可回收下腔静脉滤器预防肺栓塞实验研究

目的：评价新型可回收下腔静脉滤器(RNIVCF)的稳定性、血栓捕获能力、可回收性及安全性。方法：体外实验评定RNIVCF捕获直径2．5、3和4mm混合血栓的能力。实验犬12只，10只经股静脉注入直径2．5mm自体不透X线混合血栓，评价RNIVCF血栓捕获能力；2只在置入RNIVCF后第7天尝试取出。摄腹部及胸部平片验证滤过效果。结果：体外实验证实RNIVCF捕获了直径3和4mm混合血栓的100%，直径2．5mm混合血栓的95％～100％。成功地在12只犬下腔静脉(IVC)经皮置入13枚RNIVCF，其中1只犬为双IVC，置入2枚滤器。lO只犬体内的11枚RNIVCF成功地捕获了经股静脉注入的直径2．5mm的混合血栓，无一死亡。2枚滤器在置入后第7夫经皮回收没有困难。结论可回收滤器既可以长期留置，又可以临时置入，更为实用。优点：①可经皮经5F输送器置入及回收；②滤器无钩刺，对腔静脉壁无损伤；③置入后稳定；④捕获小血栓有效。     

一种可取出式动脉滤器的实验研究

目的设计一种颈动脉的物理模型，以替代动物实验，分析新型动脉滤器栓子捕获效率的影响因素。方法依照人体参数设置实验参数，建立模拟人颈动脉血流状态的物理模型。共进行实验1104组，以不同方式向模型中注入栓子17940个，应用多元回归Logistic模型分析栓子直径、栓子长度、管径、流量、滤器类型及栓子注入方式等参数对滤器效率的影响。结果按α=0.05标准，除流量外，栓子直径、栓子长度、管径、滤器类型及栓子注入方式均为影响滤器效率的相关因素，其中以栓子直径的影响最为显著。在管径为4、5、6、7mm时，8根丝滤器对0.5mm栓子的捕获率分别为（90±7）%、（91±8）%、（81±8）%、（68±9）%，对1mm栓子的捕获率为（93±4）%、（95±6）%、（95±6）%、（82±11）%。总体而言，滤器的空隙越小，拦截栓子的效率越高；被捕获在滤器中的栓子会使滤器对其他栓子的再捕获率下降。结论动脉滤器对颈动脉狭窄病变的介入治疗是一种有前途的脑保护装置，其对栓子的捕获率受多种因素影响，物理模型是研究影响滤器捕获效率诸因素的有效方法。     

置管溶栓术治疗下腔静脉滤器内栓子的疗效观察

目的 评价置管溶栓术治疗下腔静脉滤器内栓子的疗效及安全性.方法 2005年1月至2010年12月对31例经造影证实的下腔静脉滤器内存在栓子患者进行置管溶栓术治疗,栓子最大径均超过1 cm,溶栓药物采用尿激酶,用量为每日60万u,疗程为3～7d,术后观察临床疗效及并发症.结果 经置管溶栓治疗,18例栓子消失,7例栓子最大径缩小至3 mm以下,6例无明显变化.并发症有穿刺点渗血5例,血尿3例,腹膜后血肿1例,无严重并发症发生.并发症经对症治疗恢复良好.25枚滤器被成功取出,6枚滤器被留置.滤器取出术中及术后无急性肺栓塞发生.结论 置管溶栓术是治疗下腔静脉滤器内栓子安全、有效的方法,能提高下腔静脉滤器的取出率.     

下腔静脉Günther Tulip滤器倾斜发生机制的体外研究

目的 采用体外下腔静脉(IVC)模型探讨经股静脉Günther Tulip滤器(GTF)置入发生倾斜的机制.方法 体外IVC模型由悬吊于透明、分叉玻璃管中的1支直径25 mm、长10 cm涤纶人工血管及2支直径10 mm、长10 cm涤纶人工血管构成.经股静脉GTF置入分为两组:右直组GRS)(n ＝ 100)和左直...     

