下腔静脉滤器置放术在深静脉血栓-肺栓塞演变中的临床应用

目的探讨下腔静脉滤器(IVCF)在预防深静脉血栓(DVT)-肺栓塞(PE)演变中的临床应用价值。方法经造影和(或)彩色多普勒超声证实为下肢深静脉广泛血栓30例,其中有肺部临床表现21例,胸部影像学证实19例,DSA显示下腔静脉内血栓6例。溶栓介入治疗前置放IVCF 30例,下腔静脉内血栓形成未放IVCF 1例。置放IVCF后经患肢足背静脉滴注尿激酶或经导管血栓内抽吸、局部溶栓、导丝搅拌增加溶栓接触面积;经非患肢静脉给予抗凝、抗生素治疗。结果本组30例放置5种构型滤器32枚,其中2枚为临时滤器,置入取出均顺利,滤器无移位,术中无并发症。痊愈9例,有效14例,改善6例,无效1例。因没有及时置入IVCF进行溶栓治疗,深静脉血栓导致下腔静脉血栓6例,后置入IVCF 5例疗效良好,未放IVCF 1例,12天后因肺栓塞死亡。结论下腔静脉滤器对预防深静脉血栓向肺栓塞演变具有一定价值,其置放术安全可靠,便于临床及时溶栓抗凝治疗,但其应用价值需进行综合评价和进一步探讨。     

下腔静脉滤器的应用与研究进展

深静脉血栓形成（DVT）是血液在深静脉内异常凝结导致的静脉回流障碍性疾病,常发生于下肢。栓子脱落可引起肺动脉栓塞（PE）,DVT与PE统称为静脉血栓栓塞症（VTE）,是同种疾病在不同阶段的表现形式。DVT的高发病率及并发PE导致的猝死风险已受到临床医生的密切关注,当VTE患者出现抗凝禁忌或抗凝治疗失败时,可置入下腔静脉滤器（IVCF）,通过其网状过滤结构捕获血凝块从而预防致死性PE发生。IVCF现已在全球广泛被应用,根据使用情况,可分为永久型、临时型及可选择回收型。永久型IVCF置入人体后除非手术切开腔静脉否则无法取出,远期滤器断裂、移位、栓塞、症状性下腔静脉穿孔等出现率较高,现已被临床淘汰;临时型IVCF通过与外部的导管和固定设备相接,便于回收但易于感染,临床应用极少;可回收型IVCF具有用于回收的钩状结构,当患者VTE风险期过后,可通过介入手术取出,是目前临床应用的主要类型,但由于部分患者VTE治疗时间超过了滤器留置时间窗,从而引起一系列并发症以及患者随访丢失等原因,导致实际回收率较低,相关争议日益增多。同时新型IVCF的研发正在紧密开展,药物洗脱IVCF使用抗平滑肌增生、抗炎等药物涂覆,可阻止血管内膜的过度增生,延长IVCF的留置时间以便于回收;可转换IVCF允许滤器结构在体内发生转换,由过滤网变形为开放式支架,以期降低远期并发症,但转换后的金属支架无法取出,对腔静脉的远期影响仍需要长期的随访观察;生物可降解IVCF可完全被机体吸收,避免了二次手术,是目前国内外学者研究的热点,但如何设计材料,保证滤器所拦截的血栓吸收之前IVCF保持应有的强度,进而防止血凝块或降解片段再次栓塞的问题目前没有明确的研究数据证实,拥有可控降解特点的新型IVCF是一个明确的研发目标。另一方面,部分学者通过计算机仿真模拟分析不同结构的过滤单元以及不同支撑杆数目对滤器性能的影响,为结构最优化、血流动力学影响最小化的新型IVCF研究提供了更科学的参考与理论依据。综上所述,在倡导推广应用更细致的患者管理和临床随访来提高IVCF取出率的基础上,进一步研发出一款理想的IVCF迫在眉睫,意义重大。新型IVCF应具备以下功能：可有效拦截血凝块,以防止新发或复发PE;在VTE高风险期结束后可远程控制转换或整体同步降解;滤器固定良好,保持良好的径向支撑性能同时不损伤腔静脉壁;具有良好生物相容性;对血流动力学影响较小;可在影像学检查中清晰显影便于随访。相信随着材料学、组织工程领域的深入研究与发展,可早日研制出临床疗效优异、并发症极少的新型IVCF。     

