| 蒋鹏,曲诚家,张蕴鑫,等.经颈内静脉-股静脉双向对拉技术回收超时间窗纺锤形下腔静脉滤器的安全性及有效性分析[J].中国临床保健杂志,2026,29(2):167-171. |
| 经颈内静脉-股静脉双向对拉技术回收超时间窗纺锤形下腔静脉滤器的安全性及有效性分析 |
| Efficacy and safety of bilateral pull-back technique for the retrieval of overdue spindle-shaped inferior vena cava filters |
| 投稿时间：2026-03-06 |
| DOI：10.3969/J.issn.1672-6790.2026.02.005 |
| 中文关键词: 静脉血栓栓塞 腔静脉滤器 血管内操作 复发 |
| 英文关键词: Venous thromboembolism Vena cava filters Endovascular procedures Recurrence 〖FL |
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| 中文摘要: |
| 目的 探讨经颈内-股静脉双向对拉回收超时间窗纺锤形下腔静脉滤器(IVCF)的安全性与有效性。方法 回顾性分析2025年9月至2026年1月首都医科大学附属北京积水潭医院收治的19例超时间窗纺锤形IVCF患者的临床资料。所有患者均采用经颈内静脉与股静脉双向穿刺入路,通过单侧或双侧建立贯通导丝成袢(Loop),通过上下同轴牵拉为滤器提供稳定的轴向张力；随后沿导丝使用回收鞘管,采用机械切割方式钝性分离滤器支柱与下腔静脉壁之间的增生内膜,最终完成滤器回收。记录并分析患者基线资料、术中情况、围手术期并发症及随访结果。结果 19例患者滤器中位滞留时间为50 d(范围:27~420 d)。滤器回收技术成功率为94.7%(18/19)。中位手术时间为56 min(范围:25~210 min),中位透视时间为17 min(范围:8~55 min)。所有成功回收的病例中,均未发生下腔静脉撕裂、致命性大出血、症状性肺栓塞等严重并发症。1例患者出现轻微并发症(穿刺点血肿),经保守治疗后好转。术后中位随访62 d,超声/CT静脉造影复查提示14例患者下腔静脉均保持通畅,5例患者因就诊时即为下腔静脉闭塞,复查后下腔静脉仍闭塞。所有患者随访期内未见深静脉血栓复发。结论 对于内皮化严重、常规回收失败的超时间窗纺锤形IVCF,采用双向对拉有良好的可行性和安全性。 |
| 英文摘要: |
| Objective To evaluate the safety and clinical efficacy of a bilateral (jugular and femoral veins) pull-back technique for the retrieval of overdue spindle-shaped inferior vena cava filter (IVCF).Methods Clinical data of 19 patients with overdue spindle-shaped IVCF who underwent complex retrieval at Beijing Jishuitan Hospital Affiliated to Capital Medical University from September 2025 to January 2026 were retrospectively analyzed.All procedures utilized a combined internal jugular and common femoral vein approach.A through-and-through guidewire loop was established to provide stable,simultaneous bi-directional axial traction on the filter.A rigid/retrieval sheath was then advanced over the wire to mechanically dissect the neointimal hyperplasia adhering the filter struts to the caval wall.Technical success rate,filter dwell time,operative and fluoroscopy times,perioperative complications,and follow-up outcomes were recorded and analyzed.Results A total of 19 patients were included in this study.The middle filter dwell time was 50 d (range:27-420 d).The technical success rate of filter retrieval was 94.7% (18/19).The middle operative time was 56 min (range:25-210 min),the middle fluoroscopy time was 17 min (range:8-55 min).No major complications,such as inferior vena cava avulsion,fatal hemorrhage,or symptomatic pulmonary embolism,occurred in the successful cases.Minor complications (access site hematoma) occurred in one case and resolved with conservative management.During a middle postoperative follow-up period of 62 d,ultrasound/ CT Venography re-examination revealed that the inferior vena cava remained patent in 14 patients.Conversely,in the 5 patients who initially presented with inferior vena cava occlusion during consultation,the occlusion persisted upon re-examination.Notably,none of the patients experienced recurrence of deep vein thrombosis.Conclusions For the spindle-shaped inferior vena cava filter with severe endothelialization and failed conventional retrieval beyond the time window,bidirectional pulling has good feasibility and safety. |
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