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。     

Loop技术取出疑难性可回收下腔静脉滤器的技巧及临床应用

目的探讨Loop技术取出疑难性可回收下腔静脉滤器的技巧和临床应用。方法回顾性分析新疆维吾尔自治区人民医院2019年1～11月采用Loop技术或活检钳配合Loop技术成功取出的8例疑难性下腔静脉滤器患者的技巧。结果通过Loop技术取出5例下腔静脉滤器,其中Option滤器2例,Optease滤器2例,Denali滤器1例;采用活检钳配合Loop技术取出3例Option滤器。滤器取出后造影显示下腔静脉无造影剂外渗,血流通畅,无下腔静脉管腔狭窄。观察取出滤器形态正常,无变形。结论 Loop技术取出疑难性可回收滤器具有操作简单、微创的特点,值得临床应用推广。     

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。     

置入伞形滤器治疗下肢深静脉血栓后患者下腔静脉穿孔及其影响因素

目的观察置入伞形下腔静脉(IVC)滤器(IVCF)治疗下肢深静脉血栓后患者IVC穿孔及其影响因素。方法回顾性分析51例置入伞形IVCF的下肢深静脉血栓(DVT)患者,其中36例置入Celect滤器(Celect组)、15例置入Denali滤器(Denali组);术后均以CT随访,分析IVC穿孔情况及其与IVC直径及滤器留置时长的关系。结果 51例中,38例IVC穿孔,包括Celect组27例(27/36,75.00%)、Denali组11例(11/15,73.33%),13例未穿孔;组间IVC穿孔率及滤器穿孔级别差异均无统计学意义(P均0.05)。穿孔者IVC直径(16.45±3.09)mm,未穿孔者(17.91±1.78)mm(P0.05)。IVC直径≥16 mm及留置滤器≥3个月下肢DVT患者IVC穿孔率分别高于直径16 mm及留置3个月者(P均0.01)。结论置入伞形IVCF后,下肢DVT患者可见IVC穿孔,与置入滤器类型无关,而与IVC直径及滤器留置时长有关。     

应用指引导管辅助回收疑难贴壁下腔静脉滤器42例分析

目的探讨应用指引导管辅助回收疑难贴壁下腔静脉滤器的方法及技巧。方法回顾性分析2009年7月至2016年7月沧州市中心医院普通外一科下腔静脉滤器(Aegisy滤器)回收手术中造影发现滤器回收钩贴壁的42例病人临床资料。结果术中应用7-F多功能(MPA)或7-F"曲棍球棒式"(HS)指引导管辅助改良式拨撬法进行滤器回收。42例手术均取得成功。回收滤器均结构完整、无折断,2例拨撬处轻微变形,滤器取出后行下腔静脉造影均未发现造影剂滞留或外渗。手术时间为28~52 min,平均用时37 min,未明显增加手术时间及费用。随访2~24个月,无相关并发症发生。结论应用指引导管辅助改良式拨撬法可以显著提高回收钩贴壁的下腔静脉滤器回收成功率,使疑难性下腔静脉滤器取出变得既简单又安全,具有一定的临床应用价值。     

一种腔静脉滤器回收方法的研究

目的探讨一款腔静脉滤器回收钳夹的有效性和安全性。方法在3只普通健康家猪下腔静脉内进行临床常用的四款滤器OptEase、Option、Denali、Aegisy的释放, 通过钳夹(67次)、导丝成环(Wire Loop)(40次)和正常圈套(60次)方法进行滤器回收, 记录回收时间, 术中射线量和出血量并做单因素方差分析。结果使用滤器回收钳夹对四款滤器进行了67次回收, 四款滤器均能被钳夹有效夹持并顺利取出体外, 在回收时间, 射线量和出血量方面差异并无统计学意义(P>0.05)。回收时间分别为(17.65±6.93)、(13.65±6.43)、(17.90±6.03)、(15.29±6.32) min(F=0.479, P>0.05);射线量分别为(327.50±126.00)、(262.90±144.60)、(343.50±125.60)、(298.90±143.80) mGy(K-W=6.009, P>0.05);出血量分别为(36.25±14.31)、(32.50±20.88)、(41.80±16.71)、(32.14±12.72) ml(K-W=5.443, ...     

