改良wire-loop技术在严重倾斜下腔静脉滤器回收中的应用效果

Effect analysis of the modified wire-loop snare technique in retrieving severely tilted inferior vena cava filters

目的探讨改良wire-loop技术回收严重倾斜下腔静脉滤器的应用效果。方法回顾性分析2017年11月至2022年4月在青岛大学附属医院、青岛市第八人民医院或青岛市即墨区中医医院采用改良wire-loop技术回收下腔静脉滤器的18例患者的资料,男性12例,女性6例,年龄(62.1±13.1)岁(范围:29~78岁)。置入的滤器包括纺锤形滤器(OptEase 7例、Aegisy 2例)和伞形滤器(Celect 6例、Denali 3例)。术前CT血管造影和术中数字减影血管造影检查结果显示滤器严重倾斜、回收钩贴壁并被增生内膜覆盖。采用改良wire-loop技术分别经股静脉和颈静脉入路回收纺锤形和伞形滤器。穿刺成功后,置入回收长鞘,经长鞘置入4 F(1 F≈0.33 mm)单弯导管和圈套器;同时置入5 F猪尾导管,引导0.035英寸的软交换导丝(长260 cm),穿过滤器顶端返回;圈套器抓捕软交换导丝头端,将导丝头端牵出体外。循交换导丝头端置入4 F单弯导管至滤器顶端,形成以单弯导管和猪尾导管为支撑的wire-loop。体外固定导丝头端和尾端,在双导管支撑下,向前推送长鞘切割增生内膜,并将回收钩拽离腔静脉壁,回收滤器。结果17例滤器成功取出,手术时间(25.5±8.7)min(范围:15~45 min),无并发症发生。1例Celect滤器回收钩穿出腔静脉壁,wire-loop无法将滤器回收钩拽回腔静脉内,后经开腹手术取出滤器。结论改良wire-loop技术可用于回收严重倾斜的可回收纺锤形和伞形滤器,当滤器与下腔静脉壁粘连严重时,亦可取得较好效果。

Objective To examine the application effect of the modified wire-loop snare technique in retrieving severely tilted inferior vena cava filters(IVCF).Methods The clinical data of 18 patients(12 males and 6 females,aged(62.1±13.1)years(range:29 to 78 years))who underwent the modified wire-loop snare technique to retrieve IVCF at the Affiliated Hospital of Qingdao University,Qingdao Eighth People′s Hospital,and Jimo District Hospital of Traditional Chinese Medicine from November 2017 to April 2022 were retrospectively analyzed.The applied filters included drum-type filters(OptEase in 7 cases,Aegisy in 2 cases)and conical filters(Celect in 6 cases and Denali in 3 cases).Preoperative CT angiography and intraoperative digital subtraction angiography showed that the filter was severely tilted and the hook was covered by hyperplastic intima of the vena cave vein.A modified wire-loop snare technique was used to retrieve drum-type filters and conical filters via femoral and jugular vein approaches,respectively.After successful puncture,the long sheath was placed,the 4 F(1 F≈0.33 mm)vertebral catheter and a snare were inserted through the long sheath,and the 5 F pigtail catheter was inserted simultaneously to guide a 0.035 inch soft guide-wire(260 cm in length)to pass through the top of the filter and turning back.The tip of the soft guide-wire was snared by the vertebral catheter and pulled out of the sheath.The 4 F vertebral catheter was inserted following the tip of the guide-wire to form a wire-loop using the vertebral catheter and the pigtail catheter.After fixing the tip and tail of the soft guide-wire in vitro,the long sheath was pushed forward to cut the hyperplastic intima and the hook was pulled away from the vena cava wall to retrieve the filter under the support of two catheters.Results The filters were successfully retrieved in 17 cases,the operation time was(25.5±8.7)minutes(range:15 to 45 minutes),no complication occured.The hook of one filter(Celect)penetrated out of the vena vava wall and the wire-loop could not pull the hook back into the vena cava.Then the filter was removed by laparotomy.Conclusion The modified wire-loop snare technique could retrieve the severely tilted retrivable drum-type filters and conical filters,even when serve adhesion exists between the filter and the vena cava wall.