一种自制可取出式腔静脉滤过器的实验研究

目的　评价自制可取出式不锈钢 (316L改进型 )腔静脉滤过器 (self maderetrievablevenacavalfilter,SRVCF)的安全性及有效性。方法　 (1)通过体外实验装置检验SRVCF的滤过率及捕获栓子后的两端静脉压差。 (2 ) 8条犬按SRVCF置入后观察时间 (10d、2周、3周和 4周 )随机分为 4组 ,每组 2条 ;经股静脉将SRVCF置入下腔静脉 ;按预定时间 ,将每组中 1条犬当即处死取材 ,另 1条犬经颈静脉将SRVCF取出观察 2周后处死取材 ;除血管造影外 ,还进行光、电镜检查。结果　 (1) 5mm×30mm栓子的滤过率水平位及垂直位均为 10 0 %。捕获 4块 7mm× 2 0mm栓子后 ,两端压力差为9 5cmH2 O (1cmH2 O =0 .98Pa)。 (2 )SRVCF置入均成功。 10d组和 2周组取出顺利 ,内膜轻度损伤 ,2周后修复完好。 3周组和 4周组未能取出。造影显示腔静脉畅通 ,SRVCF无倾斜和移位。大体观察未见腹膜后出血、腔静脉穿孔及血栓形成。光、电镜下 ,2周时SRVCF固定部被一薄层未成熟的新生内膜覆盖 ;4周时内膜成熟并增厚 ;钢丝和焊点未见腐蚀。结论　SRVCF具有 :(1)较高的滤过率 ,同时对血流影响不大 ;(2 )定位稳定而不倾斜 ;(3)具有较好的生物相容性、低致血凝性和耐腐蚀性 ;(4) 2周内可顺利取出。     

下腔静脉基于圆周长的直径与投照横径临床对比研究

【摘要】 目的 探讨下腔静脉（IVC）基于圆周长的直径（CD）与前后位投照横径（PD）的差异。方法 前瞻性收集2021年1月至2月在常州第二人民医院接受腹部CT检查患者的临床和影像资料。根据IVC影像分为5型（Ⅰ型:椭圆形,长轴与水平线成一定角度;Ⅱ型:正圆形;Ⅲ型:垂直长轴直径大于水平长轴直径的椭圆形;Ⅳ型:IVC水平长轴与水平线平行的椭圆形;Ⅴ型:不规则形状）。采用圆周长公式计算CD,前后位投照获得PD（在CT横断位模拟）。分析CD与患者性别、年龄、身高、体质量及体质量指数（BMI）的相关性。结果 共纳入516例患者,其中男286例（55.4%）,年龄（58.4±14.1）岁。PD、CD分别为（20.93±3.21） mm、（19.36±2.58） mm（P＜0.01）。IVC影像分型Ⅰ型371例（71.9%）,PD＞CD［（21.04±3.02） mm比（19.43 ± 2.42） mm,P＜0.01］;Ⅱ型18例（3.5%）, PD≈CD［（20.26±2.19） mm比（20.11 ± 1.90） mm,P=0.224］;Ⅲ型11例（2.1%）,PD＜CD［（16.18±3.07） mm比（18.58±3.11） mm,P＜0.01］;Ⅳ型25例（4.8%）,PD＞CD［（22.68±3.12） mm比（19.96±2.58） mm, P＜0.01］;Ⅴ型91例（17.6%）,PD＞CD［（20.69±3.60） mm比（18.85±3.15） mm,P＜0.01］。男性CD值大于女性［（19.79±2.63） mm比（18.83±2.41） mm,P＜0.01］。CD影响因素分析显示, CD与年龄呈负相关,与身高、体质量呈正相关,与BMI无关。结论 正圆形IVC（Ⅱ型）少见,96.5%患者CD比PD能更好地反映IVC真实直径。大多数临床情况下,依据PD选择滤器可能加重滤器与IVC不匹配程度,CD值对于选择滤器具有一定的参考价值。     

