下腔静脉滤器预防肺栓塞的临床应用

目的：评价置入下腔静脉滤器预防因下肢静脉血栓脱落引起肺栓塞的效果和安全性。材料与方法：１６例下肢深静脉血栓患者置入钛质Ｇｒｅｎｆｉｅｌｄｆｉｌｔｅｒ（ＴＫＧ）１２例,Ｂｉｒｄ’ｓｎｅｓｔｆｉｌｔｅｒ（ＢＮＦ）４例。滤器位于双肾静脉水平以下的腔静脉内。术后分别于１、６、１２个月摄腹部平片复查,观察滤器的位置、形态变化。结果：全部滤器经股静脉穿刺置入,经右股静脉１３例,左股静脉３例,无严重并发症发生。随访发现ＴＫＧ２例向足侧移位,１例向头侧移位,１例跨度增大,腹部ＣＴ,腔静脉造影发现滤器的１只脚穿透腔静脉壁,未出现任何症状;２例发生滤器偏斜,角度小于１５°。ＢＮＦ未见位置改变。无１例发生腔静脉阻塞或复发肺栓塞。结论：置入下腔静脉滤器预防肺栓塞是安全、有效的方法。     

Population-Based Disparities in Inferior Vena Cava Filter Procedures Among Medicare Enrollees With Acute Venous Thromboembolism

PurposeVenous thromboembolism (VTE) imposes a significant clinical and financial burden on patients and society. Inferior vena cava filters (IVCFs) are considered for patients with absolute contraindications or failures of anticoagulation. However, studies examining the population-based disparities of IVCF placement and retrieval are limited. The association between patient and clinical characteristics in the likelihood of and time to IVCF placement and retrievals in a nationally representative cohort was examined.MethodsMedicare patients aged ≥65 years with index VTE claims between 2015 and 2018 were followed through 2019 to identify IVCF placements and retrievals. Rates were compared using survival analysis methods.ResultsOf the 516,978 patients with VTE diagnoses, 5,864 (1.1%) had IVCFs placed, and 1,884 (32.1%) of those underwent retrieval procedures. Placement and retrieval rates varied significantly by demographics, comorbidity burden, and geographic region. From Cox regression, older age (hazard ratio [HR], 1.26; P < .0001), higher baseline comorbidity (Elixhauser) score (HR, 1.07; P < .0001), and outpatient (vs inpatient) site of VTE service (HR, 2.11; P < .0001) were associated with increased frequency of IVCF placement. The rate of retrieval was significantly lower for men (HR, 0.83; P = .0393), patients with higher comorbidity scores (HR, 0.95; P = .0037), and those with outpatient (vs inpatient) VTE sites of service (HR, 0.77; P = .0173). Neither facility- nor county-level characteristics were significantly associated with placements or retrievals.ConclusionsThis large cohort of Medicare beneficiaries with newly diagnosed VTE demonstrated inequities in IVCF placement and retrieval.     

Use of Retrievable Compared to Permanent Inferior Vena Cava Filters: A Single-Institution Experience

The purpose of this study was to review the use, safety, and efficacy of retrievable inferior vena cava (IVC) filters in their first 5 years of availability at our institution. Comparison was made with permanent filters placed in the same period. A retrospective review of IVC filter implantations was performed from September, 1999, to September, 2004, in our department. These included both retrievable and permanent filters. The Recovery nitinol and Günther tulip filters were used as retrievable filters. The frequency of retrievable filter used was calculated. Clinical data and technical data related to filter placement were reviewed. Outcomes, including pulmonary embolism, complications associated with placement, retrieval, or indwelling, were calculated. During the study period, 604 IVC filters were placed. Of these, 97 retrievable filters (16%) were placed in 96 patients. There were 53 Recovery filter and 44 Tulip filter insertions. Subjects were 59 women and 37 men; the mean age was 52 years, with a range of from 18 to 97 years. The placement of retrievable filters increased from 2% in year 1 to 32% in year 5 of the study period. The total implantation time for the permanent group was 145,450 days, with an average of 288 days (range, 33–1811 days). For the retrievable group, the total implantation time was 21,671 days, with an average of 226 days (range, 2–1217 days). Of 29 patients who returned for filter retrieval, the filter was successfully removed in 28. There were 14 of 14 successful Tulip filter retrievals and 14 of 15 successful Recovery filter retrievals. In one patient, after an indwelling period of 39 days, a Recovery nitinol filter could not be removed secondary to a large clot burden within the filter. For the filters that were removed, the mean dwell time was 50 days for the Tulip type and 20 days for the Recovery type. Over the follow-up period there was an overall PE incidence of 1.4% for the permanent group and 1% for the retrieval group. In conclusion, there was an increase in the use of retrievable filters over the study period and an overall increase in the total number of filters implanted. The increased use of these filters appeared to be due to expanded indications predicated by their retrievability. Placement and retrieval of these filters have a low risk of complications, and retrievable filters appeared effective, as there was low rate of clinically significant pulmonary embolism associated with these filters during their indwelling time.     

