腔内技术回收倾斜贴壁下腔静脉滤器31例分析  

Endovascular retrieval of tilted and adhered inferior vena cava filters:analysis of 31 patients

作　　者：聂梦林 汪海洋[1] 付健[1] 刘凡运 孙建明[1] NIE Menglin;WANG Haiyang;FU Jian;LIU Fanyun;SUN Jianming(Department of Abdominal Wall,Hernia and Vascular Surgery,Second Affiliated Hospital,Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第二医院血管疝腹壁外科,400010

出　　处：《介入放射学杂志》2022年第5期488-494,共7页Journal of Interventional Radiology

基　　金：重庆市医学科学计划项目(20142037)。

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。Objective To summarize the clinical experience of retrieving the tilted and adhered retrievable inferior vena cava filter(IVCF)by using balloon-assisted pushing catheter displacement technique and wire-looping-snare technique,and to discuss its manipulation skills.Methods The clinical data of 31 patients with tilted,adhered and difficult-removed IVCF,who were admitted to the Second Affiliated Hospital of Chongqing Medical University of China to receive treatment between March 2017 and September 2020,were retrospectively analyzed.The patients included 15 males and 16 females with a mean age of(57.9±16.4)years.The indwelling time of IVCF was 7-693 days.During the operation,balloon-assisted pushing catheter displacement technique and wire-looping-snare technique were used to relieve the wall-adhered state of the catheter hook,then to remove IVCF.The perioperative complications were recorded and the patency of inferior vena cava(IVC)during follow-up period was checked.Results Successful retrieval of tilted and adhered IVCF was accomplished in all the 31 patients.The retrieved IVCFs included Denali(n=3),OptEase(n=20),Celect(n=6)and Günther Tulip(n=2).Balloon-assisted pushing catheter displacement technique was adopted in 12 patients,and wire-looping-snare technique was employed in 19 patients,including single wire-looping-snare technique(n=6),same directional dual wire-looping-snare technique(n=9)and bidirectional dual wire-looping-snare technique(n=4).The time spent for the surgery was 35-157 minutes.The incidence of procedure-related complications was 9.68%(3/31),no severe complications occurred.The patients were followed up for 4-48 months,with a mean of(21.39±10.62)months.One patient died of brain glioma,and the patency rate of IVC was 100%.Conclusion The balloon-assisted pushing catheter displacement technique and wire-looping-snare technique can effectively remove the tilted and adhered retrievable IVCF,and improve the retrieval rate of difficult-removed IVCF,therefore,these techniques are worthy promoting th

关 键 词：下腔静脉滤器 倾斜贴壁 回收方法 肺栓塞 

分 类 号：R654.3[医药卫生—外科学]