Retrievable Inferior Vena Cava Filters in Trauma Patients: Prevalence and Management of Thrombus Within the Filter

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• 作者：Y. Pan ; J. Zhao ; ^{junnzhao@126.com} ; J. Mei ; M. Shao ; J. Zhang ; H. Wu
• 关键词：Deep vein thrombosis ; Caval filters ; Trauma ; Pulmonary embolism ; Thrombolysis
• 刊名：European Journal of Vascular and Endovascular Surgery
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：52
• 期：6
• 页码：830-837
• 全文大小：1210 K
• 卷排序：52

文摘

The incidence of thrombus was investigated within retrievable filters placed in trauma patients with confirmed DVT at the time of retrieval and the optimal treatment for this clinical scenario was assessed. A technique called “filter retrieval with manual negative pressure aspiration thrombectomy” for management of filter thrombus was introduced and assessed.MethodsThe retrievable filters referred for retrieval between January 2008 and December 2015 were retrospectively reviewed to determine the incidence of filter thrombus on a pre-retrieval cavogram. The clinical outcomes of different managements for thrombus within filters were recorded and analyzed.ResultsDuring the study 764 patients having Aegisy Filters implanted were referred for filter removal, from which 236 cases (134 male patients, mean age 50.2 years) of thrombus within the filter were observed on initial pre-retrieval IVC venogram 12–39 days after insertion (average 16.9 days). The incidence of infra-filter thrombus was 30.9%, and complete occlusion of the filter bearing IVC was seen in 2.4% (18) of cases. Retrieval was attempted in all 121 cases with small clots using a regular snare and sheath technique, and was successful in 120. A total of 116 cases with massive thrombus and IVC occlusion by thrombus were treated by CDT and/or the new retrieval technique. Overall, 213 cases (90.3%) of thrombus in the filter were removed successfully without PE.ConclusionsA small thrombus within the filter can be safely removed without additional management. CDT for reduction of the clot burden in filters was effective and safe. Filter retrieval with manual negative pressure aspiration thrombectomy seemed reasonable and valuable for management of massive thrombus within filters in some patients. Full assessment of the value and safety of this technique requires additional studies.