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。     

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。     

开放手术回收腔内取出困难的下腔静脉滤器36例报告

背景与目的 下腔静脉滤器（IVCF）可有效预防致命性肺栓塞（PE）的发生,得到临床广泛应用,适用于反复发生PE者、下肢深静脉血栓（DVT）围手术期存在抗凝禁忌,需进行机械血栓清除术和接触性导管溶栓术治疗者。当血栓消失或处于稳定期,PE风险降低后,回收IVCF已是专家共识,大多可回收IVCF可通过腔内手术回收,但锥形滤器回收钩穿透下腔静脉（IVC）壁或纺锤形滤器超出滤器回收时间窗时,滤器腔内回收困难。选择强行腔内回收滤器可能会损伤IVC,患者面临生命危险;选择滤器永久留置,患者会面临滤器断裂、穿孔、IVC阻塞、长期抗凝等并发症,更使患者处于焦虑情绪状态。此类患者可选择开放手术回收滤器,且疗效满意。本研究进一步探索开放手术回收腔内取出困难的IVCF手术方法、安全性、有效性和术后短中期情况。方法 回顾性收集2020年1月—2023年12月36例行开放手术回收腔内取出困难的IVCF患者资料,分析滤器类型、滤器取出率、术后并发症情况,以及术后血液指标与焦虑状态的变化。结果 36例患者的IVCF包括30例（83.3%）纺锤形滤器,6例（16.7%）为锥形滤器;2例（5.6%）位于肾上IVC,34例（94.4%）位于肾下IVC。滤器中位留置时间15（5~41）个月;36枚滤器均顺利回收,回收率100%,无围术期死亡病例。与术前比较,术后首次血红蛋白水平降低,D-二聚体、天门冬氨酸氨基转移酶水平升高（均P<0.05）,但无安全风险;患者焦虑状态阳性率与汉密尔顿焦虑量表评分均明显降低（均P<0.05）。1例（2.8%）发生呼吸衰竭,1例（2.8%）发生IVC周围血肿,无症状性PE发生。3~6个月随访未见下肢DVT复发或血栓加重,1例（2.8%）发生IVC闭塞,2例（5.6%）发生切口疝,3例（8.3%）存在少量滤器金属残留,无症状性PE发生。结论 开放手术回收腔内取出困难的IVCF安全,可顺利回收滤器,未发生症状性PE和新发下肢DVT,并可显著性改善患者焦虑状态。     

后循环介入术后合并基底动脉尖综合征

目的探讨后循环介入术后发生基底动脉尖综合征(TOBS)的发病率及患者临床特点和影像学表现。方法收集43例接受介入治疗的后循环病变患者的临床及影像学资料,对术后发生TOBS患者的临床症状、影像学表现等进行回顾,分析后循环介入术后TOBS发病率、发病机制、影像学特点及其临床表现。结果 43例中,6例(6/43,13.95%)发生TOBS,包括2例严重TOBS,其中1例动脉瘤介入栓塞后发生严重TOBS导致患者死亡,1例后循环动静脉畸形(AVM)介入术后发生严重TOBS,患者处于植物状态。TOBS患者术后1~7天出现急性颞叶、枕叶、顶叶、丘脑等梗死,CT平扫可见片状低密度影,MRI呈稍长T1稍长T2信号;栓塞畸形血管团责任血管后,部分供血区域内的血流灌注降低。结论介入术中发生TOBS的主要原因包括过度栓塞导致弹簧圈移位致使血管闭塞、术后脑水肿导致血管痉挛闭塞引发脑梗死、栓塞穿支血管等,影像学表现为颞顶枕区、小脑、丘脑等急性缺血表现。严重TOBS可致患者植物状态甚至死亡,但多数可通过营养神经、神经功能刺激等对症处理后得到缓解。     

