临床研究(Clinical Research)

复杂可回收下腔静脉滤器回收的方法和技巧:附29例分析

Published at: 2017年第26卷第6期

孙振阳 1 , 芮清峰 1
1 安徽省阜阳市第二人民医院 血管外科,安徽 阜阳 236015
通讯作者 振阳 孙 Email: 13966805312@163.com
DOI: 10.3978/j.issn.1005-6947.10.3978/j.issn.1005-6947.2017.06.013
基金:

摘要

目的:探讨复杂可回收下腔静脉滤器回收的方法和技巧。方法:回顾性分析29例复杂滤器回收的下肢深静脉血栓形成患者资料。所有患者均先行造影了解滤器情况;对回收钩贴壁患者,分别采用猪尾管支撑技术、导丝成攀及搅拌技术、双向导丝技术、鹅颈抓捕器与成攀导丝结合技术等回收;对下腔静脉继发血栓患者,必要时再次新置滤器1枚,经溶栓、吸栓处理后,将滤器回收。结果:成功回收24例,1例患者滤器未能成功回收,4例放弃,回收率83.9%。术中无下腔静脉破裂出血、肺栓塞并发症,取出滤器完整、无折断现象。至少随访半年,下腔静脉血流通畅、无血栓形成,腹腔无明显积液。结论:导管、导丝及鹅颈抓捕器辅助,溶栓、吸栓等方法可增加复杂可回收下腔静脉滤器回收率,可减少长期留置引起相关并发症。


Methods and technical skills for complicated filter retrieval of retrievable inferior vena cava filter: an analysis of 29 cases

Abstract

Objective: To investigate the methods and technical skills for complicated filter retrieval of the retrievable inferior vena cava filter (IVCF). Methods: The data of 29 patients with lower extremity deep vein thrombosis (DVT) undergoing complicated filter retrieval were analyzed. All patients underwent venography first to assess the status of the filter. In patients with the retrieval hook engaged to the vessel wall, IVCF retrieval was performed by using pigtail catheter assistance, guidewire looping and stirring techniques, bidirectional guidewire, and gooseneck snare catheter combined with guidewire looping, respectively; in those with thrombus in the inferior vena cava, a new filter was placed into the inferior vena if necessary, and then the filters were retrieved after thrombolysis and thrombus extraction. Results: IVCF retrieval was successfully performed in 24 patients, was unsucessful in one patient and was abandoned in 4 patients, and the retrieval rate was 83.9%. No complications such as inferior vena cava rupture and pulmonary embolism occurred during operation. The retrieved filters were noted to be intact with no fractures. Follow-up was conducted for a period of at least 6 months after treatment, and the inferior vena cavae were patent, with no thrombus formation and no obvious fluid collections in the abdominal cavity. Conclusion: The methods of use of catheter, guidewire and gooseneck snare assistance, as well as thrombolysis and thrombus extraction can increase the retrieval rate of the complicated retrievable IVCF retrieval, and thereby, reduced complications caused by long-term filter retention.


comments powered by Disqus

全文

引用

引用本文: 振阳 孙, 清峰 芮. 复杂可回收下腔静脉滤器回收的方法和技巧:附29例分析 [J]. 中国普通外科杂志, 2017, 26(6): 752-757.
Cite this article as: SUN Zhenyang, RUI Qingfeng . Methods and technical skills for complicated filter retrieval of retrievable inferior vena cava filter: an analysis of 29 cases [J]. Chin J Gen Surg, 2017, 26(6): 752-757.