Perforation of the IVC: Rule Rather Than Exception After Longer Indwelling Times for the Gunther Tulip and Celect Retrievable Filters
Perforation of the IVC: Rule Rather Than Exception After Longer Indwelling Times for the Gunther Tulip and Celect Retrievable Filters
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DOI：
10.1007/s00270-011-0151-9
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发表时间：
2012-04-01
影响因子：
2.9
通讯作者：
Kerlan, Robert K.
中科院分区：
文献类型：
--
作者：
Durack, Jeremy C.;Westphalen, Antonio C.;Kerlan, Robert K.
目的本研究旨在评估腔静脉穿孔的发生率，幅度，并对可回收性的影响，Gunther Tulip和Celect圆锥形下腔静脉（IVC）过滤器的计算机断层扫描（CT imaging.Methods）的Gunther Tulip和Celect IVC过滤器放置在2007年7月至2009年5月的医疗记录。在置入的272件IVC滤器中，50件（Gunther Tulip 23件，46%; Celect 27件，54%）在因与滤器无关的原因进行的随访腹部CT扫描中进行了回顾性评估。通过计算机断层扫描检查滤器穿透腔静脉壁、倾斜或腔静脉周围组织损伤的证据。程序记录进行了审查，以确定是否IVC过滤器检索尝试和successful.Results穿孔的至少一个过滤器组件通过IVC观察到43 50（86%）过滤器的CT扫描1和880天之间获得的过滤器放置后。71天后成像的所有滤器均显示一定程度的腔静脉穿孔，通常为渐进性过程。在50件滤器中的20件（40%）中观察到滤器倾斜，并且所有倾斜的滤器也显示腔静脉穿孔。结论可回收Gunther Tulip和Celect下腔静脉滤器留置时间长，易造成腔静脉穿孔。尽管文献中很少报告，但IVC滤器组件破坏腔静脉的临床后遗症可能很严重。我们提倡在有临床指征时尽早回收滤器，并在所有随访成像研究中增加对IVC滤器外观的关注。
Purpose This study was designed to assess the incidence, magnitude, and impact upon retrievability of vena caval perforation by Gunther Tulip and Celect conical inferior vena cava (IVC) filters on computed tomographic (CT) imaging.Methods Gunther Tulip and Celect IVC filters placed between July 2007 and May 2009 were identified from medical records. Of 272 IVC filters placed, 50 (23 Gunther Tulip, 46%; 27 Celect, 54%) were retrospectively assessed on follow-up abdominal CT scans performed for reasons unrelated to the filter. Computed tomography scans were examined for evidence of filter perforation through the vena caval wall, tilt, or pericaval tissue injury. Procedure records were reviewed to determine whether IVC filter retrieval was attempted and successful.Results Perforation of at least one filter component through the IVC was observed in 43 of 50 (86%) filters on CT scans obtained between 1 and 880 days after filter placement. All filters imaged after 71 days showed some degree of vena caval perforation, often as a progressive process. Filter tilt was seen in 20 of 50 (40%) filters, and all tilted filters also demonstrated vena caval perforation. Transjugular removal was attempted in 12 of 50 (24%) filters and was successful in 11 of 12 (92%).Conclusions Longer indwelling times usually result in vena caval perforation by retrievable Gunther Tulip and Celect IVC filters. Although infrequently reported in the literature, clinical sequelae from IVC filter components breaching the vena cava can be significant. We advocate filter retrieval as early as clinically indicated and increased attention to the appearance of IVC filters on all follow-up imaging studies.