穿透下腔静脉壁,导致常规腔内介入方法无法取出,甚至发生严重并发症。因此,本研究探讨全腹腔镜辅助下回收钩穿透下腔静脉壁的锥形滤器取出的安全性与效果,为临床提供有效的处理策略与方法。方法:回顾性分析2016年12月—2019年11月收治15例下腔静脉锥形滤器植入患者的临床资料。其中男12例,女3例;平均年龄(47.7±13.3)岁。置入Celect滤器12例,Denali滤器2例,Option滤器1例。所有滤器经颈静脉介入无法取出,术前CT提示滤器回收钩穿透下腔静脉壁,所有患者在全麻下采用全腹腔镜辅助下滤器取出术。结果:手术方式为经腹腔途径9例(60.0%),经腹膜外途径6例(40.0%)。全腹腔镜辅助下滤器成功取出14例(93.3%),其中1例为Option滤器,2例为Denali滤器,11例为Celect滤器。1例(6.7%)Celect滤器腹腔镜手术未能分离回收钩,中转开腹手术成功取出。腹腔镜取出率为93.3%。患者滤器置入时间为(103.9±70.3)d,围手术期1例(6.7%)术中失血给予输血治疗,1例(6.7%)切口皮肤感染,术后平均住院(7.4±2.8)d。结论:全腹腔镜辅助下取出回收钩穿透下腔静脉壁的锥形滤器是安全有效的,能避免滤器长期植入导致的并发症,术前CT评估能提高手术成功率。     

永久性下腔静脉滤器在下肢深静脉血栓治疗中的中长期疗效及应用价值

目的 总结永久性下腔静脉滤器在下肢深静脉血栓治疗中的中长期疗效并评估其应用价值.方法 回顾性分析上海交通大学医学院附属仁济医院血管外科2010年1月-2015年10月置入永久性下腔静脉滤器的86例下肢深静脉血栓的病例资料,其中男性41例,女性45例,年龄50 ～ 94岁,平均年龄71.8岁.深静脉血栓位于左下肢51例,右下肢25例,双下肢10例,合并肺栓塞6例.滤器置入后,无溶栓禁忌者行导管溶栓,必要时行髂股静脉球囊扩张及支架置入.术后除抗凝禁忌者外,均采用抗凝治疗.结果 所有患者均一次性放置滤器成功.置入贝朗Vena Tech LP滤器76例,强生TrapEase滤器10例.单纯滤器置入65例,滤器置入+导管溶栓7例,滤器置入+导管溶栓+球囊扩张/支架置入14例.随访12～81个月,平均51个月,死亡27例,均非滤器相关性,其中恶性肿瘤17例,其他死因10例.深静脉血栓复发3例,支架狭窄伴血栓形成2例.滤器倾斜6例,倾斜角度＜15°,滤器下方血栓形成3例,滤器明显移位2例,无滤器断裂、下腔静脉穿孔及出血等发生,无症状性肺栓塞新发或者复发.结论 永久性滤器可以有效预防下肢深静脉血栓导致的肺栓塞,但长期留置可能导致相关并发症,对于高龄或者合并晚期肿瘤等、预期寿命有限的患者,永久性滤器仍是不错的选择.     

Accurate deployment of vena cava filters: comparison of intravascular ultrasound and contrast venography

BACKGROUND: The increasing use of vena cava filters by trauma surgeons has led to reports of filter placement using intravascular ultrasound (IVUS). Although attractive because of its ease of use and elimination of contrast and radiation, no studies have examined the accuracy of filter placement by IVUS as compared with contrast venography (CV). The purpose of this study was to compare the anatomic information obtained by both techniques during filter placement. METHODS: Twenty-one patients meeting trauma service criteria for filter placement were studied (11 women and 10 men; mean age, 46.8 years). All procedures were performed in the operating room by trauma surgeons. Vascular access was obtained by percutaneous placement of an 8 French sheath in the right femoral vein. CV, IVUS, and bilateral selective renal venography were performed before deployment of a Greenfield filter. Localization and diameter measurements were made in reference to a radiopaque ruler placed on the patient's abdomen. We chose the "best location" for filter deployment as 1 cm below the junction of the lowest renal vein and the vena cava. Measurements by CV and IVUS were compared with the "gold standard" of selective renal venography. RESULTS: As compared with selective renal venography, the difference between best location by CV and IVUS was 16.3 +/- 13.8 mm and 3.7 +/- 5.6 mm, respectively (p = 0.001). In four cases (19%) the CV missed best location by 3 cm or more. CV overestimated the diameter of the vena cava in all cases. Average vena cava diameter was 26.4 +/- 3.3 mm by venography and 20.6 +/- 3.1 mm by IVUS (p < 0.0001). CV incorrectly identified four patients as having vena cava diameters too large (>2.8 cm) for the placement of a Greenfield filter. The two renal vein anomalies (one double left renal vein and one absent left renal vein) were correctly diagnosed by IVUS. CONCLUSION: IVUS is a more accurate method of localizing the renal veins and measuring vena cava diameter for placement of vena cava filters than contrast venography.     

