摘要
目的探讨疑难性下腔静脉滤器取出的策略及操作技巧。方法 2005年11月至2010年10月我院收治的采用常规圈套技术无法成功取出的下腔静脉滤器置入术后患者11例,采用导管辅助法、异物钳法及股静脉剖开等方法行下腔静脉滤器取出术,其中男性8例,女性3例,年龄22～71岁。术后给予抗凝、抗炎治疗3～5d。随访4～12个月复查血管超声。结果 10例患者成功回收下腔静脉滤器,成功率91%。导管辅助法取出7例;异物钳法取出2例;1例因滤器无法进入鞘中,股总静脉剖开后取出滤器。1例因滤器与血管壁粘连紧密,回拉捕捉器时,回收钩断裂,最后家属放弃,取出失败。回收过程平均透视时间57.2min(17～115min)。滤器平均体内留置时间为37.8d(0～80d)。术后5d内全部患者顺利出院。随访期间,复查血管超声未出现下肢静脉血栓形成。结论采用多种辅助性圈套技术回收疑难性下腔静脉滤器的成功率较高,可有效提高下腔静脉滤器回收率,有一定临床应用价值。
Objective To explore the tactic and technique of retrievals for difficult inferior vena cava（IVC） filter.Methods From Nov.2005 to Oct.2010,eleven patients were refered to a single radiology department for difficult IVC filter retrievals（8 men and 3 women;22~71 years old）.All 11 filters had not been removed by using snare technique alone.Retrievals were performed with catheter aided retrievals techniques,grasping forceps,and phlebotomy techniques.All patients accepted anticoagulation and antibiotic treatment for 3~5 days after operation.Vascular ultrasound was reexamined in 4~12 months after primary operation.Results Ten filters were successfully removed,for a success rate of 91%.No procedure-related complications occurred.Successful retrievals were performed with catheter twist（n=2）,catheter loop（n=1）,catheter-snare loop（n=4）,grasping forceps（n=2）,and phlebotomy（n=1） techniques.One filter adhered tightly to vascular wall and was not retrieved due to retrieval hook fragmentation during snare loop withdrawing.The mean fluoroscopy time of operation was 57.2 minutes（17~115 minutes）.The average dwelling time for filters successfully removed was 37.8 days（0~80 days）.The patients were discharged within 5 days after operation.Thrombus in lower extremity deep venous did not aggregate during follow-up.Conclusion The success rate of catheter aided retrievals,grasping forceps,and phlebotomy techniques for difficult inferior vena cava filter was satisfactory,the techniques were helpful to increase the rate of IVC filter retrievals.
基金
国家十一五科技支撑计划(2007BAI-05B04)
辽宁省教育厅创新团队基金(2007T183)
关键词
腔静脉滤器
腔静脉
下
肺栓塞
Vena cava filters
Vena cava
inferior
Pulmonary embolism