序贯介入治疗Budd-Chiari综合征合并下腔静脉新鲜血栓

目的观察序贯介入治疗Budd-Chiari综合征合并下腔静脉(IVC)新鲜血栓的有效性及安全性。方法对27例Budd-Chiari综合征合并IVC新鲜血栓患者行小球囊预扩张、置管溶栓及大球囊扩张等序贯介入治疗;记录不良反应;术后随访复查超声,评估治疗效果。结果对27例均以直径10～14 mm小球囊预扩张IVC闭塞段,扩张后原闭塞段血流均部分恢复;经留置溶栓导管泵入尿激酶40～60×10~4U/d、平均(44.10±8.40)×10~(4 )U/d,持续4～15天、平均(6.72±5.21)天后,超声显示20例IVC内血栓完全消失,7例仍残留少量陈旧血栓;以大球囊(直径25～30 mm)扩张IVC原狭窄段,之后IVC血流恢复,侧支血管明显减少或消失。围手术期未见肺栓塞、大出血等严重并发症。术后平均随访(20.22±18.43)个月,27例患者均存活,相关临床症状及体征消失或不同程度缓解。结论序贯介入治疗Budd-Chiari综合征合并IVC新鲜血栓安全、有效。     

髋臼骨折外科治疗进展

髋臼骨折外科治疗提倡解剖复位、有效内固定和早期功能锻炼。髋臼位置特殊、骨折复杂,必须根据影像学表现作出准确分型,才能指导外科治疗。髋臼关节面移位、头臼不匹配、存在不能接受的顶弧角度、关节内有骨折块和股骨头半脱位时必须采取手术治疗,其疗效与复位质量呈正相关。新固定材料大量应用于临床,具有针对不同类型骨折的优势。对某些预计预后不良的髋臼骨折及伴有严重骨质疏松的老年患者,主张行初期全髋关节置换术。对延误治疗或内固定失败,出现晚期并发症患者,全髋关节置换术可有效改善关节功能。     

髋臼骨折外科治疗进展

髋臼骨折外科治疗提倡解剖复位、有效内固定和早期功能锻炼。髋臼位置特殊、骨折复杂,必须根据影像学表现作出准确分型,才能指导外科治疗。髋臼关节面移位、头臼不匹配、存在不能接受的顶弧角度、关节内有骨折块和股骨头半脱位时必须采取手术治疗,其疗效与复位质量呈正相关。新固定材料大量应用于临床,具有针对不同类型骨折的优势。对某些预计预后不良的髋臼骨折及伴有严重骨质疏松的老年患者,主张行初期全髋关节置换术。对延误治疗或内固定失败,出现晚期并发症患者,全髋关节置换术可有效改善关节功能。     

下腔静脉滤器植入在下肢深静脉血栓形成溶栓治疗中的应用

目的探讨下腔静脉滤器(IVCF)在下肢深静脉血栓形成(DVT)的溶栓治疗中,对预防致命性肺栓塞(PE)的有效性、安全性及手术指征。方法 10例下肢DVT患者接受IVCF植入术,术后给予溶栓及抗凝治疗。结果全组病例均获成功,疗效满意。10例均获得随访,随访时间1～23个月,随访期间无PE、严重出血性疾病及滤器相关死亡发生。结论 IVCF植入的应用不仅有效预防PE的发生,而且使溶栓治疗更为安全。     

OptEase retrievable inferior vena cava filter: initial multicenter experience

The purpose of this article is to describe our experience with the retrievable OptEase inferior vena cava filter (IVCF) (Cordis Corporation, Miami Lakes, FL) in the prevention of pulmonary embolus (PE). Forty patients (24 men, age range 15-85 years, mean age 38 years) who were at temporary risk of PE underwent insertion and retrieval of the OptEase IVCF at two institutions. Eleven patients were treated with filter implantation and subsequent repositioning in the inferior vena cava (IVC) to extend implantation time. All patients were followed up for 24 hours after retrieval, with additional follow-up at the physician's discretion. Forty patients had successful filter insertion. Two patients who underwent intravascular ultrasound guidance for filter deployment required filter repositioning within 24 hours owing to inadvertent placement in the right common iliac vein. All 40 patients underwent successful filter retrieval with no adverse events. In those patients who did not undergo IVCF repositioning, the time to retrieval ranged from 3 to 48 days (mean +/- SD 16.38 +/- 7.20 days). One patient had a successful retrieval at 48 days, but all other retrieval experiences were performed within 23 days. The second strategy involved implantation, with repositioning at least once before final retrieval. This latter strategy occurred in 11 patients, and the time to first capture ranged from 4 to 30 days (mean +/- SD 13.82 +/- 6.13 days). No symptomatic PE, IVC injury or stenosis, significant bleeding, filter fracture, or filter migration was observed. In this feasibility study, the OptEase IVCF prevented symptomatic PE, was safely retrieved or repositioned up to 48 days after implantation, and served as an effective bridge to anticoagulation. In patients who require extended IVCF placement, the OptEase IVCF can be successfully repositioned within the IVC, thereby extending the overall implantation time of this retrievable IVCF.     