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。     

下腔静脉滤器在创伤并下肢深静脉血栓中的应用

目的评价下腔静脉滤器(IVCF)在创伤合并下肢深静脉血栓形成(DVT)患者中的效用。方法回顾性分析52例创伤合并DVT患者的临床资料,术前植入可回收IVCF,分别为Aegisy滤器(29例)及Denali滤器(23例),Ⅱ期取出联合经皮机械性吸栓治疗,分析患者总体数据,并比较两组患者的差异。结果患者平均年龄53.31±14.03岁,IVCF植入及取出成功率100%,无肺栓塞(PE)发生,19例回收滤器中可见血栓,总体并无IVCF断裂,移位,穿孔,血栓形成的发生,2例Aegisy滤器出现倾斜,但均安全取出。两种滤器操作均较为顺利,IVCF植入及回收的平均操作时间及透视时间并未明显差异。结论可回收IVCF植入对于创伤合并DVT患者安全有效,可确保骨科手术及二期血栓清除的安全进行。     

Celect可回收滤器在骨折合并下肢深静脉血栓治疗的应用

目的探讨Celect可回收腔静脉滤器在骨折合并下肢深静脉血栓形成(DVT)患者中的应用,并对滤器植入路径及回收方法进行总结。方法对2013年6月至2014年6月77例骨折合并DVT患者的临床资料进行回顾性分析,选择经股静脉(71例)及右侧颈内静脉(6例)路径放置Celect滤器。结果技术成功率100%,滤器在体内留置时间为10~111天,平均37.5天。2例(2.6%)发生症状性肺栓塞(PE),无致命性PE。64例患者进行了滤器回收,62例(96.9%)成功取出,2例取出失败。27例(42.2%)捕获大量血栓,经导管溶栓后二期回收。左侧股静脉路径放置时滤器倾斜可能性大于右侧股静脉(P0.01)。结论 Celect滤器用于骨折合并DVT的患者可有效预防PE。滤器于股静脉路径植入时无明显前跳及回缩现象,定位良好,安全性高;颈内静脉路径植入可能有0~2cm回缩距离。捕获大量血栓也可在溶栓后顺利回收,最大程度提高了滤器可回收率,鉴于不可预知的远期风险,建议在PE风险可控时及早回收。     

复杂可回收下腔静脉滤器回收的方法和技巧：附29例分析

目的:探讨复杂可回收下腔静脉滤器回收的方法和技巧。方法:回顾性分析29例复杂滤器回收的下肢深静脉血栓形成患者资料。所有患者均先行造影了解滤器情况;对回收钩贴壁患者,分别采用猪尾管支撑技术、导丝成攀及搅拌技术、双向导丝技术、鹅颈抓捕器与成攀导丝结合技术等回收;对下腔静脉继发血栓患者,必要时再次新置滤器1枚,经溶栓、吸栓处理后,将滤器回收。结果:成功回收24例,1例患者滤器未能成功回收,4例放弃,回收率83.9%。术中无下腔静脉破裂出血、肺栓塞并发症,取出滤器完整、无折断现象。至少随访半年,下腔静脉血流通畅、无血栓形成,腹腔无明显积液。结论:导管、导丝及鹅颈抓捕器辅助,溶栓、吸栓等方法可增加复杂可回收下腔静脉滤器回收率,可减少长期留置引起相关并发症。     

