永久性下腔静脉滤器置入后相关并发症探讨

An evaluation on complications following the placement of permanent inferior vena cava filters

目的 探讨永久性下腔静脉滤器置入术后 ,相关并发症出现的原因和预防措施。 方法 1999年 12月～ 2 0 0 3年 6月 ,71例经彩色超声确诊下肢深静脉血栓 (deepveinthrombosis,DVT)置入永久性下腔静脉滤器 (venacavafilter ,VCF) ,其中急性下肢DVT 4 0例。术中常规行下腔静脉造影 ,确定下腔静脉和滤器释放途径静脉无血栓形成 ,将滤器放置平于肾静脉开口之下的下腔静脉。应用的滤器包括Titan -Greenfield滤器、Simon -Nitinol滤器、LGM滤器和TrapEase滤器。术后常规肝素和华法令抗凝。 结果 本组VCF均释放成功。术后 1～ 4 1个月随访 ,下腔静脉滤器放置部位血栓形成 2例 ,滤器倾斜 5例 ,倾斜角度 <15°。无滤器释放不全、穿孔、脱落、移位、出血和滤器释放通路血栓形成 ,无肺栓塞 (pulmonaryembolism ,PE)发生。 结论 不同类型滤器出现并发症的种类和发生率不同。滤器置入术前行彩色超声检查和术中下腔静脉造影 ,了解下腔静脉和VCF放置通路的情况 ,术中操作要点的实施 ,以及术后严格的抗凝治疗 ,是确保VCF放置成功、有效预防PE发生、避免或降低并发症的关键。

Objective To investigate the causes of and preventive measures for complications following the placement of permanent inferior vena cava filter (VCF). Methods A total of 71 patients, with proven diagnosis of lower limb deep vein thrombosis (DVT) by Doppler ultrasonography, underwent the placement of permanent VCF from December 1999 to June 2003. Forty of the patients were acute lower limb DVT. Cavography was performed routinely during operation to confirm no thrombosis in inferior vena cava and access veins. The insertion site of filters was below the renal veins. Four types of permanent VCF were used: Titan-Greenfield filters, Simon-Nitinol filters, LGM filters and TrapEase filters. Anticoagulation treatments were used in all the cases post-VCF insertion. Results The placement of VCFs was successfully accomplished in all the cases in the study. Follow- up observations for 1～41 months revealed vena cava thrombosis at the site of insertion in 2 cases and filter tilting less than 15° in 5 cases. There were no events of filter migration, filter fracture, vessel wall perforation, filter embolism or access vein thrombosis, as well as pulmonary embolism (PE). Conclusions Different types of VCFs have different kinds of complications and their incidence rates. Preoperative ultrasonography and intraoperative cavography should be performed to evaluate the vena cava and access vein. Careful surgical management and strict anticoagulation therapy are the key to the successful VCF placement and the prevention of PE or other complications.