导管抽吸联合滤器保护治疗下腔静脉滤器血栓形成初步探讨

Preliminary discussion on the catheter aspiration thrombectomy combined with filter protection for the treatment of inferior vena cava filiter thrombosis

目的评估导管抽吸联合滤器保护治疗下腔静脉滤器血栓形成(IVCFT)的安全性和有效性。方法回顾性分析2017年6月至2019年11月东南大学附属中大医院收治的12例IVCFT患者临床资料。下肢静脉超声和肺动脉CTA明确下肢深静脉血栓形成(DVT)和肺栓塞(PE)。健侧股静脉入路行下腔静脉滤器置入、导管抽吸清除血栓,并逐一取出原滤器和保护滤器。术后予以抗凝治疗,观察患者症状、体征缓解情况,记录手术技术成功率、临床成功率、下腔静脉通畅情况、血栓清除情况及PE等并发症。结果12例下肢DVT伴PE患者均成功置入下腔静脉滤器保护,抗凝治疗后患肢水肿缓解10例,未缓解2例,健侧下肢肿胀3例。下腔静脉造影显示血栓形成在滤器下方6例,滤器内12例,滤器上方2例,无一例滤器内、上方、下方均有血栓。12例患者均成功完成导管抽吸,清除较多陈旧血栓;12枚原滤器和12枚保护滤器成功取出,取出成功率100%。术后造影显示下腔静脉通畅,下腔静脉残余附壁血栓7例。术中患者均无肺部症状和体征,术后2 d出现症状性PE 1例,临床成功率91.7%。结论导管抽吸取栓联合滤器保护治疗IVCFT安全有效,有助于提高IVCFT患者滤器取出率和取出安全性。

Objective To evaluate the safety and efficacy of catheter aspiration thrombectomy combined with filter protection in the treatment of inferior vena cava filter thrombosis(IVCFT).Methods The clinical data of 12 patients with IVCFT,who admitted to the Affiliated Zhongda Hospitall of Southeast University of China between June 2017 and November 2019,were retrospectively analyzed.Venous ultrasound and pulmonary artery CTA confirmed the diagnosis of lower limb deep venous thrombosis(DVT)associated with pulmonary embolism(PE).Via femoral vein approach of healthy side,the implantation of IVC filter and catheter aspiration thrombectomy were carried out,and the previously implanted filter and the protection filter implanted in this procedure were retrieved one by one.Postoperative anticoagulant therapy was employed.The improvement of clinical symptoms and signs,the technical success rate,the clinical curative rate,the patency of inferior vena cava,the thrombus removal rate and the complications such as PE were recorded.Results Successful implantation of inferior vena cava filter was accomplished in all 12 patients with DVT associated with PE.After anticoagulation treatment,the edema of the affected limb was alleviated in 10 patients,the edema was not alleviated in 2 patients,and edema of the healthy limb was seen in 3 patients.Venography of inferior vena cava showed that the thrombosis was located below the filter in 6 patients,within the filter in 12 patients,and above the filter in 2 patients.No patient had thrombosis that was simultaneously located at above mentioned three sites.In all the 12 patients catheter aspiration thrombectomy was successfully carried out and a lot of old thrombus was removed.The 12 previously implanted filters and the 12 protection filters implanted in the therapeutic procedure were successfully retrieved,the success rate of filter removal was 100%.Postoperative venography showed that inferior vena cava was unobstructed,and residual mural thrombus was seen in 7 patients.During the operation no patient had pulmonary symptoms or signs,and two days after treatment one patient developed symptomatic PE,the clinical success rate was 91.7%.Conclusion For the treatment of IVCFT,catheter aspiration thrombectomy combined with filter protection is safe and effective.The filter protection technique can improve the filter retrieval rate and the procedural safety.(J Intervent Radiol,2021,30:703-706)