下腔静脉滤器的选择介绍.pptVIP

Bird’sNestRecoveryG2Simon非永久性滤器是一种以替代永久性滤器为目标的新产品。主要包括可回收滤器及临时性滤器。可回收滤器在设计上既有使滤器固定在腔静脉壁上的倒钩，同时在滤器顶部带有小钩可通过鹅颈抓捕器取出。可回收滤器，其优势在于既可作为永久性滤器长期置于体内，也可作为非永久性滤器取出。永久性可回收但其缺点在于作为非永久性滤器在体内放置的时间窗较短，一般仅为两周，时间过长因倒钩引发内皮化问题使滤器与血管壁粘合一体而不易取出。对于有滤器植入指征的患者在如何选择滤器种类的问题上，目前仍存在较大争议。已有研究证实，与单纯抗凝治疗相比，永久性滤器植入术后的DVT患者PE发生率有所降低，但静脉血栓形成的几率显著增加。同时永久性滤器植入后需要终身抗凝。内部资料严禁外传高风险、禁忌症等主观性描述不够具体，对于VTE患者而言，哪些患者可被明确列为高风险患者？没有具体标准腔静脉滤器只能作为PE预防的二线方法。高出血风险举例：颅内出血、无法纠正的严重的凝血障碍、脊髓损伤伴或怀疑脊髓周围血管瘤，常常被视为抗凝禁忌症VTE的危险因素，恶性肿瘤、大手术或创伤、高龄、VTE既往史以及病理性肥胖等。AbsoluteIndications(ProvenVTE)RecurrentVTE(acuteorchronic)despiteadequateanticoagulationContraindicationtoanticoagulationComplicationofanticoagulationInabilitytoachieve/maintaintherapeuticanticoagulationRelativeIndications(ProvenVTE)IliocavalDVTLarge,free-floatingproximalDVTDifficultyestablishingtherapeuticanticoagulationMassivePEtreatedwiththrombolysis/thrombectomyChronicPEtreatedwiththromboendarterectomyThrombolysisforiliocavalDVTVTEwithlimitedcardiopulmonaryreserveRecurrentPEwithfilterinplacePoorcompliancewithanticoagulantmedicationsHighriskofcomplicationofanticoagulation(eg,ataxia,frequentfalls)ProphylacticIndications(NoVTE,primaryprophylaxisnotfeasible*)TraumapatientwithhighriskofVTESurgicalprocedureinpatientathighriskofVTEMedicalconditionwithhighriskofVTEContraindicationstoFilterPlacementNoaccessroutetothevenacavaNolocationavailableinvenacavaforplacementoffilterFig.5—82-year-oldmanwithlong-standinginfrarenalinferiorvenacava(IVC)filter(OptEase,Cordis).A,CTimageshowscompleteIVCandiliacveinthrombosis(arrows),whichextendsaboveIVCfilterandisatriskofoccludingbilateralrenalveins.B,Patientunderwentemergentthrombolysiswithinsertionofsuprarenalfilter(blackarrow)(Celect,CookMedical)andleftcommoniliacveinstent(whitearrows).InferiorVenaCavaFilter–AssociatedAbnormalities