ObjectiveTo discuss the implantation and conversion technology of convertible inferior vena cava filter and the experience of management.MethodsThe clinical data of 115 patients with convertible inferior vena cava filter implantation admitted to our vascular surgery center from January 2018 to December 2018 was retrospectively analyzed.ResultsAmong the 115 patients with convertible inferior vena cava filter implantation, 74 were males and 41 were females. The ages ranged from 22 to 87 years, with median age 54 years. The successful rate of filter implantation was 100% without any surgical related complications. After implantation surgery, patients were followed up from 4 to 455 days with a median of 90 days and the recurrence rate of adverse events was 7.8% (9/115). The recurrence time were 16 to 104 days after conversion, with a median of 42 days. Twenty-three patients (20.0%) received filter conversion, one of them failed and all the others succeeded. The technical successful rate was 95.7% (22/23). The conversion operative time was 22.8 to 51.4 min, with median time 27.4 min. The intervals between implantation and conversion were from 4 to 455 days, with median time 159 days. Accessory techniques were used in 20 of 22 successful filter conversions and the application rate of accessory technique was 90.9%. The patients were followed-up from 30 to 180 days after conversion with a median time of 90 days and no adverse event was reported.ConclusionConvertible inferior vena cava filter is a significant choice for patients application of inferior vena cava filter due to its high safety of conversion surgery, technical success rate and possibility of conversion after long-term indwelling.
目的研究置管溶栓联合球囊扩张导管碎栓治疗下肢深静脉血栓形成（DVT）的疗效及安全性。 方法回顾性分析2011年9月至2015年1月本院收治的82例急性下肢DVT患者的临床资料。将患者分成两组：A组行单纯经导管直接溶栓（CDT）治疗，共32例，其中男10例、女22例，平均年龄（56±15）岁；B组行CDT联合机械碎栓（球囊扩张导管碎栓）治疗，共50例，其中男18例、女32例，平均年龄（57±17）岁。比较2组治疗前后静脉通畅率、静脉通畅度评分、健侧和患侧下肢周径差，比较2组尿激酶用量及溶栓导管留置时间，以出血并发症、肺栓塞的发生率评价治疗的安全性。 结果2组共82例患者完成溶栓及碎栓疗程，B组较A组溶栓时间更短，A组平均9（7，12）d；B组平均5（4，7）d，2组差异有统计学意义（P<0.01）；B组较A组尿激酶用量更少，A组平均7.250（6.355，8.255）×106 U，B组平均4.925（3.715，5.810）×106 U，2组差异有统计学意义（P<0.01）；B组治疗后的静脉通畅度评分显著优于A组，A组65.0%（40.5%，86.5%），B组为100%（90%，100%），差异有统计学意义（P<0.01）。治疗后2组出血并发症发生率差异无统计学意义（P=0.0976）。2组患者随访时间3～18个月，A组随访率50.0%，B组随访率58.0%，均未发生肺动脉栓塞。 结论在下腔静脉滤器保护下，CDT联合球囊扩张导管碎栓治疗急性下肢DVT较单纯CDT治疗，溶栓效果好、尿激酶用量少、不增加肺栓塞及出血发生率。
ObjectiveTo explore the value of recombinant inferior vena cava filter (IVCF) in the prevention of perioperative pulmonary embolism in patients with lower limb or pelvic fracture combined with deep venous thrombosis (DVT).MethodsThe clinical data of 168 patients with lower limb or pelvic fracture combined with DVT were analyzed retrospectively.ResultsThe filters were successfully implanted in 168 patients, and the recoverable filters were removed after (48.3±4.8) d (14–97 d). The filters were removed successfully in 159 cases, and the removal rate was 94.6%. Sixty-one cases were found to have thrombus on the filter after contrast examination or removal of vena cava filter, that is, the thrombus interception rate was 36.3%.ConclusionFor patients with lower limb or pelvic fracture combined with DVT, the rechargeable vena cava filter can effectively stop thrombosis and avoid pulmonary embolism.