Bedside insertion of vena cava filters in the intensive care unit using intravascular ultrasound to locate renal veins

BACKGROUND: Historically, contrast venography has been used to determine renal vein location and assist with vena cava filter placement. This technique, however, exposes the patient to nephrotoxic contrast and radiation. For trauma patients in the intensive care unit (ICU), inferior vena cava filters should ideally be placed without contrast at the bedside to avoid nephrotoxic agents, radiation, and transport of a critically injured patient to the operating room or x-ray department. Previously, the authors have shown that intravascular ultrasound is a safe and accurate method for locating renal veins and assisting with vena cava filter placement. The purpose of this study was to evaluate bedside vena cava filter placement prospectively using only intravascular ultrasound for imaging. METHODS: Between August 2000 and July 2003, 29 patients met trauma service criteria for prophylactic or therapeutic placement of a vena cava filter. The 7 females and 22 males had a mean age of 51.3 years (range, 20-92 years), a mean height of 177 cm (range, 160-218.4 cm), a mean weight of 101.9 kg (range, 59.1-186.4 kg), and a body mass index of 33 (range, 14.7-56.1). Fifteen patients (55.5%) had a body mass index exceeding 30. The mean Injury Severity Score was 25.4 (range, 12-45). Intravascular ultrasound was the sole imaging method, and no contrast or fluoroscopy was used. All procedures were performed in the ICU by trauma surgeons. Data collection was prospective and included demographics, injuries, vena caval anatomy, length of procedure, complications, and follow-up radiographic confirmation of appropriate deployment. RESULTS: The location of the renal veins and vena cava diameter was imaged in all the patients. Three patients were noted to have accessory renal veins, and no patient had thrombus in the vena cava. The inferior vena cava diameter was less than 28 mm in all the patients, thus allowing standard filters to be deployed. Filter deployment was successful for all the patients. Of the 29 patients, 27 had abdominal computed tomography (CT) during their hospital stay. When the location of the renal veins identified by CT was compared with the level of the filter on abdominal x-ray, the filter tip was found to be at or below the level of the most caudal renal vein in 26 of the 27 patients (96.3%). In one patient, the filter tip was purposely placed 2 to 3 cm above an accessory caudal renal vein, but below the main right and left renal veins. The mean procedure time was 37.7 minutes (range, 12-86 minutes). No complications were associated with filter placement. CONCLUSIONS: Intravascular ultrasound is a safe and effective imaging method that may be used for the bedside placement of vena cava filters in the ICU. This technique avoids the use of nephrotoxic intravenous contrast and eliminates the risk of transporting a critically injured patient to the operating room or x-ray department.     

EARLY AND LATE RESULTS AFTER BIRD'S NEST FILTER PLACEMENT IN THE INFERIOR VENA CAVA: CLINICAL AND DUPLEX ULTRASOUND FOLLOW UP

From February 1989 to November 1992, 61 Bird's Nest filters were placed in the infrarenal vena cava in 61 patients (36 men and 25 women; mean age ± s.d., 63 ± 15, range (16–83). In 27 (44.3%). the filter was inserted because of contraindication to anticoagulation, in 19 (31.1%) for anticoagulation failure and in 15 (24.6%) as prophylaxis against pulmonary embolism in high risk patients. All the filters were introduced by percutaneous puncture of the femoral vein after preliminary screening venography demonstrated that the iliac vein was free of thrombus. Two deaths occurred within 24 h of filter placement (periprocedure mortality 3.3%) while five other patients died within 1 month (30 day cumulative mortality 11.5%). At follow up, 2–40 months later (mean ± s.d., 17 ± 9), a further 13 patients had died (cumulative mortality 32.8%). At 36 months, the probability of survival, calculated by the Kaplan-Meier Product Limit Method, was 55% (95% confidence intervals 37–74%). Apart from the two patients dying within 24 h, none of the early or late deaths were attributable to the procedure and there were no recurrent pulmonary emboli. Thirty-seven of the surviving 41 patients were recalled for clinical examination and Duplex ultrasound interrogation of the vena cava and the lower limb veins. No new venous thromboses in the legs were observed and no increase or onset of leg swelling was reported. The vena cava patency was 100% in these 37 patients. Considering that the annual attack rate for deep venous thrombosis in New South Wales, Australia is 60 per 100000, and for pulmonary embolism 45 per 100000, vena caval filter placement is an effective but underused resource.     

