滤器致下腔静脉穿孔1例

下腔静脉(inferior vena cava,IVC)滤器(IVC filter,IVCF)已广泛应用于临床.近年来,有关IVCF并发症的报道越来越多,主要包括:IVCF移位、断裂、IVC穿孔及IVC闭塞等[1-4].为了进一步提高对滤器导致的IVC穿孔的认识,现就1例滤器导致的IVC穿孔的患者作一报道. 临床资料 患者男,67岁.因“突发腹痛4h”入院.患者4h前进食隔夜食物后出现腹痛,呈阵发性,有恶心,无呕吐,无腹泻.该患者7年前因肺栓塞在我科置入IVCF (Simon Nitinol filter,Bard,图1①).入院查体:血压124/80 mmHg,神志清,精神焦虑,腹平软,金腹部有压痛,无反跳痛,叩诊鼓音,无移动性浊音,肠鸣音4次/min.     

Aortic pseudoaneurysm after penetration by a Simon nitinol inferior vena cava filter

This report describes an unusual complication related to inferior vena cava (IVC) filter placement. A 50-year-old woman undergoing long-term anticoagulation presented to her primary care physician with abdominal pain after a motor vehicle accident. An IVC filter had been placed 7 years earlier. Computed tomography of the abdomen demonstrated a moderate perisplenic hematoma and a fragmented IVC filter penetrating the aorta. A small infrarenal aortic pseudoaneurysm had developed at the penetration site. Wallgraft placement successfully sealed the aneurysm.     

Fracture and migration of a suprarenal inferior vena cava filter in a pregnant patient

Placement of retrievable inferior vena cava (IVC) filters as prophylaxis for pulmonary embolism (PE) is an increasingly attractive option for patients who require temporary IVC filtration. However, experience thus far with retrievable filters in pregnant patients is limited. This report describes a suprarenally placed Recovery IVC filter in a pregnant woman with PE despite therapeutic anticoagulation. After failed induction of labor and uneventful cesarean section, the patient returned for filter retrieval 167 days after initial placement. Fracture and inferior migration of the filter was observed, and subsequent attempts at filter retrieval were unsuccessful.     

Evaluation of the inferior vena cava with intravascular US after Greenfield filter placement.

An animal model was used to evaluate the utility of intravascular ultrasound (US) imaging of the inferior vena cava (IVC) following Greenfield filter placement. Ten Greenfield filters were placed in the IVCs of five sheep and three dogs. Experimentally induced thrombi were injected into four filters at the time of placement. Intravascular US and cavography were performed 4 weeks after filter implant. The imaging studies were evaluated for demonstration of filter position, orientation, and leg distribution, as well as prediction of caval wall penetration by filter hooks. Experimentally induced and spontaneous intrafilter thrombi were also imaged. Findings were compared with those of postmortem examination. Exact filter position and orientation were most simply and accurately demonstrated on radiographs. Filter leg distribution and extent of intrafilter thrombus were best evaluated on intravascular US images. The prevalence of caval wall penetration was underestimated with both studies. The results of this animal study suggest that the information about the IVC provided at cavography and intravascular US following Greenfield filter placement may be complementary.     

Experience with the recovery filter as a retrievable inferior vena cava filter

PURPOSE: This study evaluates clinical experience with the Recovery filter as a retrievable inferior vena cava (IVC) filter. MATERIALS AND METHODS: One hundred seven Recovery filters were placed in 106 patients with an initial clinical indication for temporary caval filtration. Patients were followed up to assess filter efficacy, complications, eventual need for filter removal, time to retrieval, and ability to remove the filter. RESULTS: The patient cohort consisted of 62 men and 44 women with a mean age of 48 years (range, 18-90 y). Mean implantation time was 165 days. Indications for filter placement in patients with deep vein thrombosis (DVT) and/or pulmonary embolism (PE) included contraindication to anticoagulation (n = 33), complications of anticoagulation (n = 8), poor cardiopulmonary reserve (n = 6), large clot burden (n = 3), and PE while receiving anticoagulation (n = 1). Indications for filter placement in patients without proven PE or DVT included immobility after trauma (n = 35); recent intracranial hemorrhage, neurosurgery, or brain tumor (n = 18); and other surgical or invasive procedure (n = 3). Three patients (2.8%) had symptomatic PE after placement of the Recovery filter. No caval thromboses were detected. No symptomatic filter migrations occurred. Recovery filter removal was attempted in 15 of 106 patients (14%) at a mean of 150 days after placement. The Recovery filter was successfully retrieved in 14 of 15 patients (93%); one removal was unsuccessful at 210 days after placement. Ninety-two filters (87%) currently remain in place. CONCLUSIONS: Although all the filters were placed with the intention of being removed, a large percentage of filters were not retrieved. The Recovery filter was safe and effective in preventing PE when used as a retrievable IVC filter.     