Bedside intravascular ultrasound-guided vena cava filter placement

OBJECTIVE: Several reports have demonstrated the efficacy of inferior vena cava filter (IVCF) placement with intravascular ultrasound guidance (IVUS). The majority of these procedures,however, have been done in concert with contrast venography and/or fluoroscopic guidance. The purpose of this report was to evaluate the potential for bedside IVCF placement with "real-time" IVUS guidance only. DESIGN OF STUDY: In a phase I trial, 10 patients underwent IVUS interrogation of the IVC for diameter measurements and localization of the renal veins. Contrast venography verified the IVUS findings prior to filter deployment. In a phase II trial, another 35 patients underwent intensive care unit bedside placement of an IVC filter with only "real time" IVUS guidance using a double puncture technique in the same femoral vein. All patients underwent color-flow ultrasonography of the femoral veins after filter placement to rule out post procedure femoral vein thrombosis and plain radiographs of the abdomen to identify filter location. RESULTS: In the phase I trial, all filters were placed within 15 mm of the most inferior renal vein identified by IVUS. There were no complications, and successful filter placement was verified by contrast venography. In phase II, 33 IVCFs were placed without complications at approximately the L2 level by plain radiograph. One patient had an IVCF deployed in the common iliac vein, which necessitated placement of an uneventful second IVCF at the infrarenal location by IVUS. This same patient had a femoral deep venous thrombosis identified by postoperative duplex ultrasonography. A second patient had IVC thrombus identified by IVUS, and placement was performed with contrast venography in the fluoroscopy suite. IVC measurements ranged from 18-28 mm in diameter. CONCLUSIONS: IVUS accurately measures the IVC diameter and localizes the renal veins, allowing for exact placement of IVCFs. IVUS further avoids the need for contrast agents and for transport of critically ill patients. Bedside insertion of an IVcF with IVUS guidance is simple, safe, and accurate. Further assessment of this technique is warranted.     

Retrievable inferior vena cava filters: early clinical experience

AIM: Multiple-trauma patients often have injuries that prevent the use of anticoagulant or sequential compression device prophylaxis. Temporary inferior vena cava filters (IVCFs) offer protection against pulmonary embolism (PE) during the early, highest-risk perioperative and immediate injury period, while avoiding potential long-term sequelae of a permanent IVCF. The objective of this study was to evaluate the efficacy of prophylactic, temporary IVCF placement at the intensive care unit (ICU) bedside under real-time intravascular ultrasound (IVUS) guidance in multiple-trauma patients. METHODS: One hundred and three multiple-trauma patients between July 1, 2002, and July 1, 2004, under-went placement of Günther-Tulip (n=38), Recovery (n=30) or OptEase (n=35) retrievable IVCFs under real-time IVUS guidance. The mean+/-SD injury severity score of the patients was 27.7 (+/-2.2). All patients had abdominal X-rays to verify filter location. Before IVCF retrieval, all patients underwent femoral vein color-flow ultrasonography to rule out deep vein thrombosis (DVT) and pre and postprocedure vena-cavography for possible IVCF thrombus entrapment and postretrieval IVC injury. RESULTS: Twenty-four patients died of their injuries; no deaths were related to IVCF placement. One PE occurred during follow-up after filter retrieval, and 2 insertion site femoral vein DVT occurred. As verified by abdominal X-rays, 97.1% (100/103) of IVCFs were placed without complications at the L2-3 level. Filter-related complications included 3 groin hematomas (2.9%) and 3 IVCFs misplaced in the right iliac vein early in our experience; these filters were uneventfully retrieved and replaced in the IVC within 24 h. Forty-four patients underwent uneventful retrieval of IVCFs after DVT or PE anticoagulation prophylaxis was initiated. Thirty-five filters were not removed, including 32 because severity of injury prevented DVT or PE prophylaxis and 3 because of thrombus trapped with the filter. CONCLUSIONS: Prophylactic, temporary IVCFs placed at the ICU bedside under IVUS guidance in multiple-trauma patients serves as an effective bridge to anticoagulation until venous thromboembolism prophylaxis can be initiated. Further investigation of this bedside technique and the role of temporary IVCFs in these patients is warranted.     