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。     

达芬奇机器人手术系统辅助下腔静脉滤器取出术的临床疗效

目的达芬奇机器人手术系统辅助下下腔静脉滤器取出术的临床疗效。 方法采用回顾性描述性研究方法,收集2019年7月陆军军医大学西南医院血管外科收治的亚洲首例行达芬奇机器人手术系统辅助下下腔静脉滤器取出术患者的临床资料。患者下腔静脉滤器置入术后2个月余,血管腔内技术无法取出下腔静脉中的滤器,在达芬奇机器人手术系统辅助下取出下腔静脉滤器。观察指标：术中及术后情况;随访及生存情况。采用门诊进行随访,了解患者术后生存情况。随访时间截至2019年8月。 结果患者成功行达芬奇机器人手术系统辅助下下腔静脉滤器取出术。手术时间326 min,术中出血量100 ml,完成下腔静脉滤器取出术后,下腔静脉切口吻合良好,无出血及狭窄,无术中并发症发生。患者术后住院时间3 d。随访及生存情况：患者术后随访1个月,腹部穿刺套管孔愈合良好,患者生存良好。 结论达芬奇机器人手术系统辅助下下腔静脉滤器取出术安全可行。     

可转换型腔静脉滤器临床应用的个体化及安全性评估

背景与目的：腔静脉滤器置入是预防下肢深静脉血栓形成患者发生肺栓塞最直接和最有效的手段,已被临床广泛应用。可转换型滤器用于预防肺栓塞的时限更加灵活,转换操作更加简单,但其临床应用的资料尚不足,因此,本研究通过单中心回顾性分析,综合评估可转换型腔静脉滤器的临床应用特点。 方法：回顾性分析本中心行DSA引导下置入可转换型腔静脉滤器的52例患者资料。测量不同个体的下腔静脉直径,髂静脉分叉与低侧肾静脉开口距离,滤器释放时前跳距离,滤器释放后长度与宽度等指标,进一步明确置入安全距离。并收集滤器转换时间及转换术中情况,探讨复杂病例转换技巧。 结果：经测量,52例患者的髂静脉分叉与低侧肾静脉开口距离为（116.4±13.2）mm,远大于滤器释放后的平均长度（54.6±1.3）mm;滤器释放后的滤器平均宽度为（22.9±3.0）mm,略大于释放前下腔静脉平均直径（20.8±3.4）mm;19例（36.5%）发生滤器释放后的前跳,平均前跳距离为（6.5±1.8）mm。释放后,滤器均无明显倾斜。在拟行转换的48例患者中,42例（87.5%）一次性成功解锁,平均耗时（4.5±0.8）min;其中39例（81.3%）回收钩取出后,滤器未打开或未完全打开,均经猪尾导管搅拌后完全打开。在41例超期转换病例中（>2个月）,37例患者（90.2%）一次性转换成功,其中4例患者（8.5%）有回收钩贴壁,经导丝成袢技术联合鹅颈抓捕技术辅助下成功转换。 结论：可转换型腔静脉滤器是一种安全有效、容易转换的滤器选择。在置入过程中应考虑前跳可能。在超过推荐转换时限的患者,一次性转换成功率仍然较高。     

The use of retrievable inferior vena cava filters in orthopaedic patients

This study was undertaken to evaluate the safety and efficacy of retrievable inferior vena cava filters in high-risk orthopaedic patients. A total of 58 patients had a retrievable inferior vena cava filter placed as an adjunct to chemical and mechanical prophylaxis, most commonly for a history of previous deep-vein thrombosis or pulmonary embolism, polytrauma, or expected prolonged immobilisation. In total 56 patients (96.6%) had an uncomplicated post-operative course. Two patients (3.4%) died in the peri-operative period for unrelated reasons. Of the 56 surviving patients, 50 (89%) were available for follow-up. A total of 32 filters (64%) were removed without complication at a mean of 37.8 days (4 to 238) after placement. There were four filters (8%) which were retained because of thrombosis at the filter site, and four (8%) were retained because of incorporation of the filter into the wall of the inferior vena cava. In ten cases (20%) the retrievable filter was left in place to continue as primary prophylaxis. No patient had post-removal thromboembolic complications. A retrievable inferior vena cava filter, as an adjunct to chemical and mechanical prophylaxis, was a safe and effective means of reducing the acute risk of pulmonary embolism in this high-risk group of patients. Although most filters were removed without complications, thereby avoiding the long-term complications that have plagued permanent indwelling filters, a relatively high percentage of filters had to be left in situ.     

