| 困难可回收滤器成因分析及取出策略 |
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| 引用本文： | 陈光,沈洋,陈亚红,赵文军. 困难可回收滤器成因分析及取出策略[J]. 中华全科医学, 2019, 17(7): 1222-1224. DOI: 10.16766/j.cnki.issn.1674-4152.000906 |
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| 作者姓名： | 陈光 沈洋 陈亚红 赵文军 |
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| 作者单位： | 台州恩泽医疗中心(集团)浙江省台州医院血管外科, 浙江 临海 317000 |
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| 基金项目： | 浙江省医药卫生科技计划项目(2016KYA192) |
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| 摘 要： | 目的探讨困难可回收下腔静脉滤器形成原因及取出技巧。方法回顾性分析2017年1月-2018年10月期间浙江省台州医院收治的405例患者,其中单纯滤器植入组植入滤器232例,腔内组植入滤器173例。滤器植入组回收101例,腔内治疗组回收160例。2组共有30例滤器无法按常规方法回收,其中滤器植入组10例发生滤器倾斜、移位,2例滤器内捕获血栓;腔内治疗组17例发生滤器倾斜、移位,1例滤器内捕获血栓。对于滤器内捕获血栓的患者,采用置管溶栓辅助常规圈套技术法、导管吸栓辅助常规圈套技术取出法进行回收。对于滤器倾斜、贴壁的患者,采用导引导管辅助常规圈套技术法、圈套辅助硬导丝拉动钩端法等方法进行回收。结果针对滤器捕获血栓的3例,采用置管溶栓辅助常规圈套技术法取出1例,导管吸栓辅助常规圈套技术取出法取出2例。针对滤器倾斜、贴壁的27例,采用导引导管辅助常规圈套技术法取出24例,圈套辅助硬导丝拉动钩端法取出2例,另一例因滤器与下腔静脉壁广泛粘连,难以回收。30例困难滤器实际成功回收29例,成功率为96.7%。结论滤器倾斜、贴壁及捕获血栓是导致下腔静脉滤器难以取出的主要原因,采用多种辅助性圈套技术可以提高其回收率。
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| 关 键 词： | 下腔静脉滤器 回收率 辅助圈套技术 |
| 收稿时间： | 2018-11-27 |
Cause analysis and removal strategy of difficult retrieve filters |
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| Affiliation: | Department of Vascular, Taizhou Hospital Affiliated to Taizhou Enze Medical Center (Group), Linhai, Zhejiang 317000, China |
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| Abstract: | Objective To study the causes of difficult retrievable inferior vena cava filter and its removal strategies. Methods A retrospective analysis was made of 405 DVT patients admitted to Taizhou Hospital of Zhejiang Province from January 2017 to October 2018. Among them, 232 cases underwent filter implantation in the simple filter implantation group, 173 cases were treated in the endovascular treatment group. One hundred and one cases in the filter implantation group and 160 cases in the endovascular treatment group underwent filter removal treatment. There were 30 cases with inferior vena cava filter implantation could not be successfully removed by conventional trap technique in these two groups. Ten cases with tilted filter or adherent filter, and 2 cases with thrombus captured were found in the simple filter implantation group. In the endovascular treatment group, 17 cases were found filter tilted or displaced and 1 case was found with thrombus captured in the filter. For patients captured thrombus in filter, catheter thrombolysis assisted with conventional trap technique and catheter suction assisted with conventional trap technique were used to remove filers. For the patients with tilted filter or adherent filter, catheter assisted with conventional trap technique and Ring-assisted stiff wire pulling hook end method were used to retrieve filters. Results One case was removed by catheter thrombolysis assisted with conventional trap technique, 2 cases by catheter suction assisted with conventional trap technique, 24 cases by catheter assisted with conventional trap technique, and 2 cases by Ring-assisted stiff wire pulling hook end method, 1 case with filter adhered severely to the vena cava could not remove the filter. Successfully retrieved 29 filters, the technical success rate was 96.7%. Conclusion Inclination, adherence and thrombus capture are the main causes for the difficulty of removal of inferior vena cava filters. The recovery rate can be improved by using various assistant trapping techniques. |
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| Keywords: | Inferior vena cava filter Recovery rate Assistant trapping technique |
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