Retrievable Inferior Vena Cava Filters: Initial Clinical Results

Anticoagulation is the accepted therapy for patients with thromboembolic disease. When contraindications to anticoagulant therapy are present, however, interruption of the inferior vena cava (IVC) may prevent pulmonary embolism (PE). The objective of this study was to report our early technical and clinical results with retrievable IVC filters (IVCFs) for the prevention of PE. One hundred and twenty-seven multitrauma patients between December 1, 2002, and December 31, 2004, underwent placement of Gunther-Tulip (n = 49), Recovery (n = 41), or OptEase (n = 37) retrievable IVCFs under real-time intravascular ultrasound (IVUS) guidance. All patients had abdominal X-rays to verify filter location. Prior to IVCF retrieval, all patients underwent femoral vein color flow ultrasonography to rule out deep vein thrombosis (DVT) and vena-cavography to assess the IVCF for trapped emboli, filter tilt, or retrained thrombus. Thirty-nine patients died of their injuries; no deaths were related to IVCF placement. One PE occurred during follow-up after filter retrieval, and two femoral vein insertion-site DVTs occurred. One hundred twenty (94.4%) of IVCFs were placed without complication at the L2-3 level, as verified by abdominal X-rays. Filter-related complications included three groin hematomas (2.9%) and three IVCFs misplaced in the right iliac vein early in our experience (2.3%); these filters were uneventfully retrieved and replaced in the IVC within 24 hr. Sixty-six patients underwent uneventful retrieval of IVCFs after DVT or PE anticoagulation prophylaxis was initiated. Forty-five IVCFs were not removed: 41 due to contraindications due to anticoagulation and four because of trapped thrombus within the filter. The role of retrievable IVCFs continues to evolve, but in this study of 127 patients, prophylactic temporary IVCF placement was simple and safe, prevented fatal PE, and served as an effective “bridge” to anticoagulation. Further investigation of this bedside IVUS technique and the role of temporary IVCFs in different patient populations is warranted. SECTION EDITOR: Samuel S. Ahn, MD     

提高下腔静脉滤器回收率核心要点

静脉血栓栓塞症是院内常见的致死性心血管疾病之一,应用下腔静脉滤器能大幅度降低致死性肺栓塞的发生率,同时下腔静脉滤器长期植入带来的相关并发症不可忽视。越来越多的指南推荐当肺栓塞风险可控时应及时回收腔静脉滤器。但是由于临床理念与技术发展差异,临床上下腔静脉滤器的总体回收率并不高,大多数滤器最终还是永久性植入。减少滤器的并发症并大幅度提高下腔静脉滤器回收率须做到以下3点：（1）明确植入指征,严格选择,规范操作,精准植入。（2）植入后对滤器进行系统监测,及时处理原发血栓,充分抗凝。（3）有效处理滤器内血栓,回收技术规范化,充分利用多种介入技术提高回收率。     

Real-time intravascular ultrasound-guided placement of a removable inferior vena cava filter

BACKGROUND: Reports have demonstrated the benefit of prophylactic inferior vena cava filter (IVCF) placement to prevent pulmonary embolism. This series evaluates the potential for the bedside placement of a removable IVCF under "real-time" intravascular ultrasound (IVUS) guidance. METHODS: Twenty trauma patients underwent intensive care unit placement of a removable IVCF with IVUS guidance. All patients had ultrasonography of the femoral veins after placement to rule out postprocedure femoral vein thrombosis and radiographs to identify filter location. RESULTS: Nineteen of 20 IVCFs were placed at approximately the L2 level as verified by radiography. One patient had a large IVC (34 mm) and underwent bilateral common iliac IVCF placement under IVUS. Within 3 weeks of placement, 12 IVCFs were retrieved. Of the remaining eight patients, six had indications for permanent implantation, two had contralateral deep venous thrombosis, and one had ipsilateral deep venous thrombosis. CONCLUSION: Bedside insertion of a removable IVCF with IVUS guidance and its removal are simple, safe, and accurate.     