经皮下腔静脉滤器置入术后观察

目的　探讨下腔静脉滤器置入术的应用范围和临床疗效。方法　 17例下肢深静脉血栓形成患者置入下腔静脉滤器 ,其中 4例经静脉对血栓进行抽吸 ,13例经患侧足背静脉对血栓进行溶栓治疗。结果　 17例滤器置入成功 ,无并发症发生。接受抽吸治疗者中有 2例出现血栓脱落 ,溶栓治疗中有 4例血栓部分脱落 ,未发生肺梗塞。结论　下腔静脉滤器可有效预防血栓脱落造成肺梗塞 ,而且也是深静脉血栓介入治疗的安全保证     

Inferior Vena Cava Filter Evaluation and Management for the Diagnostic Radiologist: A Comprehensive Review Including Inferior Vena Cava Filter-Related Complications and PRESERVE Trial Filters

Inferior vena cava filters are commonly encountered devices on diagnostic imaging that were highlighted in a 2010 Food and Drug Administration safety advisory regarding their complications from long-term implantation. The Predicting the Safety and Effectiveness of Inferior Vena Cava Filters (PRESERVE) trial is an ongoing after-market study investigating the safety and utility of commonly utilized filters in practice today. While most of these filters are safe, prompt recognition and management of any filter-associated complication is imperative to prevent or reduce the morbidity and mortality associated with them. This review is aimed at discussing the appropriate utilization and placement of inferior vena cava filters in addition to the recognition of filter-associated complications on cross-sectional imaging. An overview of the PRESRVE trial filters is also provided to understand each filter's propensity for specific complications.     

Inferior Vena Cava Filter Placement and Retrieval Rates among Radiologists and Nonradiologists

Purpose

To evaluate inferior vena cava (IVC) filter placement and retrieval rates among radiologists, vascular surgeons, cardiologists, other surgeons, and all other health care providers for Medicare fee-for-service beneficiaries in the years 2012–2015.

Transfemoral Filter Eversion Technique following Unsuccessful Retrieval of Option Inferior Vena Cava Filters: A Single Center Experience

This report describes the technical feasibility of using the filter eversion technique after unsuccessful retrieval attempts of Option and Option ELITE (Argon Medical Devices, Inc, Athens, Texas) inferior vena cava (IVC) filters. This technique entails the use of endoscopic forceps to evert this specific brand of IVC filter into a sheath inserted into the common femoral vein, in the opposite direction in which the filter is designed to be removed. Filter eversion was attempted in 25 cases with a median dwell time of 134 days (range, 44–2,124 d). Retrieval success was 100% (25/25 cases), with an overall complication rate of 8%. This technique warrants further study.     

下腔静脉重复畸形（附9例报告）

上腔静脉重复畸形是一种罕见的先天性血管发育变异。本文报道９例，对其胚胎发育过程中的形成机制、ＣＴ表现、诊断及鉴别诊断进行了分析和讨论，并提出了对下腔静脉畸形的分型标准。     

In Vivo Evaluation of the Effects of Gravitational Force (+Gz) on Over-the-Wire Stainless Steel Greenfield Inferior Vena Cava Filter in Swine

This study was done to determine the effect of exposure to gravitational force (acceleration stress) on in vivo over-the-wire stainless steel Greenfield inferior vena cava filters. Fifteen pigs underwent venous cut down and placement of a stainless steel Greenfield filter. A 4-week observation period simulated realistic convalescence and allowed sufficient time for epithelialization. Ten pigs were exposed to acceleration stress in a centrifuge (3G run for 15 sec followed by rest until return to baseline heart rate, then a 9G run for 15 sec), with inertial loading in a head-to-tail direction (+Gz). Fluoroscopy during acceleration stress allowed assessment for filter migration. Five pigs were not exposed to acceleration stress. AP and lateral abdominal radiographs were obtained at post-filter placement, convalescence, and centrifuge exposure to determine the position and integrity of the filter. All 15 IVCs were resected and evaluated for gross or histological injury to the vessel wall. IVC filter placement was technically successful in all 15 pigs. Radiographic measurements were limited secondary to differences in pig positioning. Fluoroscopy showed no filter migration. All filters were securely attached to the vena cava by the hooks without gross evidence of perforation or hemorrhage. There were varying degrees of fibroplasia involving the hooks and tip of the filters in both the control and experimental groups. Histologically, there was evidence of prior hemorrhage at the level of the hooks, which was similar between the control and experimental groups. It is concluded that Greenfield filter position and vena caval integrity at the implantation site is unaffected by high acceleration stress.     

