下腔静脉滤器长期留置并发症CT随访的单中心研究

目的 探讨下腔静脉滤器(IVCF)长期留置并发症发生率.方法 通过CT随访观察63例IVCF留置1～15年、平均(4.68±3.18)年患者(Aegisy滤器12例,OptEase滤器19例,TrapEase滤器11例,Simon-Nitinol滤器13例,VenaTech滤器8例)滤器相关并发症,包括滤器断裂、下腔静脉穿孔、症状性下腔静脉血栓形成或闭塞、深静脉血栓形成(DVT)复发及症状性肺栓塞(PE)再发.根据Durack分级标准,将下腔静脉穿孔分为0～Ⅳ级.记录IVCF置入后是否接受规范性抗凝治疗.采用Fisher精确检验对比并发症发生率.结果 63例患者共经CT随访131次,每例患者随访1～5次,平均2.08次.结果显示,IVCF断裂6例(6/63,9.52％),含OptEase 2例(2/19,10.53％),TrapEase 4例(4/11,36.36％);Ⅰ级以上下腔静脉穿孔22例(22/63,34.92％),含Aegisy 1例(1/12,8.33％),OptEase 2例(2/19,10.53％),VenaTech4例(4/8,50％),TrapEase 3例(3/11,27.27％),Simon-Nitinol 12例(12/13,92.31％),Simon-Nitinol滤器穿孔发生率高于其它4款滤器(P＜0.05);症状性下腔静脉血栓形成或闭塞5例(5/63,7.94％),含OptEase1例(1/19,5.26％),TrapEase1例(1/11,9.09％),Simon-Nitinol 3例(3/13,23.08％);DVT复发8例(8/63,12.70％),含OptEase 3例(3/19,15.79％),TrapEase 1例(1/11,9.09％),VenaTech 1例(1/8,12.50％),Simon-Nitinol 3例(3/13,23.08％),规范性抗凝患者DVT复发发生率低于未规范抗凝患者(P=0.044);再发症状性PE 1例(1/63,1.59％),为置入Aegisy(1/12,8.33％)且未规范抗凝治疗患者.结论 IVCF长期留置并发症并不少见,尤其是下腔静脉穿孔及DVT复发发生率较高.应重视对未取出IVCF的CT随访观察,尽早发现相关并发症并及时处理,同时重视IVCF置入后规范性抗凝治疗.     

腔内技术回收倾斜贴壁下腔静脉滤器31例分析

【摘要】 目的 探讨球囊移位和导丝成襻Loop技术取出倾斜贴壁的可回收下腔静脉滤器(IVCF)的技巧和临床经验。 方法 回顾性分析2017年3月至2020年9月在重庆医科大学附属第二医院接受处理的31例IVCF倾斜贴壁回收困难患者临床资料。其中男15例, 女16例,年龄为(57.9±16.4)岁。滤器留置( 7～693) d,术中采用球囊辅助移位、导丝成襻Loop技术解除回收钩贴壁状态,取出滤器。记录患者围术期并发症和随访期下腔静脉(IVC)通畅性。结果 31例倾斜贴壁IVCF均成功取出,其中应用Denali滤器3例,OptEase滤器20例,Celect滤器6例,Günther Tulip滤器2例。采用球囊辅助移位技术12例,导丝成襻Loop技术19例(单Loop 6例,同向双Loop 9例,双向双Loop 4例)。手术时间为35～157 min。回收相关并发症发生率为9.68%(3/31),未发生严重并发症。术后随访4～48个月,1例因颅内胶质瘤死亡,IVC通畅率为100%。结论 采用球囊移位、导丝成襻Loop技术可有效解除滤器倾斜,提高倾斜贴壁所致取出困难的可回收IVCF回收率,值得临床推广应用。     

下腔静脉滤器预防肺栓塞的长期随访结果

目的 探讨置入下腔静脉滤器(IVCF)预防肺栓塞(PE)的长期安全性、疗效及并发症.方法 回顾性分析1994年1月至2005年6月期间73例接受了IVCF置人术,并经多普勒超声、DSA、CT或MRI确诊的深静脉血栓形成(DVT)和(或)PE患者资料,随访时间为放置IVCF后5个月至11年,包括电话或问卷随访、病历回顾、腹部X线片复查、超声、CT肺动脉成像(CTPA)或下肢间接性CT静脉成像(CTV)检查.结果 73例患者共置入78枚滤器,置入时1例滤器张开不全.复查时2例滤器捕获血栓,1例滤器倾斜,无滤器移位、断裂和穿孔.73例中失访5例.14例死亡,存活时间5 d至41个月,平均存活期为14.5个月.存活的54例中,确诊的再发DVT 3例、下腔静脉血栓1例、滤器血栓1例,未发现再发PE.结论 长期使用IVCF预防PE是安全、有效的,并且IVCF置入后的远期严重并发症不常见.     