Role of prophylactic temporary inferior vena cava filters placed at the ICU bedside under intravascular ultrasound guidance in patients with multiple trauma

OBJECTIVE: Patients with multiple trauma often have injuries that preclude the use of anticoagulation therapy or sequential compression device prophylaxis. Temporary inferior vena cava (IVC) filters (IVCFs) offer protection against pulmonary embolism during the early immediate injury and perioperative period, when risk is highest, while averting potential long-term sequelae of permanent IVCFs. The objective of this study was to evaluate the efficacy of prophylactic, temporary IVCF placement at the intensive care unit bedside under real-time intravascular ultrasound (IVUS) guidance in patients with multiple trauma. INTERVENTIONS: Ninety-four patients with multiple trauma seen between July 1, 2002, and November 1, 2003, underwent placement of OptEase (Cordis Endovascular) retrievable IVCFs under real-time IVUS guidance. Mean (+/-SD) Injury Severity Score was 25.1 +/- 2.2). Abdominal x-ray films were obtained in all patients to verify filter location. Before IVCF retrieval all patients underwent femoral vein color-flow ultrasound scanning to rule out deep vein thrombosis (DVT), and pre-procedure and post-procedure vena cavography to identify possible IVCF thrombus entrapment and post-retrieval inferior vena cava injury. RESULTS: Nineteen patients died of their injuries; no deaths were related to IVCF placement. One pulmonary embolism occurred during follow-up after filter retrieval, and 1 insertion site femoral vein DVT occurred. As verified on abdominal x-ray films, 96.8% (91 of 94) of IVCFs were placed without complications at the L2-3 level. Filter-related complications included 2 groin hematomas (2.1%) and 3 IVCFs misplaced in the right iliac vein (3.2%), early in our experience; the filters were uneventfully retrieved and replaced in the inferior vena cava within 24 hours. Thirty-one patients underwent uneventful retrieval of IVCFs after DVT or pulmonary embolism anticoagulation prophylaxis was initiated. Forty-four filters were not removed, 41 because severity of injury prevented DVT or pulmonary embolism prophylaxis and 3 because of thrombus trapped within the filter. CONCLUSIONS: Prophylactic, temporary IVCF placement at the intensive care unit bedside under IVUS guidance in patients with multiple trauma is simple and safe, and serves as an effective "bridge" to anticoagulation therapy until venous thromboembolism prophylaxis can be initiated. Further investigation of this bedside technique and the role of temporary IVCFs in patients with multiple trauma is warranted. CLINICAL RELEVANCE: Patients with multiple trauma often have injuries that preclude the use of anticoagulation therapy or sequential compression device prophylaxis. Temporary inferior vena cava filters (IVCFs) offer protection against pulmonary embolism during the perioperative and immediate injury period, when risk is highest. Ninety-four patients with multiple trauma underwent prophylactic, temporary IVCF placement at the intensive care unit bedside under real-time intravascular ultrasound. One pulmonary embolism occurred during follow-up after filter retrieval, and 1 insertion site femoral vein deep venous thrombosis occurred. Ninety-one of 94 IVCFs (96.8%) were placed without complication. Thirty-one patients underwent uneventful retrieval of IVCFs after anticoagulation prophylaxis was initiated. Forty-four filters were not removed, because of severity of injury (n = 41) or because of trapped thrombus within the filter (n = 3). Prophylactic, temporary IVCFs placed under intravascular ultrasound guidance at the bedside in patients with multiple trauma is simple, safe, and an effective bridge to anticoagulation therapy.     

超声引导下腔静脉滤器置入术的临床应用

目的探讨彩色多普勒超声引导下下腔静脉滤器置入术的临床应用价值。方法对我院收治的16例单侧下肢深静脉血栓（DVT）患者,在彩色多普勒超声经腹扫查实时动态引导下,行经健侧股静脉下腔静脉滤器置入术。结果 16例患者均在实时彩色多普勒超声引导下,置入VenaTechTMLP永久型下腔静脉滤器16只。术中出血少,无肺栓塞发生及滤器误置入其他血管。术后伤口均恢复良好,术后1周至半年超声及X线随访示滤器无变形、移位,无肺栓塞发生。结论超声引导下经皮穿刺下腔静脉滤器置入术是一种安全、可靠、简便、经济、无辐射的方法 ,具有较高的临床应用价值。