腔静脉滤器1-永久vs选择性.ppt

VTE+抗凝无效/禁忌/并发症/无法维持治疗量 VTE+高PE风险/高抗凝风险/抗凝依从性差 无VTE+高VTE风险+高抗凝风险 绝对适应证 相对适应证 预防性使用适应证 DVT + 致死性PE 理想适应证 围手术期 急性期DVT DVT＋无法接受抗凝 血栓蔓延，新生血栓更易脱落 DVT介入治疗期间的临时保护 操作引起的脱落风险增高 一个滤器，一座桥 低风险 低风险 高风险 滤器不应成为患者一生的负担 为什么永久性滤器还在被大量使用？ 医生的观念 医生的恐惧 医生的担忧 预防PE的效果？ 长期留置的安全性？ 回收成功率？ 选择性滤器的结果 绝对适应症＋长期抗凝风险 永久性／选择性 绝对适应症＋短期抗凝风险 选择性 预防性使用／相对适应症 选择性 据估计，2012年有259,000 腔静脉滤器在美国被使用，其中75%是选择性滤器。 SmouseB,JoharA.Is market growth of vena cava filters justified? A review of indications,use,and market analysis 谢谢！ Fig. 5—82-year-old man with long-standing infrarenal inferior vena cava (IVC) filter (OptEase, Cordis). A, CT image shows complete IVC and iliac vein thrombosis (arrows), which extends above IVC filter and is at risk of occluding bilateral renal veins. B, Patient underwent emergent thrombolysis with insertion of suprarenal filter (black arrow) (Celect, Cook Medical) and left common iliac vein stent (white arrows). Inferior Vena Cava Filter– Associated Abnormalities: MDCT Findings Balaji Rao，AJR 2012; 198:W605–W610 * A。Vena tech lp 滤器内和下放（下箭头）及滤器上方（上箭头）血栓 B。腔静脉造影显示大范围的腔静脉血栓形成 植入滤器4年后发现上述问题 溶栓后，经复杂的腔内方法将滤器取出。 Complex Retrieval of Embedded IVC Filters: Alternative Techniques and Histologic Tissue Analysis William T. Kuo，Springer Science+Business Media, LLC and the Cardiovascular and In terventional Radiological Society of Europe (CIRSE) 2011 May12 published on line * Fig. 9—65-year-old woman with inferior vena cava (IVC) filter (Bird’s Nest, Cook Gianturco-Roehm). A–C, CT images show IVC filter has fractured, with fragment mobilized into right ventricle and bilateral pulmonary artery branches (arrows, B and C). * * Fig. 1. 62-year-old male patient with fracture of Tempofilter II. Tempofilter II was deployed in infrarenal position. Tethering catheter is straight in shape. B. Three weeks later, fluoroscopic image of inferior vena cava revealed upward displacement of Tempofilter II about 3 cm and fracture of one leg of filter. C. Tempofilter II was removed successfu