Current Indications for Preoperative Inferior Vena Cava Filter Insertion in Patients Undergoing Surgery for Morbid Obesity

Background: Pulmonary embolus is a potentially lethal complication in patients undergoing surgery for morbid obesity. In a select group of patients at high risk for venous thromboembolic events (VTE), we have chosen to prophylactically insert inferior vena cava filters via a jugular percutaneous approach. We propose guidelines for preoperative insertion of inferior vena cava filters in patients with clinically significant obesity. Methods: All patients who underwent preoperative insertion of inferior vena cava (IVC) filters as prophylaxis for pulmonary emboli were reviewed. Data regarding body mass index (BMI), prior history of venous thromboembolism, current anticoagulant usage, as well as other patient data were compiled and analyzed. Additionally, all operative notes were reviewed, and operative data were analyzed and compared. Results: 14 patients underwent preoperative IVC filter placement before gastric bypass. Mean patient age was 49.1 ± 1.52 years and mean BMI was 56.5 ± 4.45 kg/m². No complications occurred due to preoperative filter placement, and no pulmonary emboli occurred in this group. Indications for preoperative IVC filter insertion included prior pulmonary embolus (6), prior deep venous thrombosis (7), and lower extremity venous stasis (1). Conclusions: Vena caval filter placement in the preoperative period can be undertaken safely in bariatric patients. We recommend that routine preoperative vena caval filter placement should be undertaken in all bariatric patients with prior pulmonary embolus, prior deep venous thrombosis, evidence of venous stasis, or known hypercoagulable state. Possible roles for IVC filter placement in this patient population are expanding as more data is acquired.     

根据下腔静脉轴偏转角塑形Celect滤器推送杆对滤器释放后倾斜的影响

目的 观察根据下腔静脉轴偏转角对Celect滤器推送杆塑形对滤器释放后倾斜角度的影响。方法 回顾性分析187例接受置入Celect可回收腔静脉滤器的下肢深静脉血栓患者,将94例根据下腔静脉轴偏转角对滤器推送杆进行塑形者作为观察组,93例未塑形者作为对照组;观察2组滤器释放后倾斜角度及滤器回收术中操作时间（即回收时间）。结果 观察组滤器无倾斜或倾斜程度较小,对照组滤器释放后均存在不同程度倾斜,观察组滤器释放后倾斜角度及滤器回收时间均小于对照组（P均<0.05）。结论 对下肢深静脉血栓患者置入Celect可回收腔静脉滤器前,根据下腔静脉轴偏转角对滤器推送杆进行塑形,可有效抑制滤器释放后倾斜。     

Celect滤器回收困难病例的取出技巧

目的探讨复杂性回收钩贴壁下腔静脉滤器的取出技巧及应用策略。方法收集因滤器回收钩贴壁、采用Günther Celect配套回收装置无法成功取出Celect下腔静脉滤器9例,采用交换导丝成襻法行下腔静脉滤器取出术。结果 9例患者,最长植入时间为142天,最短37天,平均(88.67±33.85)天。使用交换导丝成襻法8枚滤器成功取出,1例患者因下腔静脉严重弯曲致回收失败,滤器回收成功率为88.89%(8/9)。滤器回收耗时57~162min,平均(69.89±12.12)min。所有滤器取出后形态完整,术后下腔静脉造影复查未见管壁穿孔,对比剂外渗。结论采用交换导丝成襻法可有效提高回收钩贴壁下腔静脉滤器成功回收率,具有一定的临床应用价值。     

Off-bypass implantation of a self-expandable valved stent between inferior vena cava and right atrium

A glutaraldehyde preserved valved bovine jugular xenograft mounted in a nitinol 'Z' stent, expandable from 7 to 28 mm of internal diameter, was evaluated in vitro (column of water developing a pressure of 45 mmHg and a mock loop including a pulsatile pump) and in vivo in five adult pigs with intra-vascular ultrasound to measure the inferior vena cava diameter via a retroperitoneal access. Through a stent-graft delivery system (24 French) the self expandable valved stent was implanted off-bypass in the inferior vena cava, between hepatic veins and cavo-atrial junction, with flow and pressure gradient recording. The mean length of the valved stent was 22.80+/-1.06 mm, the mean internal diameter 20.97+/-0.5 mm and the mean external diameter 26.67+/-0.9 mm. The valve leaking under pressure was 32.5+/-12.3 ml/min. The mean pressure gradient recorded across the self expandable valved stent implanted in the inferior vena cava was 1.0+/-0.5 mmHg (range 0-2 mmHg). Intra-vascular ultrasound showed partial opening and closing of the valve (mean area reduction from 148.5 to 81.5 mm2), with almost complete occlusion only during deep breaths. The in vitro and in vivo experiments confirmed the feasibility of potential application of the self-expandable valved stent implanted off-bypass in the inferior vena cava for late conversion of failing total cavo-pulmonary connection; intra-vascular ultrasound allows for adequate implantation and evaluation.