经颈股静脉双入路取出回收钩贴壁的OptEase下腔静脉滤器

The Removal of Adhesive OptEase Filter by Using Jugular and Femoral Vein Dual-Access Technique

目的评价经颈股静脉双入路取出回收钩贴壁的OptEase下腔静脉滤器的安全性及有效性。方法2009年1月至2013年1月间，对5例常规圈套技术无法成功取出的OptEase腔静脉滤器行经颈股静脉双入路法取出。具体过程如下：下腔静脉造影证实滤器回收钩贴壁而常规法无法取出后，行右侧颈静脉入路，鹅颈抓捕器与导丝从滤器不同网眼进入滤器并抓捕导丝软头拉出体外。将导丝两端套入8F导引导管内并将导引导管送至滤器近心端收紧，前推或后拉导引导管使滤器回收钩与下腔静脉壁分离，同时经股静脉入路常规法套取滤器回收钩并回收滤器。术后即刻造影及6～12个月的临床随访观察有无出血或血栓形成。结果5例经颈股静脉双人路取出回收钩贴壁的OptEase下腔静脉滤器均获成功，其中1例出现滤器金属丝焊接点断裂及髂静脉部分血栓形成。术后即刻血管造影及临床随访6～12个月未见出血及下腔静脉血栓形成等并发症发生。结论经颈股静脉双入路取出回收钩贴壁的OptEase下腔静脉滤器安全有效，可提高下腔静脉滤器回收成功率。

Objective To evaluate the safety and efficacy of retrieving adhesive OptEase filter by using jugular and fem- oral vein dual-access technique. Methods From January 2009 to January 2013, standard retrieval techniques failed to catch the adhesive OptEase filter in 5 patients, who received the retrieval from jugular and femoral vein dual-access tech- nique. The specific procedure was as follows. After angiography of inferior vena cava （IVC） confirming that the filter re- trieval hook adhered to IVC wall, the jugular vein access was created. Both the wire and snare were introduced into the fil- ter from different meshes, and then the wire was grasped and withdrawn into the sheath. The sheath was advanced to the fil- ter apex and ＂to or fro＂ movements made the adhesion separated. Finally, the retrieval hook was grasped and the filter was retrieved. After the procedure, immediate angiography and clinical follow-up （6 -12 months） revealed whether there were bleeding and thrombosis or not. Results The removal of adhesive OptEase filter by using jugular and femoral vein dual- access technique was successful in all 5 patients （ 100% ）. Metal wire fracture of the filter and partial iliac vein thrombosis occurred in one patient. There were no complications at 6 - 12 months clinical follow up. Conclusion The removal of ad- hesive OptEase filter by using jugular and femoral vein dual-access technique is safe and effective, and it can markedly im- prove the retrieval success rate.