Gunther Tulip下腔静脉滤器置入术的临床应用

目的:评价GuntherTulip下腔静脉滤器置入术对预防肺栓塞(PE)的效果及使用中的问题。方法:对16例下肢深静脉血栓形成患者实施经皮股静脉穿刺GuntherTulip下腔静脉滤器置入术,术后立即行下腔静脉(IVC)造影及术后1,3,6,12个月分别摄腹部平片或做滤器处彩超,观察滤器位置、形态及有无并发症。结果:16例均经股静脉成功置入滤器于肾静脉下方1·16±1·21cm的IVC内,3例滤器释放瞬间有一向前弹性冲力,但滤器前跳均<0·5cm。1例经左股静脉置入滤器倾斜度>15°,无扩展不良。复查时均未发现滤器移位及PE发生。结论:GuntherTulip下腔静脉滤器置入术对预防肺栓塞是一种操作简便、安全、有效的方法,其可取出体外的特点而具有广阔的应用前景。     

国产ZQL型可回收式腔静脉滤器的初步临床应用与观察

目的　探讨自行开发的可回收式腔静脉滤器 (国产ZQL型可回收式腔静脉滤器 ,以下简称滤器 )预防肺动脉栓塞的临床应用价值。方法　对 2 4例下肢深静脉血栓形成 (deepveinthrombosis,DVT)和 (或 )肺动脉栓塞 (pulmonaryembolism ,PE)的患者经右侧颈内静脉或经健侧股静脉置入滤器 ,并同时行肺动脉造影。术后第 3和第 7天摄腹部平片。术后 3、6、12、18个月摄腹部平片及行下腔静脉、肺动脉造影。如果在 2周内下肢深静脉血栓完全清除 ,则取出滤器 ,取出前摄腹部平片及行下腔静脉、肺动脉造影 ;如果在 2周内下肢深静脉血栓未能完全清除则将滤器长期留置于下腔静脉内。如果随访期间出现病情变化 ,则需随时复查。所有影像资料经 2位主任医师采用盲法进行评价。结果　 2 4例患者的下腔静脉滤器均成功置入预定部位 ,其中肾静脉水平以下 2 3例 ,肾静脉水平以上1例 ,2例患者置于肾静脉水平以下的滤器分别于术后第 7天和第 9天顺利取出。中位随访期为 6个月。未发生滤器展开不良、滤器移位 (>10mm)、滤器倾斜 (>10°)、滤器断裂或滤器穿透静脉壁造成血肿等。除 1例腔静脉滤器捕获栓子外 ,未发生滤器血栓形成 ,无下腔静脉闭塞发生 ,随访期内全部患者未再发生肺动脉栓塞。结论　国产滤器置入操作简便、定位准确、稳定性     

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。     

Option和Denali下腔静脉滤器置入时发生倾斜的危险因素分析

目的 探讨Option和Denali下腔静脉(IVC)滤器置入时发生倾斜的危险因素。方法 搜集本院2019年1月至2021年9月所有置入Option和Denali IVC滤器患者的临床资料,分为Option组和Denali组,对比两组数据。结果 共纳入65例患者,Option组34例、Denali组31例。Option组倾斜发生率高于Denali组(88.2%vs.19.4%,P<0.001),但两组平均倾斜角度差异无统计学意义(7.65°±3.22°vs.7.50°±3.38°,P=0.920)。Option组：右侧髂静脉入路(24例)发生左侧倾斜的数量显著高于右侧(20例vs.1例),左侧髂静脉入路(7例)发生倾斜方向均为右侧(6例),差异具有统计学意义(P<0.001),滤器倾斜角度与髂总静脉-IVC夹角呈正相关(r=0.663,P<0.001),髂总静脉-IVC夹角每增加一度,倾斜角度为10.1°～15.0°的可能性是倾斜角度为5.1°～10.0°可能性的1.141倍(P=0.002,OR=1.141,95%CI:1.049～1.242)。Denali组：倾斜...     