【摘要】 目的 探讨健康教育路径在下腔静脉滤器（inferior vena cava filter，VCF）置入术患者中的应用效果。 方法 2008年1月－2010年5月，将62例VCF置入术患者随机分为观察组（32例）和对照组（30例），观察组采用健康教育路径进行健康教育，对照组患者采用常规健康教育。 结果 观察组患者的健康教育达标率明显高于对照组（Plt;0.05），焦虑发生率明显低于对照组。 结论 应用健康教育路径对VCF置入术患者实施，能提高患者对健康知识的掌握程度和效果，促进患者早日康复；同时可强化护患沟通，和谐护患关系。【Abstract】 Objective To investigate the effect of health education pathway in patients treated with placement of inferior vena cava filter (VCF). Methods Sixty-two patients treated with placement of inferior VCF from January 2008 to May 2010 were randomly divided into experimental group (n=32) and control group (n=30). Health education pathway and routine general way were adopted respectively to treat patients in the experimental group and the control group. Results Standard-achieving rate of the health education in the experimental group was significantly higher than that in the control group (Plt;0.05), and the incidence of anxiety was also lower in the experimental group. Conclusion Health education pathway for patients treated with placement of inferior VCF can increase the patients’ health care knowledge, lessen patients’ anxiety, and strengthen the nurse-patient communication and harmonious relations.
ObjectiveTo explore the effect of catheter directed thrombolysis (CDT) in treatment of acute deep venous thrombosis (ADVT) in lower extremity. MethodsLimb circumference at 15 cm above and below the knee at affected side, as well as patency improvement score of 46 patients with ADVT in lower extremity, who received treatment in The Rocket Army General Hospital of PLA between January 2014 and October 2015, were colleted retrospectively, to analyze the effect of CDT in treatment of ADVT in lower extremity. ResultsAll patients were placed catheter successfully, 5 patients were placed catheter by 'contralateral mountain' technique retrograde, 40 patients were placed catheter through the limb popliteal vein at affected side anterograde, guiding by ultrasound, 1 patient was placed catheter through femoral vein at affected side. All of 46 patients got successful thrombolysis, and thrombolysis time was (4.7±1.8) d (3-12 d). There were 8 patients suffered from complications in different situation, and got treatment of drug withdrawal or tube drawing all ease, no one died. Compared with before CDT treatment in same group, the limb circumference at 15 cm above (P=0.028, P=0.017, P=0.031) and below (P=0.035, P=0.038, P=0.047) the knee at affected side, and patency improvement score (P=0.023, P=0.028, P=0.031) in all patients group, 22-45 years group, and 46-74 years group were all lower after CDT treatment. The limb circumference at 15 cm above (P=0.073, P=0.387, P=0.358) and below (P=0.416, P=0.625, P=0.253) the knee at affected side after CDT treatment were not differed with corresponding indexes of healthy side in the same group of all patients group, 22-45 years group, and 46-74 years group. Ultrasound after treatment showed that, blood vessel recanalization occurred in 15 patients (32.6%), partial blood vessel recanalization occurred in 28 patients (60.9%), but thrombus of 3 patients (6.5%) didn't removed, the total effective rate was 93.5% (43/46). Forty three patients were followed up for 1-24 months, the median is 18-month. During follow-up period, skin color obviously deepened after the activity occurred in 5 patients, obvious limb acid bilges occurred in 19 patients, vein thrombosis (DVT) recurred in 9 patients of 28 patients with partial blood vessel recanalization, in addition, thrombosis syndrome (PTS) occurred in 11 patients. ConclusionCDT is the most direct and effective way to treat ADVT.
Objective To discuss and evaluate the value of insertion of inferior vena cava filter in treating lower extremity deep venous thrombosis (DVT). Methods Inferior vena cava filters were placed in 46 patients with lower extremity DVT prior treatment, 20 in which were treated by therapy with anticoagulation and thrombolysis, and therapy with pressure gradient, and the other 26 patients by operation and thrombolysis therapy, and therapy with pressure gradient. Whether patients occurred pulmonary embolism was observed and the form and site of filters were monitored by periodic fluoroscopy. Results Inferior vena cava filters were placed successfully in all patients, 38 cases were implanted permanence inferior vena cava filter, 8 cases were implanted temporary inferior vena cava filter. Symptoms and signs of DVT disappeared or remitted in 44/46 patients after treatment. None of pulmonary embolism was occurred. Follow up 2-24 months (average 13 months) for 36 cases with permanence inferior vena cava filter, there was no complication of the filter and pulmonary embolism occurred. Conclusions The method of inserting inferior vena cava filter is simple and safe, which can prevent pulmonary embolism effectually to offer sufficient safeguard for the treatment of DVT.