下腔静脉滤器植入术预防肺动脉栓塞症的应用价值

目的探讨经皮穿刺下腔静脉滤器植入术(IVCF)预防肺动脉栓塞症的临床应用价值。方法自2004年9月—2007年1月对10例下肢深静脉血栓形成患者施行IVCF植入术。男6例,女4例,年龄45~79岁,患者经健侧股静脉径路植入IVCF全部成功,植入部位均为肾静脉开口水平以下,随访12~30个月。结果本组10例均成功植入,术后无局部血肿及血栓形成,均无肺栓塞发生,无一例滤器移位、腔静脉血栓阻塞和死亡。然而5例患者均残存不同程度的患侧肢体麻木、无力、肿胀等下肢静脉功能不全症状。1例术后1月停用华法林,自行中药治疗而再次股静脉栓塞,但未发生肺栓塞。结论IVCF植入术能有效预防肺动脉栓塞,并防止再发肺栓塞所致死亡,对深静脉血栓形成患者是一种安全、有效的防治措施。     

Histology of Tissue Adherent to OptEase Inferior Vena Cava Filters Regarding Indwelling Time

The purpose of this paper is to report on the histology of tissues found on retrieved filters with regard to indwelling time. Between February 2006 and January 2007, 28 Optease inferior vena cava filters (Cordis Europa, Roden, The Netherlands) were retrieved from 27 patients. Twenty-two filters were inserted prophylactically for trauma patients and six for patients with venous thromboembolism. Cavography was performed both before and after filter removal to evaluate the presence of thrombi or wall damage. Filters were retrieved with the snare and sheath method. All material adherents to the filters were examined histologically. The mean indwelling time of the filters was 24.9 days (range, 6–69 days). Red tissue fragments were seen on all the filters, consistent microscopically with clots and fibrin. On five filters (18%; mean indwelling time, 45.4 days) white tissue consistent with vascular intima was found. All postprocedure cavographies were normal. We conclude that most material adherent to the retrieved filters is thrombi, while vascular intima can be found in the minority of filters with a longer indwelling time.     

下腔静脉阻塞的X线解剖及临床意义

通过对４５例下腔静脉阻塞血管造影的影像学分析，将其Ｘ线解剖分为三个基本类型：１型为肝静脉人口平面膜性阻塞占４０％，２型为肝静脉人口平面以下至肾静脉人口平面之间阻塞占４４．４％，３型为下腔静脉广性闭塞占１５．６％，文章依据其Ｘ线分型提出介入治疗的原则，并对Ｘ线分型的临床意义进行了讨论。     

下腔静脉螺旋CT扫描方法初探

目的　探讨下腔静脉CT增强扫描 (CTA)方法和技巧。方法　使用PICKER60 0 0单螺旋CT扫描机 ,扫描层厚 3 .0～ 4.0mm ,螺距 1.2 5～ 1.5,间隔 1.5～ 2 .0mm ,应用Smooth功能对 12例病人进行下腔静脉CT增强扫描。结果　所有病例 10 0 %获得了满意的图像 ,经VOXEL工作站重建后 ,能够清楚显示下腔静脉正常解剖结构和阻塞的部位、范围及其阻塞程度。 12例经数字减影血管造影 (DSA)或 和手术对比证实的病例中 ,CTA显示病变的准确性是 91.67%。结论　高质量的下腔静脉CTA图像依赖于注药后扫描的时机准确性、扫描参数设置的合理性 ,正确的扫描方法以及操作者的技巧和熟练程度     

Rising Retrieval Rates of Inferior Vena Cava Filters in the United States: Insights From the 2012 to 2016 Summary Medicare Claims Data

