The Günther Tulip retrievable filter: prolonged temporary filtration by repositioning within the inferior vena cava.
The Günther Tulip retrievable filter: prolonged temporary filtration by repositioning within the inferior vena cava.
复制标题
Günther Tulip 可回收过滤器：通过在下腔静脉内重新定位来延长临时过滤时间。
DOI：
10.1097/01.rvi.0000092910.31640.1e
复制
发表时间：
2003
期刊：
影响因子：
--
通讯作者：
R. Alfonso
中科院分区：
文献类型：
--
作者：
M. D. de Gregorio;P. Gamboa;M. Gimeno;B. Madariaga;R. Tobío;M. Herrera;J. Medrano;A. Mainar;R. Alfonso
目的
报告使用可回收的 Günther Tulip 过滤器 (GTF) 作为临时腔室过滤手段来预防肺栓塞 (PE) 的经验，并使用将过滤器停留时间延长超过 14 天的技术。
材料和方法
87 名患者体内植入了 88 个 GTF。放置 GTF 的目的是在初次植入后 14 天内取出所有患者。 87 名患者中有 23 名 (26%) 需要将临时腔静脉滤过延长至超过建议的 14 天。这是通过使用来自右颈内静脉的经皮技术成功实现的，在最终移除装置之前，将过滤器重新定位到下腔静脉（IVC）内的不同位置。
结果
在 87 名患者体内植入的 88 个 GTF 中，70 个被成功取出，18 个永久留在原位。初次植入后，46 名患者的 47 个过滤器被移除，无需在 IVC 内经皮重新定位以延长停留时间（平均停留时间，13 天）。在 23 名需要在 IVC 内重新定位 23 个 GTF 以延长临时腔静脉滤过的患者中，平均停留时间为 34.8 天；尝试取滤器的患者中，平均重新定位手术次数为 1.5 次，平均重新定位手术间隔时间为 13.8 天，平均透视时间为 4.4 分钟。一名患者在两次不同的情况下接受了两次 GTF 的放置和随后的移除，以预防 PE 的围手术期。部署后，没有过滤器被错放在意外位置或相对于主腔轴倾斜（> 15 度）。在一名患者中，GTF 在初次植入后 16 天永久固定在 IVC 中，并且无法经皮取出。九名患者有轻度或中度颈部血肿。一名患者在插入过滤器 2 个月后再次出现无症状 PE。
结论
大多数患者在移除装置之前可以达到 14 天的停留时间。通过颈静脉入路在 IVC 内对装置进行经皮重新定位，可以安全、轻松地将停留时间延长到 14 天以上。
PURPOSE
To report experience with the retrievable Günther Tulip filter (GTF) as a means of temporary caval filtration for the prevention of pulmonary embolism (PE) with use of a technique that prolongs filter dwell time beyond 14 days.
MATERIALS AND METHODS
Eighty-eight GTFs were implanted in 87 patients. The GTFs were placed with the intention of retrieval in all patients within 14 days after initial implantation. In 23 of the 87 patients (26%), there was a need to prolong temporary caval filtration beyond the recommended period of 14 days. This was successfully achieved with use of percutaneous techniques from the right internal jugular vein whereby the filter was repositioned to a different location within the inferior vena cava (IVC) before definitive device removal.
RESULTS
Of 88 GTFs implanted in 87 patients, 70 were successfully retrieved and 18 were left in place permanently. Forty-seven filters in 46 patients were removed after initial implantation with no need for percutaneous repositioning within the IVC to prolong dwell time (mean dwell time, 13 days). In the 23 patients who required repositioning of 23 GTFs within the IVC to prolong temporary caval filtration, the mean dwell time was 34.8 days; the mean number of repositioning procedures was 1.5, the mean time between repositioning procedures was 13.8 days, and the mean fluoroscopy time was 4.4 minutes in patients in whom filter retrieval was attempted. One patient underwent placement and subsequent removal of the GTF twice for perioperative prophylaxis against PE on two separate occasions. No filters were misplaced in an unintended location or tilted (>15 degrees ) in relation to the main caval axis after deployment. In one patient, a GTF became permanently fixed in the IVC 16 days after initial implantation and could not be removed percutaneously. Nine patients had mild or moderate-sized cervical hematomas. One patient had recurrent asymptomatic PE 2 months after filter insertion.
CONCLUSION
Dwell times of 14 days can be achieved in most patients before device removal. Prolongation of the dwell time beyond 14 days can be safely and easily achieved by performing percutaneous repositioning of the device within the IVC via a jugular approach.