下腔静脉滤器在下肢深静脉血栓形成治疗中的应用

下肢深静脉血栓形成(deep vein thrombosis,DVT)是一种常见的血管疾病,下肢DVT的主要并发症是肺动脉栓塞(pulmonary embolism,PE)和下肢深静脉血栓后综合征(post-thrombotic syndrome,PTS).当肺动脉栓塞80％以上时,常导致患者死亡,即致死性肺梗死[1],也是最严重的并发症,且死亡率高达31％～41％[2].下腔静脉滤器置入后,降低了下肢DVT患者血栓脱落并导致PE的可能性,而且及时行溶栓及抗凝治疗,可减少PTS的发生.我院2005-01～2010-09对17例DVT患者行下腔静脉滤器(inferior vena cava filter,IVCF)置入术,术中患肢置管溶栓,术后行患肢溶栓治疗,取得良好效果,现报道如下.     

下肢深静脉血栓治疗中下腔静脉滤器的临床应用

目的探讨下腔静脉滤器(IVCF)在下肢深静脉血栓治疗中预防肺栓塞的安全性、有效性。方法31例确诊为下肢深静脉血栓的患者于其他治疗前置入IVCF,共置入滤器31支,其中Simmon Nitinol滤器(SNF)7支,Trap Ease滤器(TEF)18支,可回收式Opt Ease滤器(OEF)6支,滤器均放置于肾静脉开口之下的下腔静脉。滤器放置后对18例下肢深静脉血栓行抗凝溶栓治疗,13例行手术取栓。结果31例IVCF置入全部成功,其中,SNF滤器倾斜3例,倾斜角度均小于15°。术后随访1～38个月,无1例症状性肺栓塞发生,无其他相关并发症。下肢深静脉血栓经治疗后,症状及体征消失或缓解。结论下肢深静脉血栓治疗中,IVCF置入可有效预防肺栓塞的发生,但需精心选择手术适应证、手术指征和合适的滤器。     

下腔静脉滤器的临床应用分析附198例报道

目的探讨下腔静脉滤器（inferior vena cava filter,IVCF）应用的适应证和并发症的预防。方法回顾性地分析198例为预防肺栓塞（pul monary embolism,PE）放置IVCF的临床资料,并做了5～84个月的随访。结果本组病例IVCF均1次成功植入,其中放置永久性滤器165例,临时性的33例。随访122例（62%）,未出现肺栓塞;3例（2%）放置永久性滤器者术后6周至17个月出现下腔静脉阻塞综合征,经过治疗病情缓解。结论置入IVCF是预防PE安全、有效的方法,但是应注意放置滤器适应证的选择和并发症的预防。     

单中心10年1722例下腔静脉滤器临床应用回顾性分析

目的 探讨重庆医科大学附属第一医院10年间下腔静脉滤器（IVCF）应用趋势,分析影响IVCF回收的因素。方法 收集2011年1月至2020年12月IVCF置入患者临床资料,记录患者性别、年龄、诊断、伴发疾病、治疗方案、所在科室、IVCF置入指征、IVCF类型、IVCF回收情况、出院诊断等。采用Origin 2021软件绘制研究结果趋势图,二元logistic回归模型分析影响IVCF回收的因素。结果 10年间共置入1 722枚IVCF,年均增长率为15.2%,54.8%(944/1 722)患者有置入IVCF绝对适应证。87.6%(1 509/1 722)IVCF为可回收型,其中611枚回收成功,总回收率为40.5%;至2020年回收率达70.5%(146/207)。拟合趋势线绘制提示,以绝对适应证置入IVCF数量呈持续上升趋势。二元logistic回归分析显示,置入年份、患者年龄、Charlson共病指数（CCI）、下肢深静脉血栓形成（DVT）分型、恶性肿瘤、抗凝禁忌、肺栓塞是IVCF回收的影响因素。结论 过去10年IVCF在静脉血栓栓塞症患者中应用日趋增加,其回收率逐年提高。高龄、伴...     