ObjectiveTo understand the characteristics of patients who have undergone the removal of the inferior vena cava (IVC) filter, so as to provide a reference for optimizing the clinical application strategy of IVC filters. MethodThe demographic and clinical characteristics of patients underwent IVC filter removal in the Division of Vascular Surgery, Department of General Surgery, West China Hospital, Sichuan University from December 2016 to December 2023 were retrospectively collected. ResultsA total of 102 patients were enrolled, including 48 (47.1%) males and 54 (52.9%) females. The age of the patients was (46.75±16.72) years old, and 75 (73.5%) patients were aged between 20 and 59 years old. The proportion of patients underwent retrieval after IVC filter placement due to combined central deep vein thrombosis was highest, accounting for 48.0% (49/102). Of the 102 patients, 72 (70.6%) patients underwent IVC filter removal within 90 d and 6 (5.9%) patients underwent IVC filter removal after more than one year. The median duration of filter placement for all patients was 35 d (ranging from 5 to 7 300 d). The filter was removed via interventional method in 92 (90.8%) patients and via open surgery in 10 (9.8%) patients. The endovascular retrieval failed in one of 92 patients and then the follow-up observation was selected. Compared with the interventional treatment, the patients who had the filter removal by open surgery had a longer placement time of the filter in the IVC (median: 136.5 d vs. 32.5 d, P=0.002). ConclusionsFrom the analysis results of this cases data, patients with IVC filters don’t show obvious gender characteristics. The majority of them are young and middle-aged, and interventional method is mostly used for the removal of IVC filters. Patients who receive open surgery to remove the filter have a longer placement time in the IVC, suggesting the necessity of early removal of the IVC filter.
【摘要】 目的 〖JP2〗评价腔静脉滤器植入联合足背静脉溶栓在下肢深静脉血栓（DVT）治疗中的疗效。 方法 2006年12月-2009年10月，对26 例下肢深静脉血栓患者行下腔静脉滤器植入术，并结合足背静脉溶栓治疗。 结果 26例患者均未出现大出血和致死性肺动脉栓塞等严重并发症，彩色多普勒超声显示17例患者下肢DVT 完全溶解，11例部分溶解。 结论 介入性综合治疗下肢DVT 是一种安全可行、疗效好的方法。【Abstract】 Objective To evaluate the therapeutic effect of filter planting combining thrombolysis therapy through the dorsum pedis vein on patients with deep veins thrombosis of lower limb. Methods The clinical data of 26 patients from December 2006 to October 2009 were retrospectively analyzed. All the patients underwent filter planting combining thrombolysis therapy through the dorsum pedis vein. Results There was no serious complication such as hemorrhea or fatal pulmonary embolism. The phlebothrombosis was fully dissolved in 11 patients and partial dissolved in 17 patients. Conclusion Interventional combined therapy is safe and effective for deep venous thrombosis of lower limb.
目的探讨下肢深静脉血栓形成(DVT)的治疗方法及经验。方法分析我院2007年1月至2010年1月期间237例DVT患者的临床资料，其中行以抗凝、祛聚为主的非手术治疗198例，行介入手术治疗39例。结果198例给予抗凝、祛聚为主的非手术治疗者中临床治愈85例(42.93%)，有效108例(54.55%)，无效5例(2.52%); 39例给予介入手术治疗(均先行下腔静脉滤器置入，然后行球囊导管取栓治疗33例，行介入溶栓6例)者均临床治愈(100%)。总有效率为97.89%（232/237)。对39例行介入手术治疗患者术后随访3～24个月(平均10个月)，2例患者出现下腔静脉阻塞并发下肢DVT，经抗凝、祛聚等治疗后症状缓解； 均未见滤器移位、肺栓塞等并发症。结论DVT患者介入治疗效果优于非手术治疗，早期诊断和合理的治疗方案是DVT治疗成功的关键。
The dynamic analysis of the implantation process of a new vena cava filter was carried out by finite element analysis method to reveal the influence of the angle, length, width and thickness of the filter rod on its mechanical properties and the inner wall of the blood vessel. The results showed that the high-stress and high-strain areas of the filter were mainly concentrated in the connection between the filter rod and the filter wire. With the increase of the angle of the filter rod, the maximum equivalent stress and the maximum elastic strain on the filter wall decreased, while the maximum equivalent stress on the vascular wall increased. With the increase of the length of the filter rod, the maximum equivalent stress and strain peak of the filter wall increased, but the maximum equivalent stress of the vessel wall decreased. With the increase of the width and thickness of the filter rod, the maximum equivalent stress of the filter wall, the maximum elastic strain and the maximum equivalent stress of the vessel wall all showed an upward trend. The static safety factor of all filter models was greater than 1, and the structure after implantation was safe and reliable. The results of this study are expected to provide a theoretical basis for the structural optimization and deformation mechanism of the new type vena cava filter.