Retrieval of Recovery IVC Filter After 1,463-Day Implantation

A young female victim of multiple trauma had a Recovery inferior vena cava filter placed for pulmonary embolism prophylaxis. She was lost to follow-up for planned retrieval of the filter. After a period of more than four years she re-presented and had successful and uneventful retrieval of the filter. Certain inferior vena cava filters may potentially be retrieved even after very long implantation periods.     

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??Guiding catheter assisted recovery of difficult and adherent inferior vena cava filter: An analysis of 42 cases CHAI Wei, LEI Bao, ZHANG Lei, et al. Department of General Surgery, Cangzhou Central Hospital, Cangzhou 061000, China
Corresponding author: ZHANG Zhi-quan, E-mail:chaiwei007686@163.com
Abstract Objective To explore the methods and techniques of recovery the difficult and adherent inferior vena cava filter by applying guiding catheter. Methods A total of 42 cases with its refractory hook being affixed to the venous wall by intraoperative angiography who admitted inferior vena cava filter (Aegisy filter) recovery operation in First Department of General Surgery, Cangzhou Central Hospital from July 2009 to July 2016 were analyzed retrospectively. Results All the cases successfully used MPA or HS guide catheter assisted method for the recovery of filters. The structure of all the being recycled filters were complete, and 2 cases were deformed slightly. After removed the inferior vena cava filter, contrast agent was not be found stranded or extravasation by angiography. The operation time was 28 to 52 min, with an average of 37 min, did not significantly increase the operation time and cost. After being followed up for 2 to 24 months, no related complication occurred. Conclusion For the difficult and adherent inferior vena cava filter, using guiding catheter can improve the recycling success rate with certain clinical value.     

Optional filters in trauma patients: can retrieval rates be improved?

Prophylactic inferior vena cava interruption may be appropriate in trauma patients at risk for pulmonary embolism for whom anticoagulation is contraindicated. The Recovery filter is approved for removal up to 180 days from insertion. High retrieval rates need to be achieved before we can lower the threshold for inserting these filters prophylactically. The objective of this study was to evaluate the retrieval rate of the Recovery filter in this patient population and how it has influenced our practice. This is a retrospective study in which the records of 122 consecutive trauma patients in whom the Recovery filters were inserted between October 2003 and October 2005 were reviewed. Patients who had the new generation of this filter were excluded. All these filters were inserted with the intention of retrieval. We attempted to contact all these patients at 3 months. The technical factors associated with failure to retrieve these filters were reviewed. There were no complications related to filter insertion. Excluding six patients (4.9%) who expired from causes unrelated to the insertion procedure, 20 patients could not be reached (17.3%) and 21 patients declined retrieval (18.1%). The filters were considered permanent in 18 patients (15.5%) if they were not ambulatory or if they developed inferior vena cava occlusion. Inferior vena cava occlusion was diagnosed in four patients (5.5%). Seventy-three (62.9%) patients presented for follow-up and were evaluated by color venous duplex ultrasound. We attempted to retrieve the filters in 52 patients and were successful in 45 (86.5%). However, the total retrieval rate was 40.5%. All failures of retrieval were related to tilting of the filters or bending of the limbs. There were no complications related to the retrieval procedure. Insertion and retrieval of the Recovery inferior vena cava filter are safe. In spite of the thorough follow-up and the good success rate in retrieving the filters, the overall retrieval rate in this patient population is still low. This should be strongly considered at the time of insertion. Multiple factors were found to contribute. Attention to details in patient selection and follow-up as well as modifications in technique may improve the retrieval rate.