Novel Techniques for Removal of Embedded Inferior Vena Cava (IVC) Filters Reduce Risk of Long-Term Complications
With the loop snare forcefully closed around the filter legs, the metal guide is pulled back with the filter into the sheath. The captured filter legs fold in half and the filter apex begins to invert (arrow).
可检索的IVC过滤器用于暂时治疗患者进行肺栓塞（PE）预防，包括下LIMB手术后面对延长床质的患者。一旦没有立即出现血栓栓塞的风险，医疗管理取代心血管干预措施，就可以拆除设备以防止长期并发症的风险。—并发症可能包括滤波器骨折，栓塞，腔渗透，具有讽刺意味的是，具有讽刺意味的是，具有讽刺意味过滤过滤后的经常性深静脉血栓形成。（常规的患者随访对于最佳结果至关重要，以及定期图表的审查和与患者联系的多次尝试。〜下腔静脉过滤器，尤其是数月或几年的腔静脉过滤器，可以嵌入在周围的组织中，即使是最复杂的IVC滤波器切除案例，新型技术也常常可以成功。
Frank Lynch, MD, clinical professor of radiology, surgery, and medicine atPenn State Health Milton S. Hershey Medical Center, has performed more than 1,500 filter retrieval procedures. Most IVC filter removals require capture of the filter apex. When the filter is severely tilted and the apex is in contact with the caval wall and covered by an endothelial cap, a significant technical challenge exists.² One novel technique is a standard angioplasty balloon to free the apex of severely tilted filters with endothelial apical caps.² A more common, yet still complex, procedure is a modified loop snare technique in which an angled surgical wire and gooseneck snare form an in situ snare.³ The filter is withdrawn into the sheath folded over, and the filter apex inverted and pulled free from the caval wall.³
These techniques were developed in response to the rapid increase of retrievable IVC filters. “In 1999 when retrievable filters were approved in the United States, their use exploded,” says Lynch. “For example, in 2012, more than 250,000 devices were placed, up from 10,000 just a few years before. However, national retrieval rates remained low, just 15 to 20 percent.” In 2010, the FDA issued a statement strongly urging improved follow-up with these patients, many of whom began to suffer long-term complications, a position they reiterated in 2012. The FDA also challenged device manufacturers to provide additional long-term clinical data to justify the use of their retrievable IVC filters. In the future, Lynch hopes these data and advanced techniques will dispel the prevailing belief that IVC filters cannot be safely removed.
Frank C. Lynch, MD
放射学，手术和医学临床教授
Phone:717-531-5418
Email:fcl3@psu.edu
Fellowship:Cardiovascular and interventional radiology, Johns Hopkins University Hospital, Baltimore, Maryland
Residency:放射学，诊断，马里兰州巴尔的摩约翰·霍普金斯大学医院
Medical School:宾夕法尼亚州宾夕法尼亚州宾夕法尼亚州立医学院
Connect with Frank C. Lynch, MD, on Doximity
参考
- Lynch FC.A Method for Following Patients with Retrievable Inferior Vena Cava Filters: Results and Lessons Learned from the First 1,100 Patients.J Vasc IntervRadiol 2011;22:1507–1512.
- Lynch FC.Balloon-assisted切除倾斜下腔Cava Filters with Embedded Tips.J Vasc IntervRadiol 2009; 20:1210–1214.
- Lynch FC.Modified Loop Snare Technique for the Removal of Bard Recovery, G2, G2 Express, and Eclipse Inferior Vena Cava Filters.J Vasc IntervRadiol 2012; 23:687–690.