Thrombosis at venous insertion sites after inferior vena caval filter placement

Color Doppler flow imaging or compression ultrasound (US) was used to prospectively determine frequency of thrombosis at 54 venous insertion sites (47 in common femoral veins, seven in right internal jugular veins) after percutaneous placement of Greenfield filters for interruption of the inferior vena cava. Fifty-one filters were successfully placed in 51 patients with a dilator set or a balloon angioplasty catheter. Nine focal thrombi were detected in the common femoral vein (19%) and one in the right internal jugular vein (14%). Use of dilators induced eight thrombi (24%), compared with two (10%) from balloon catheters. The left common femoral vein had a high frequency of thrombosis, regardless of dilation technique (five of nine). Of nine patients with acute common femoral vein thrombosis, four became symptomatic within 10 days after the procedure. Patients may remain asymptomatic or have delayed symptoms; thus, US is valuable for determining patients at risk of thrombosis of the common femoral vein.     

Technical problems associated with placement of the Bird's Nest inferior vena cava filter.

Technical problems encountered during percutaneous placement of 165 Bird's Nest filters over 16 months are described. Filter deployment was successful in all patients. Although frequent, the technical problems were all minor with no long-term sequelae. Several problems were inherent to the design of the filter. Other problems related to the patient's anatomy were seen as well. Because deployment of the Bird's Nest filter is more operator-dependent than is deployment of other types of inferior vena cava filters, knowledge of pitfalls and means to avoid problems are particularly important.     

Superior vena caval placement of a Kimray-Greenfield filter

Kimray-Greenfield filters placed in the inferior vena cava have been shown effective for prophylaxis against pulmonary embolism from lower extremity or pelvic thrombi. Percutaneous filter placement in the superior vena cava is described in a patient with pulmonary embolism and upper extremity thrombosis in whom anticoagulative therapy was contraindicated.     

Retrievable vena cava filter placement during treatment for deep venous thrombosis

The purpose of our study is to evaluate the safety of insertion and removal of the retrievable vena cava filter and the efficacy of this filter in preventing pulmonary embolism during treatment of stenosis or obstruction of the lower extremity due to deep venous thrombosis. We retrospectively evaluated placement of 10 filters in 6 patients with lower extremity deep venous thrombosis who had undergone various treatments, including those utilizing techniques of interventional radiology. Worsening of or the new formation of pulmonary embolism was prevented in all patients. All attempts at both implantation and retrieval of the filter were safely accomplished. No complication related to filter placement occurred. Filters were left in the vena cava for permanent use when deep venous thrombosis was refractory to treatment. These results demonstrate that both placement and removal of the retrievable vena cava filter can be accomplished safely and that this type of filter is useful to prevent pulmonary embolism during treatment of deep venous thrombosis of the lower extremity. Further, the use of a retrievable vena cava filter might be preferred over that of a temporary vena cava filter, especially if further implantation of a filter becomes necessary since replacement with a permanent filter would not be required when using a retrievable vena cava filter.     

Percutaneous transfemoral placement of the Kimray-Greenfield vena cava filter

In 109 patients in whom inferior vena caval interruption was indicated to prevent pulmonary embolism, Kimray-Greenfield (K-G) filters were inserted from a percutaneous transfemoral approach, 94 from the right common femoral vein and 15 from the left common femoral vein. All attempts at transfemoral filter insertion were successful except in two patients in whom a left common femoral approach was used. No complications occurred during insertion. In four patients, clinical evidence of femoral vein thrombosis ensued within 48 hours of filter insertion. There were no complications related to filter migration, and in 97% of patients the alignment was satisfactory. The percutaneous transfemoral route is a rapid and effective method for inserting K-G filters. The most frequent postinsertion complication was femoral vein thrombosis (ten patients), but only two patients suffered permanent sequelae.     

Bird's Nest filter placement within an enlarged hemiazygos vein for prevention of pulmonary embolism

Thrombosis of the inferior vena cava (IVC) may result in considerable enlargement of paravertebral, azygos, and hemiazygos collateral veins that may in turn serve as pathways for thromboemboli to the pulmonary circulation. Herein we describe the transfemoral placement of a Bird's Nest filter within an enlarged hemiazygos vein to provide prophylaxis against pulmonary embolism in a patient with right femoral venous thrombosis who could not tolerate systemic anticoagulation. There had been earlier transjugular placement of a Greenfield filter within the suprarenal IVC.     