Inferior vena cava filter from left-sided superior vena cava

We describe the unusual case of a 71-year-old male with a history of deep vein thrombosis and recurrent multiple pulmonary embolism (PE) despite adequate anticoagulation. Computed tomography (CT) and brachiocephalic venography revealed a left-sided superior vena cava. We describe successful placement of an inferior vena cava filter via a left-sided superior vena cava.     

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.     

Optional vena cava filters: preliminary experience with a new vena cava filter

PURPOSE: To prevent pulmonary embolism, some clinical situations only need a vena cava filter for several days, without the inconveniences of temporary vena cava filters in the short-medium term and without the drawbacks of permanent ones in the long term. We report our initial experience with a new definitive vena cava filter, easy to retrieve when it becomes unnecessary. MATERIAL AND METHODS: From the beginning of January 1999 to December 2001, 18 ALN vena cava filters were deployed. The approach used was transbrachial in ten patients, transjugular in seven, and transfemoral in the others. The indications were pelvic trauma in eleven patients, hip replacement in three; four filters were "prophylactically" placed before surgery in patients at high risk of thromboembolic disease (three with ileal or femoral or ileo-femoral thrombosis, and one without clinically manifest thromboembolic disease). Optional vena cava filters were evaluated for malpositioning, caval perforation, filter migration, acute caval thrombosis or access site thrombosis. Seven optional vena cava filters were retrieved. CT was performed before retrieving the vena cava filters to document the absence of thrombi inside the filters. The transjugular ap-proach was used to retrieve the filters. RESULTS: Technical success was achieved in all patients. No complications were encountered during the procedure; no migration or rupture of the filters was detected during the follow-up. No thrombosis of the vena cava or at the insertion site was encountered. The median retrieval time for the filters was 12': only the transfemoral filters required 15' of fluoroscopy. The median permanence was 63 days. No thrombi were found inside the filters. DISCUSSION: A definitive vena cava filter, easy to retrieve when it becomes unnecessary, is the ideal device in many clinical conditions: young subjects with pelvic fractures orthopaedic and gynaecologic interventions.     

Retrieving the Amplatz retrievable vena cava filter

The new Amplatz retrievable filter was placed 15 times into the inferior vena cava (IVC) of 7 dogs. Retrieval of the filter was attempted in 11 cases after 1 week and in 3 cases after 2 weeks. The retrieval was successful and without complication in all 14 cases. The 15th placement resulted in thrombotic occlusion of the IVC, and no retrieval was attempted.     

下腔静脉滤过器的临床应用(附20例报告)

目的 评价置入下腔静脉滤过器预防各种因素所致静血栓脱落引起肺动脉栓塞的效果和安全性。方法：２０例下肢深静脉、盆腔静脉及下腔静脉血栓患者经布销骨下静脉或股静脉置入钛质Ｂｉｒｄ’ｓ ｎｅｓｔ ｆｉｌｔｅｒ（ＢＮＦ）２例,Ｖｅｎａ Ｔｅｃｈ－ＬＧＭ Ｆｉｌｔｅｒ（ＶＴＦ）１８例;滤器置于肾静脉开水平上方３例、下方１７例;术后立即摄腹部平处及血管造影,观察滤器位置、形态及血流情况,并积极进行局部或全身溶栓     

Radiologic follow-up of vena cava filter devices

A total of 66 vena cava filters was implanted to prevent pulmonary emboli: 33 Mobin-Uddin umbrellas and 33 Kim-Ray-Greenfield devices. Radiologic examinations were available in 59 patients, 37 having one or more follow-up studies. Most of the Mobin-Uddin umbrellas became thrombosed. Although most Kim-Ray-Greenfield devices remained patent, some migrated, and several penetrated the cava wall; this latter finding can be diagnosed on plain films. Neither of these devices is fully safe nor effective in preventing pulmonary emboli; further improvements are needed.