双下腔静脉畸形合并下肢深静脉血栓患者滤器植入方案的探讨

Insertion of double inferior vena cava filter in patients with deep venous thromboembolism

目的探讨双下腔静脉合并下肢深静脉血栓的特点、诊断治疗及合理的滤器植入方案。方法北京积水潭医院血管外科2006年7月至2012年6月共收治双下腔静脉畸形合并下肢深静脉血栓患者7例，回顾性分析其滤器植入的适应证、植入滤器类型以及转归。结果本组7例均有明确的滤器植入指征，其中临时滤器1例，可回收5例，永久滤器1例，临时滤器1例及可回收滤器4例取出，1例因滤器下血栓过多转换为永久。随访1—72个月，术后口服抗凝药物，无复发及肺栓塞病例发生。结论双下腔静脉合并下肢深静脉血栓发生率低，无临床特异性易于忽视。滤器植入的位置不合适可能是滤器植入后致死性肺栓塞的原因之一，反之于合理位置可获得满意的拦截效果。

Objective To explore the characteristic, diagnosis and treatment of deep venous thromboembolism （DVT） patients with congenital double inferior vena eava. Methods Retrospective analyses were conducted for the indications, filter types and efficacies of vena cava filter insertion in 7 hospitalized DVT patients with congenital double inferior vena at our hospital from 2006 to 2012. Results All of them had definite indications for vena cava filter insertion. Temporary and permanent vena caval filters were implanted in one subject while retrievable vena caval filters in another five subjects. One retrievable filter was replaced by a permanent filter due to excessive thrombus entrapped in filter. Other temporary or retrievable filters were extracted successfully. All subjects were prescribed postoperatively with oral anticoagulants. The follow-up period was 1 -72 months. No recurrent DVT or pulmonary embolism occurred. Conclusion The complications of double inferior vena eava in DVT subjects are often misdiaguosed due to its low incidence rate and a lack of clinical manifestations. Fatal pulmonary embolism after implantation may be due to an inappropriate location of filter implant. If implanted in a proper position, satisfactory outcomes ensue.