BackgroundTo determine recent inferior vena cava filter (IVCF) retrieval volumes and rates in the Medicare population.MethodsThe summary Medicare claims data were searched for the years 2012 to 2016 to identify the frequency of IVCF placements and retrievals. The new Healthcare Common Procedure Coding System code for filter retrieval introduced in 2012, 37193, was used to track filter retrievals. Trends in number of IVCF placements and retrievals over the study period were evaluated, both of which were further stratified by physician specialty and site of service. Aggregate and compound annual growth rates for retrievals were also computed.ResultsA total of 255,034 filters were placed over the study period, with the filter placement volume declining from 61,889 in 2012 to 38,095 in 2016. Filter retrievals, however, increased from 4,327 in 2012 to 8,405 in 2016. The net filter retrieval rate per annual filters placed increased from 6.9% in 2012 to 22.1% in 2016, yielding an average filter retrieval rate and compound annual growth rate of 11.6% and 18.1% respectively. Radiologists placed and retrieved the majority of filters (60.4% placed, 63.5% retrieved) compared with nonradiologists. The inpatient setting was the dominant site for filter placement compared with the outpatient setting for filter retrieval across all years and specialties.ConclusionsSince introduction of the unique Healthcare Common Procedure Coding System code for IVCF retrieval in 2012, IVCF placements in the Medicare population have been declining and net retrieval rates have risen. Radiologists continue to place and retrieve the majority of filters.     

Outcomes and Direct Costs of Inferior Vena Cava Filter Placement and Retrieval within the IR and Surgical Settings

Purpose

To compare the outcomes and costs of inferior vena cava (IVC) filter placement and retrieval in the interventional radiology (IR) and surgical departments at a tertiary-care center.

新西兰兔下腔静脉内置入125I粒子条的实验研究

目的评估兔下腔静脉腔内置入125I粒子条的可行性、安全性,以及影像学的诊断价值。材料与方法将24只新西兰兔随机分成两组:A组(2枚粒子)和B组(4枚粒子),各12只。将6711型125I粒子制成粒子条。备好的粒子条经下腔静脉前壁荷包中央置入并悬挂固定在下腔静脉内壁。比较125I粒子条置入前后血常规及肝功能的变化;分别饲养1周、2周、4周、2个月、4个月后称体重,行实验室、多层螺旋CT(MDCT)增强扫描、DSA及组织病理学检查,两组间做比较。结果两组均未发现与125I粒子辐射相关的腹泻及死亡。各组125I粒子条置入前后及两组间体重、血常规、肝功能差异无统计学意义(P>0.05)。MDCT增强及DSA显示下腔静脉血流通畅,但CT显示粒子金属伪影严重、计数困难。大体标本示下腔静脉无穿孔、血栓形成。两组光镜下均见血管内皮细胞坏死、脱落,中膜及外膜无明显改变。两组邻近125I粒子旁肝细胞坏死明显,B组较A组严重,但随着时间的延长有所修复;远处肝脏及其他组织无异常。结论兔下腔静脉管腔内置入线状排列125I粒子条是安全、可行的。影像学尤其DSA是粒子置入术对血管影响较好的评价手段。     

血管内支架放置治疗下腔静脉闭塞伴血栓形成

为了使下腔静脉闭塞伴血栓形成，在作成形手术时既能有效地保持下腔静脉再通，又能避免肺栓塞发生，我们对３例下腔静脉闭塞伴血栓形成的患者实施ＰＴＡ和ｓｔｅｎｔ置入术，均取得满意效果。支架置入后，下腔静脉通畅，无肺栓塞发生。支架具有支撑血管和压迫固定血栓的双重作用。     

125I Brachytherapy Seeds Implantation for Inoperable Low-Grade Leiomyosarcoma of Inferior Vena Cava

A 60-year-old female presented with abdominal pain and tenderness of five-day duration. Contrast enhanced CT showed a mass of 9 × 6 × 5.5 cm in size with almost complete obliteration of the inferior vena cava and massive extension to the extravascular space. CT-guided biopsy demonstrated a low-grade leiomyosarcoma. The patient underwent ¹²⁵Iodine seeds implantation in two sessions, and another balloon cavoplasty. Abdominal pain and tenderness gradually improved and the patient continues to remain as disease free state for three years after the procedures.     

下腔静脉畸形的影像学诊断（附15例报告）

本文报道下腔静脉畸形１５例，其中下腔静脉后输尿管３例，双下腔静脉畸形３例及下腔静脉膜性梗阻９例。作者根据有无下腔静脉回流障碍对该组疾病进行了分型，并结合本文病例分析，着重探讨了该组疾病的影像学表现，评价了超声、下腔静脉造影等影像学检查方法对该组疾病的诊断价值。