Suprarenal inferior vena cava filter implantation

Purpose

This study evaluated the feasibility, safety, and efficacy of the suprarenal implantation of a retrievable filter in patients with renal cell carcinoma (RCC) and renal vein thrombosis (RVT) [extending or not extending to the inferior vena cava (IVC)] undergoing surgery.

Materials and methods

Between March 2005 and May 2010, 13 patients (eight men and five women; mean age 67.08 years, range 38?C95) with RCC and RVT associated or not with IVC thrombosis underwent implantation of a retrievable suprarenal IVC filter. All patients underwent computed tomography angiography (CTA), which documented RVT and in some cases its extension to the IVC. The level of IVC involvement by the neoplastic thrombus was evaluated on the basis of the Oto classification. Cavography was performed before and after filter implantation. Surgical resection of RCC was performed in all patients. A CTA scan was performed 1 week before filter removal.

Results

The procedure had 100% feasibility. All filters were correctly deployed in the suprarenal tract of the IVC. There was no evidence of peri-or postprocedural complications. All patients were monitored for clinical symptoms of pulmonary embolism (PE). There was no evidence of PE in the 30 days after the procedure. All suprarenal IVC filters were removed from 30 to 60 days after surgery.

Conclusions

Implantation of a temporary suprarenal IVC filter is an additional and feasible procedure that can prevent immediate and perioperative PE.     

下腔静脉滤过器的临床应用(附20例报告)

目的 评价置入下腔静脉滤过器预防各种因素所致静血栓脱落引起肺动脉栓塞的效果和安全性。方法：２０例下肢深静脉、盆腔静脉及下腔静脉血栓患者经布销骨下静脉或股静脉置入钛质Ｂｉｒｄ’ｓ ｎｅｓｔ ｆｉｌｔｅｒ（ＢＮＦ）２例,Ｖｅｎａ Ｔｅｃｈ－ＬＧＭ Ｆｉｌｔｅｒ（ＶＴＦ）１８例;滤器置于肾静脉开水平上方３例、下方１７例;术后立即摄腹部平处及血管造影,观察滤器位置、形态及血流情况,并积极进行局部或全身溶栓     

经皮穿刺下腔静脉滤器置入术

目的 评价下腔静脉滤器预防肺动脉血栓栓塞的作用。方法 ２８例下肢深静脉血栓形成患者实施了经皮穿刺下腔静脉小 置入术,２６例置入岛巢式滤器,２例置入Ｓｉｍｏｎ Ｎｉｔｉｎｏｌ滤器。结果 滤器全部置入肾静脉下方的下腔静脉内。２７例随访２￣３４个月,滤器无移位,１５例不伴有肺动脉血栓栓塞者无肺栓塞发生。结论下腔静脉滤器用于预防肺动脉血栓栓寒是一种安全有效的方法。     

置管溶栓术治疗下腔静脉滤器内栓子的疗效观察

目的 评价置管溶栓术治疗下腔静脉滤器内栓子的疗效及安全性.方法 2005年1月至2010年12月对31例经造影证实的下腔静脉滤器内存在栓子患者进行置管溶栓术治疗,栓子最大径均超过1 cm,溶栓药物采用尿激酶,用量为每日60万u,疗程为3～7d,术后观察临床疗效及并发症.结果 经置管溶栓治疗,18例栓子消失,7例栓子最大径缩小至3 mm以下,6例无明显变化.并发症有穿刺点渗血5例,血尿3例,腹膜后血肿1例,无严重并发症发生.并发症经对症治疗恢复良好.25枚滤器被成功取出,6枚滤器被留置.滤器取出术中及术后无急性肺栓塞发生.结论 置管溶栓术是治疗下腔静脉滤器内栓子安全、有效的方法,能提高下腔静脉滤器的取出率.     

下腔静脉过滤器的临床应用及进展

深静脉血栓形成是常见病,有较高的发病率和死亡率。下腔静脉过滤器可有效减少致命性肺栓塞的发生。本文综述下腔静脉过滤器的历史、适应证、在不同类型深静脉血栓治疗中的应用情况,展望了未来趋势。