回收钩贴壁的疑难性下腔静脉滤器取出技巧及应用

2015-10-27樊刚李波董莉

介入放射学杂志 2015年2期

关键词：方法

樊刚，李波，董莉

·临床研究Clinical research·

回收钩贴壁的疑难性下腔静脉滤器取出技巧及应用

樊刚，李波，董莉

目的探讨回收钩贴壁的疑难性下腔静脉滤器取出技巧及应用价值。方法近3年置入172例可回收下腔静脉滤器，在取出滤器的111例患者中，对回收钩贴壁的18例患者，采用鹅颈抓捕器-单个或多个加硬导丝辅助圈套加常规套取法。结果18例常规取出法失败的病例，均成功取出。结论对回收钩贴壁的疑难性下腔静脉滤器，采用鹅颈抓捕器-单个或多个加硬导丝辅助圈套加常规套取法取出，损伤小，操作简单易行，值得推广应用。

肺栓塞；下腔静脉滤器；回收钩贴壁；加硬导丝辅助

【Abstract】ObjectiveTo explore the technical skill of retrieving the inferior vena cava filter that its recycling hook is affixed to the venous wall，and to discuss the clinical application of this technique. MethodsIn recent three years，retrievable inferior vena cava filter was placed in a total of 172 cases at authors'hospital.Of the 111 cases whose filter was retrieved，the filter's recycling hook was affixed to the venous wall in 18.The retrieval of filter was difficult in these 18 patients.One or several gooseneck protectors together with hardening wire-assisted ring and conventional retrieving method were employed to retrieve the filters.ResultsWith the help of gooseneck protector and hardening wire-assisted ring，the filter was successfully retrieved in all the 18 patients after the failure of conventional retrieving method.Conclusion For the retrieval of filter with its recycling hook being affixed to the inferior vena cava wall，combination use of one or several gooseneck protectors together with hardening wire-assisted ring can be very effective.This technique is less invasive and technically-simple.Therefore，this technique should be recommended in clinical practice.（J Intervent Radiol，2015，24：158-160）

【Key words】pulmonary embolism；inferior vena cava filter；recycling hook attached to wall；hardening wire assistance

肺动脉栓塞（PE）大多数是由于下肢及盆腔的深部静脉血栓脱落造成的，是常见的致死原因之一。因其缺乏典型的临床症状和特异性的检查、检测指标，临床不容易诊断。因此，预防治疗尤为重要。下腔静脉（IVC）滤器（inferior vena cava filter，IVCF）是为预防IVC系统栓子脱落引起PE而设计的一种装置，但滤器长期放置可引起并发症。目前，发展最快的滤器为选择性可回收滤器，由于其远期并发症较少，在临床上应用愈来愈广泛，但也有一部分可回收滤器回收失败。失败的主要原因是滤器倾斜、回收钩紧贴在血管壁上（即回收钩贴壁）。我科近3年共收治IVCF回收钩贴壁患者18例，现总结如下。