困难滤器回收策略

The technical strategy for retrieving difficult-removed indwelling inferior vena cava filtersy

下腔静脉滤器作为预防肺栓塞的重要手段,已得到广泛应用。随着滤器置入数量逐年增加,滤器回收过程中暴露的问题逐渐引起关注。不仅滤器回收率偏低,而且长期留置容易诱发各种滤器相关并发症,滤器倾斜和超期置入等原因造成的回收困难也增加手术操作的复杂性和失败率。术者有必要熟悉滤器的特点,掌握多种回收技术,以提高滤器回收的成功率。该文根据现有滤器类型和特点,分析了造成滤器回收困难的常见原因,系统总结了导丝指引技术、球囊扩张技术、导管修正技术、导丝成襻技术、支气管钳或活检钳技术、准分子激光技术、圈套器切割技术以及一些非腔内手术方式等多种滤器回收策略。

As an important means to prevent pulmonary embolism, implantation of inferior vena cava filters has been widely used in clinical practice. With the increasing number of implanted filters year by year,the problems encountered in the filter retrieval procedure have gradually attracted clinicians’ attention. Not only the retrieval rate of filters is low, but also the long-term indwelling filters tend to induce various filterrelated complications. The difficulties of filter retrieval are caused by filter tilting, over-term retention in the body and other reasons, which increase the complexity and failure rate of the surgical operation. It is necessary for the operator to be familiar with the characteristics of the filter and to master a variety of techniques so as to improve the success rate of the filter retrieval. Based on the types and characteristics of available filters in current clinical practice, this paper analyzes the common reasons that may cause difficulties in retrieving filters in detail, and systematically summarizes a variety of filter retrieval techniques including wire-guiding technique, balloon dilatation technique, catheter modification technique, wire-loop technique, bronchial forceps or biopsy forceps technique, excimer laser technique, snare cutting technique,and some non-endovascular surgical methods.(J Intervent Radiol, 2022, 31: 934-940)