上腔静脉可回收滤器的置入六例

The implantation of retrievable superior vena cava filter:report of 6 cases

目的探讨上腔静脉内临时滤器置入术的操作技术和临床意义。方法经彩色多普勒超声及静脉造影证实的颈静脉和上肢深静脉血栓患者6例,在DSA机下实施上腔静脉内临时滤器置入术。患者均为恶性肿瘤患者。静脉血栓的病因3例为中央静脉插管所致,3例为恶性肿瘤压迫侵犯。滤器置入经右侧股静脉途径,行上腔静脉造影后,经导丝引导将滤器释放系统送入上腔静脉,定位于左右头臂静脉汇合稍下方释放滤器,滤器回收时也采用股静脉途径。结果所有患者均成功置入滤器,术中未发现移位、脱落现象。2例患者分别于术后15、29 d经彩色多普勒超声复查血栓消失,经右侧股静脉途径回收滤器,另外4例患者不愿取出,一直随访。在随访期间有5例患者由于肿瘤进展等与滤器置入无关的原因分别在2～16个月内死亡,但均没有出现上腔静脉血栓或肺栓塞的事件和滤器的脱落、穿孔等并发症。结论上腔静脉可回收滤器置入术操作简单,术后可回收,是一种安全可行的方法,有助于预防颈静脉或上肢深静脉血栓脱落造成的肺栓塞和与滤器长期置入有关的并发症。

Objective To discuss the techniques and clinical value of the placement of retrievable superior vena cava （SVC） filter. Methods Under DSA guidance, the placement of retrievable SVC filter was performed in 6 patients with jugular vein thrombosis or upper extremity deep vein thrombosis. The diagnoses were proved by colour Doppler ultrasound and venography. All patients were affected with malignancy. The venous thrombosis was caused by the insertion of PICC （n = 3） or by the compression or invasion of tumor （n = 3）. Catheterization was carried out via the right femoral vein. After venography of SVC, the delivery system of SVC filter was inserted into SVC, and the filter was placed at the site slightly below the confluence of brachiocephalic veins. The retrieval of the filter was performed through the femoral vein route. Results The retrievable filter was successfully placed in SVC in all cases. No dislodgement or migration of the filters occurred during the procedure. The filter was successfully retrieved via the femoral vein in two cases at i5 days and 28 days after the placement respectively as color Doppler ultrasound showed that the venous thrombus disappeared. The remaining 4 patients were unwilling to take the procedure of filter retrieval. All the patients were followed up periodically. During the follow-up course, five patients died of some causes （deterioration of the tumor, etc. ） unrelated to filter placement in 2 - 16 months after the procedure. No serious complications such as SVC thrombosis, pulmonary embolism, migration of filter, vascular perforation, etc. occurred. Conclusion The placement of retrievable SVC filter is technically simple, clinically feasible and safe, and the filter can be retrieved easily. This technique is very useful for preventing both the pulmonary embolism caused by jugular vein or upper extremity deep vein thrombosis and the complications related to long-term retention of the filter within SVC.