Percutaneous placement of the inferior vena caval filter--a clinical experience with the Günther vena caval filter

A new inferior vena caval filter (Günther vena caval filter) was used in seventeen patients with pulmonary embolism. The filter is a basket filter which consists of twelve stainless-steal wires, and can be inserted percutaneously through a 10 F angiographic catheter. The filter was easily and safely placed in every case. No significant complications were encountered. In a follow up period of up to twenty seven months, the filter was well tolerated. One patient had a recurrence of pulmonary embolism. The author believe that the filter will be suitable for prophylactic placement for pulmonary embolism, and it will take over another filters that require surgical venotomy.     

国产ZQL滤器与进口滤器置入后并发症的中长期对照研究

目的 通过国产ZQL滤器与进口滤器置入后相关并发症的对照研究,探讨国产滤器的应用价值.方法 将因静脉血栓放置滤器患者分为国产滤器组62例和进口滤器组58例,术后行腹部X线平片、下肢静脉造影和(或)肺动脉造影及下肢静脉彩色多普勒超声检查,有怀疑肺栓塞的患者行3D-CT检查.结果 所有患者的静脉滤器均成功置入预定部位,国产滤器组术后1例发生滤器移位(>10 mm),1例滤器内有血栓,2例并发下腔静脉阻塞,1例并发肺栓塞;进口滤器组术后2例滤器内有血栓,2例并发下肢静脉血栓,9例并发下腔静脉阻塞,1例并发滤器穿破静脉壁,1例并发肺栓塞.两组并发症数据均进行χ2检验,结果差异无统计学意义(P>0.05).结论 国产ZQL滤器置入后并发症和进口滤器相比差异无统计学意义,可以替代进口滤器应用.     

Pulse-spray thrombolysis of inferior vena cava thrombosis complicating filter placement

Inferior vena cava thrombosis is an uncommon but potentially serious complication of caval filter placement. A 34-year-old man with symptomatic caval thrombosis, which occurred 6 weeks after filter placement, was successfully treated with a combination of pulse-spray and local infusion of urokinase.     

临时性腔静脉滤器在静脉血栓溶栓治疗中的应用

目的：探讨临时性腔静脉滤器置入在外周静脉血栓患者溶栓治疗中预防异位栓塞的应用价值。方法：10例下肢静脉血栓及1例永存动脉干合并右颈内静脉血栓的患者,分别经静脉置入临时性腔静脉滤器后,用大量尿激酶顺行或全身静脉溶栓治疗。结果：11例患者经7－15d的治疗后症状消失,血栓完全或部分溶解,血管开通,取出临时性腔静脉滤器,未出现并发症及异位栓塞。结论：置入临时性腔静脉滤器在外周静脉血栓患者溶栓治疗中是预防静脉血栓脱落导致异位栓塞的有效方法。     

可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢深静脉血栓形成

目的 评价可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢深静脉血栓形成(DVT)的安全性和临床效果.方法 回顾性分析2012年1月至12月收治的76例急性下肢DVT患者,均在DSA导引下置入下腔静脉滤器,然后置放溶栓导管于血栓段,经导管24 h持续微泵灌注50万U/d尿激酶.根据患者髂股静脉再通情况、住院时间、治疗前后肢体周径差、治愈率、并发症等评估近期疗效和安全性;随访1年,根据患者下肢水肿、髂股静脉闭塞、色素沉着、溃疡等评估远期疗效.结果 76例患者均成功置入下腔静脉滤器(14 d后成功回收71例),治疗14d后临床症状均不同程度缓解,髂股静脉血流基本或全部恢复,平均住院时间为(6.7±3.1)d.治疗后3、7、14 d肢体周径与治疗前比较明显缩小(P＜0.05),治疗期间未出现严重不良反应.下肢静脉彩色超声复查显示,随访6个月时髂股静脉闭塞率和色素沉着率分别为5.3％(4/76)和2.6％ (2/76),随访12个月时分别为9.2％(7/76)和7.9％ (6/76),未发生皮肤溃疡.结论 可回收下腔静脉滤器联合导管持续溶栓治疗急性下肢DVT可取得较好的近远期临床效果,安全可行.