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。     

糖尿病酮症高渗性昏迷误诊为肝昏迷1例

1 临床资料 患者,女,45岁,因上腹痛、乏力、纳差、尿黄1 d,神志不清6 h于1999-06-15入院.缘于1 d前无明显诱因出现上腹痛、乏力、纳差、尿黄,无发热、腹泻、尿少、尿频、尿急.在村卫生院就诊,诊断为"病毒性肝炎",予护肝、对症等治疗,无好转,于6 h前出现神志不清、大小便失禁,无呕吐、抽搐,转入我院门诊,以"肝昏迷"收入院.患者有"乙型肝炎"病史4年.     

下腔静脉滤器置入术96例临床总结

目的探讨下腔静脉滤器置入术(IVCF)预防致命性肺动脉栓塞(PE)的疗效、相关并发症及处理。方法经股静脉途径放置下腔静脉滤器96例。结果术后随访4～36个月。96例IVCF无一例出现致命性肺栓塞,17例出现相关的并发症。结论下腔静脉滤器可以有效预防致命性肺动脉栓塞,并发症的发生率较高,相关并发症可以有效预防和处理。     

Multisegmental anomaly of the inferior vena cava with thrombosis of the left inferior vena cava

We present a rare case of an extensive venous thrombosis associated with a multisegmental anomaly of the inferior vena cava (IVC), double IVCs, a hypoplastic right IVC, an aneurysm arising at the distal portion of the right IVC, and a severe stenosis between the prerenal and the hepatic segments of the IVC.     

Translumbar high inferior vena cava access placement in patients with thrombosed inferior vena cava filters

Venous access is a dire necessity in some patients such as those with end-stage renal disease or short gut syndrome. The right internal jugular vein is the preferred entry site for tunneled central venous catheters. Alternatively, the left internal jugular is considered next, with the external jugular and subclavian veins being considered later. Catheter-related venous stenosis approaches 40% in certain sites, resulting in loss of access sites. As sites are lost, insertion of functional long-term central venous catheters becomes challenging. Translumbar inferior vena cava (IVC) access created in two patients with limited venous access sites who had thrombosed IVCs containing IVC filters is described. Because of the higher IVC punctures in these cases, procedural planning with cross-sectional imaging is crucial to avoid puncturing the right renal artery as it passes posterior to the IVC.     

Agenesis of the inferior vena cava

A case of agenesia of 3 of the 4 segments the vena cava inferior is presented. The embryogenesis of the v. cava inferior is discussed in so far as is relevant for the malformation in this case. Exact diagnosis and classification can be made via intravenous and intraarterial DSA and computed tomography.     

Aneurysms of the inferior vena cava

Two cases of saccular aneurysms of the infrarenal inferior vena cava (IVC) associated with retrohepatic IVC obstruction are described. Ultrasonographic, computerized tomographic and inferior venacavography findings in these cases are presented.     

Leiomyosarcoma of the inferior vena cava

Primary vascular leiomyosarcoma is a rare tumor, which arises mainly from the inferior vena cava. Clinical signs are non-specific. Systemic metastasis occurs in the late stage. Imaging with color Doppler ultrasonography, contrast-enhanced computed tomography, or magnetic resonance imaging can significantly contribute to the diagnosis. We present a case of leiomyosarcoma of the inferior vena cava that extended into the right renal vein and the right iliac vein, as it is a rare case and emphasize the significance of the imaging methods in its diagnosis.     

Leiomyosarcoma of the inferior vena cava

Leiomyosarcoma of the inferior vena cava is a rare primary tumour. We present a case report of a 67-year-old man with a long history of abdominal pain and gastroesophageal reflux, who was found to have a large retroperitoneal mass confirmed to be a leiomyosarcoma. The clinical and imaging features are outlined, and in addition the treatment and prognosis.     

Leiomyosarcomas of the inferior vena cava

Leiomyosarcoma of the inferior vena cava in a rare tumor which is predominantly seen in women. The symptomatology is non specific and depends mostly of the segment of the vessel which is involved. Radiologic approach for correct preoperative diagnosis is based on ultrasonography, computed tomography and inferior vena cavography. The best treatment is en bloc resection of the mass associated with pre and post-operative chemotherapy. Although the tumor is slow-growing, the prognosis is poor and the average survival is less than two years, due to local recurrence and metastases.     

Pseudothrombosis of the inferior vena cava

Flow phenomena can cause artifacts that may simulate thrombosis. The differentiation between thrombus and flow phenomenon can be made by delayed scans and certain CT-findings in thrombosis that may not be found in pseudothrombosis.