置入Celect可回收式下腔静脉滤器的可回收性和安全性  

The recyclability and safety of Celect retrievable vena cava filter

作　　者：杜晶磊 于世平[2] 苏秀琴[2] 冯敬东[2] 乔建军[2] 卫丹[2] 李强[2] 张莉[2] Du Jinglei;Yu Shiping;Su Xiuqin;Feng Jingdong;Qiao Jianjun;Wei Dan;Li Qiang;Zhang Li(Shanxi Medical University, Taiyuan 030011, China)

机构地区：[1]山西医科大学,太原030011 [2]山西医科大学第二医院介入治疗科,太原030011

出　　处：《中华放射学杂志》2018年第2期135-139,共5页Chinese Journal of Radiology

摘　　要：目的探讨下肢深静脉血栓（DVT）患者置入Celect可回收滤器预防肺动脉栓塞的可回收性和安全性。方法回顾性分析2015年8月至2017年3月山西医科大学第二医院，置入Celect可回收式滤器的120例DVT患者资料。穿刺健侧股静脉和右侧颈内静脉，将Celect滤器置于肾静脉开口下缘1～2 cm的下腔静脉（IVC）内。置入滤器8周内开始评估滤器回收风险，达到回收标准者经颈内静脉途径回收，回收方法包括常规取出法、导丝成襻圈套法和导丝成襻联合球囊辅助法。观察腔静脉穿孔情况，并测量滤器倾斜角度。采用Kaplan-Meier法对Celect滤器的成功回收率进行评价。结果120例DVT患者均成功置入Celect滤器，其中经股静脉置入118例，经右侧颈内静脉置入2例，均未发生置入并发症。无症状性肺动脉栓塞及其相关死亡发生。24例患者未达到滤器回收标准，仍在随访中。96例患者进行了Celect滤器回收，成功回收滤器93例，滤器留置时间为7～144 d，中位时间为50 d；回收滤器失败3例，回收失败的原因为滤器严重倾斜或下腔静脉血栓机化包裹滤器，无法捕捉到滤器回收钩。21例出现腔静脉穿孔，无临床症状。35例发生滤器倾斜，其中15例倾斜角〉15°或回收钩紧贴IVC壁。13例因滤器倾斜或回收钩贴壁，采用常规取出法未成功，改为采用导丝成襻圈套法或导丝成襻联合球囊辅助法均成功取出。Celect滤器在体内的留置时间在106 d前时，回收成功率可达100%。结论DVT患者置入Celect可回收式滤器，可回收时间窗长，回收成功率高，但倾斜率和腔静脉穿孔率较高。ObjectiveTo explore the recyclability and safety of Celect retrievable filter placement in the prevention of pulmonary embolism in patients with deep venous thrombosis （DVT）.MethodsThe data of 120 DVT patients with Celect retrievable filter were collected from the Second Hospital of Shanxi Medical University from August 2015 to March 2017 and analyzed retrospectively. The Celect filter was placed in the inferior vena cava （IVC） at the inferior margin of the renal vein for 1 to 2 cm by puncturing the contralateral femoral vein or right internal jugular vein. The filter retrieve risk was assessed within 8 weeks after being implanted. The filters would be recovered through the right jugular vein when meeting the recovery standard, and the retrieve methods included conventional method, removing the guide wire into a loop trap method and guiding wire into a loop combined with balloon assisted method. The perforation of the vena cava was observed and the tilt angle of the filter was measured. The success rate of Celect filter retrieve was evaluated by the Kaplan-Meier method.ResultsCelect filters were successfully implanted in 120 patients with DVT. The IVC filters were implanted through femoral vein in 111 patients and 2 cases via right internal jugular vein. No complications, asymptomatic pulmonary embolism and related death was found in all patients. Twenty four patients did not reach the standard of filter retrieve, and were follow-uped. Ninety six cases were treated with Celect retrievable filter, among which, 93 cases were successfully recovered with the filter indwelling time ranging from 7 to 144 days and the median being 50 days. The failure of the filter retrieve occurred in 3 cases because of the serious tilt of the filter or the encapsulation of filter by inferior vena cava thrombus. Perforation of vena cava with no clinical symptoms occurred in 21 cases. Filter tilt was found in 35 cases, among which, 15 cases had inclined angle〉15 degrees or the recovery hook closed to the IVC wall. Thirteen cas

关 键 词：静脉血栓形成 肺栓塞 下腔静脉滤器 

分 类 号：R543.6[医药卫生—心血管疾病]