The use of retrievable inferior vena cava filters in severely injured military trauma patients

被引:33
作者
Johnson, Owen N., III [1 ]
Gillespie, David L. [1 ,2 ]
Aidinian, Gilbert [1 ,2 ]
White, Paul W. [1 ,2 ]
Adams, Eric [1 ,2 ]
Fox, Charles J. [1 ,2 ]
机构
[1] Walter Reed Army Med Ctr, Dept Surg, Peripheral Vasc Surg Serv, Washington, DC 20307 USA
[2] Uniformed Serv Univ Hlth Sci, Norman M Rich Dept Surg, Div Vasc Surg, Bethesda, MD 20814 USA
关键词
DEEP-VEIN THROMBOSIS; HIGH-RISK; PULMONARY-EMBOLISM; EARLY EXPERIENCE; MULTIPLE TRAUMA; FOLLOW-UP; PREVENTION; THROMBOEMBOLISM; PROPHYLAXIS; MANAGEMENT;
D O I
10.1016/j.jvs.2008.09.004
中图分类号
R61 [外科手术学];
学科分类号
摘要
Objective: Important recent data on retrievable inferior vena cava filter (R-IVCF) used in civilian trauma centers suffer from poor follow-up in these transient patients. Because US military casualties can be more easily followed globally, our objective was to further characterize R-IVCF outcomes in a trauma population with improved follow-up. Methods: From July 2003 to June 2007, trauma registry records were retrospectively reviewed for US soldiers injured in Iraq and Afghanistan who had R-IVCF placement. Indications, type of filter, complications, outcomes, and retrieval data were analyzed. Results. Seventy-two R-IVCFs were placed during the study period. Mean follow-up was 28.0 +/- 12.0 months, in 61 (85%) patients. Mean injury severity score (ISS) was 36.3 +/- 10.4 and mean patient age was 27.4 +/- 6.4 years. Fifty-nine R-IVCFs (82%) were not retrieved due to: death (1, 1.3%), technical failure (2, 2.8%), lost to follow-up (11, 15.2%), or contraindications to retrieval (45, 62.5%). Thirteen R-IVCFs were successfully removed, an overall retrieval rate of 18%. Median dwell time of those removed was 47 days (range, 10-94). IVCF indications were prophylactic in 23 (32%) and therapeutic in 49 (68%) cases. Both retrieval failures were due to incorporation into the caval wall, attempted at 90 and 156 days. Deep vein thromboses at the insertion site or pulmonary embolism following R-IVCF placement or removal were not observed. To date, there have been no reports of IVC stenosis or occlusion. Conclusion: R-IVCFs were safely and effectively used in severely injured military trauma patients with high ISS. Despite improved follow-up, overall retrieval remained low, reflecting the civilian experience. Indication, rather than follow-up losses, accounted for the low retrieval rate. Practice patterns for R-IVCF in trauma may need to be re-examined to optimize outcomes. (J Vasc Surg 2009;49:410-6.)
引用
收藏
页码:410 / 416
页数:7
相关论文
共 25 条
[1]   Retrievable vena cava filters in trauma patients for high-risk prophylaxis and prevention of pulmonary embolism [J].
Allen, TL ;
Carter, JL ;
Morris, BJ ;
Harker, CP ;
Stevens, MH .
AMERICAN JOURNAL OF SURGERY, 2005, 189 (06) :656-661
[2]   Thrombosis and coagulation: Deep vein thrombosis and pulmonary embolism prophylaxis [J].
Anaya, DA ;
Nathens, AB .
SURGICAL CLINICS OF NORTH AMERICA, 2005, 85 (06) :1163-+
[3]   Retrievable vena cava filters for preventing pulmonary embolism in trauma patients: A cautionary tale [J].
Antevil, JL ;
Sise, MJ ;
Sack, DI ;
Sasadeusz, KJ ;
Swanson, SM ;
Rivera, L ;
Loine, BR ;
Weingarten, KE ;
Kaminski, SS .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2006, 60 (01) :35-39
[4]   Dislodgment of inferior vena cava filters during central line placement: Case report [J].
Barraco, RD ;
Scalea, TM .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2000, 48 (01) :140-142
[5]   Deep venous thrombosis after percutaneous insertion of vena caval filters [J].
Blebea, J ;
Wilson, R ;
Waybill, P ;
Neumyer, MM ;
Blebea, JS ;
Anderson, KM ;
Atnip, RG .
JOURNAL OF VASCULAR SURGERY, 1999, 30 (05) :821-828
[6]   A clinical trial of vena caval filters in the prevention of pulmonary embolism in patients with proximal deep-vein thrombosis [J].
Decousus, H ;
Leizorovicz, A ;
Parent, F ;
Page, Y ;
Tardy, B ;
Girard, P ;
Laporte, S ;
Faivre, R ;
Charbonnier, B ;
Barral, FG ;
Huet, Y ;
Simonneau, G .
NEW ENGLAND JOURNAL OF MEDICINE, 1998, 338 (07) :409-415
[7]   Acute complications associated with Greenfield filter insertion in high-risk trauma patients [J].
Duperier, T ;
Mosenthal, A ;
Swan, KG ;
Kaul, S .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2003, 54 (03) :545-549
[8]   Trauma system development in a theater of war: Experiences from operation Iraq freedom and operation enduring freedom [J].
Eastridge, Brian J. ;
Jenkins, Donald ;
Flaherty, Stephen ;
Schiller, Henry ;
Holcomb, John B. .
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE, 2006, 61 (06) :1366-1372
[9]   Contemporary management of wartime vascular trauma [J].
Fox, CJ ;
Gillespie, DL ;
O'Donnell, SD ;
Rasmussen, TE ;
Goff, JM ;
Johnson, CA ;
Galgon, RE ;
Sarac, TP ;
Rich, NM .
JOURNAL OF VASCULAR SURGERY, 2005, 41 (04) :638-643
[10]   Recurrent thromboembolism in patients with vena cava filters [J].
Greenfield, LJ ;
Proctor, MC .
JOURNAL OF VASCULAR SURGERY, 2001, 33 (03) :510-514