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<p><b>OBJECTIVE</b>To evaluate the application of inferior vena cava filter (IVCF) in prevention of peri-operative pulmonary embolism (PE) in lower limb bone fracture patients with deep venous thrombosis (DVT).</p><p><b>METHODS</b>From January 2003 to December 2012, 2 248 cases of lower limb and pelvic fractures with DVT were retrospectively analyzed. Before the procedure of IVCF implantation began, January 2003 to December 2007, there were 1 052 cases of acute trauma patients with DVT were classified as the group of early none-IVCF. The IVCF implantation was began since January 2008. From that time to December 2012, 712 cases of bone fractures with DVT received filter implantation, which were classified as IVCF group. The other 484 patients who had not undergone filter deployment were divided as group of late none-IVCF. The baseline conditions of the three groups were significantly different in addition to the ages between group of early none-IVCF and IVCF group. The incidences of PE and mortality of PE in each group were recorded and analyzed by χ(2) test.</p><p><b>RESULTS</b>There were totally 31 cases of symptomatic PE, among which 12 cases died. Totally 712 filters were deployed successfully without any major complications. The incidences of symptomatic PE were 0.14% (1/712), 2.19% (23/1 052) and 1.45% (7/484) in IVCF group, group of early none-IVCF and group of late none-IVCF, respectively. The mortality of PE were 0 (0/712), 0.86% (9/1 052) and 0.62% (3/484) in these groups. The incidence of symptomatic PE in IVCF group was significantly different from that in the group of early and late none-IVCF (χ(2) = 11.762, P = 0.001; χ(2) = 7.395, P = 0.007, respectively). The mortality of IVCF group was also significantly lower compared with the other two groups (χ(2) = 6.122, P = 0.013; χ(2) = 4.424, P = 0.035, respectively).</p><p><b>CONCLUSION</b>IVCF implantation effectively prevents symptomatic and fatal PE of patients of lower limb and pelvic fractures with DVT in the peri-operative period.</p>
Subject(s)
Adult , Aged , Female , Humans , Male , Middle Aged , Leg Injuries , Lower Extremity , Pulmonary Embolism , Retrospective Studies , Vena Cava Filters , Venous ThrombosisABSTRACT
Objective To study the complications related to and its management after retrieving temporary and retrievable IVC filters.Methods From Jul 2007 to Mar 2012,576 consecutive cases of deep venous thrombosis secondary to bone fractures confirmed by Duplex ultrasonography,received IVCF deployment to avoid fatal pulmonary embolism during perioperative period.There were 192 cases receiving temporary filters and 384 cases with retrievable filters.The temporary and retrievable filters were removed 2 to 4 weeks after implantation.Results The success rate of temporary filter removing was 100％.In 24 cases,the filters captured huge thrombi,and they were removed after thrombolysis using the Uni-fuse catheter.One patient received permanent filter deployment before removing the tempo-filter.Filters were successfully removed in 367 out of 384 cases with retrievable ones with a successful rate of 95.57％.In 7 cases the filters were removed with large thrombi.Double-snare-technique was used to retrieve 15 seriously tilted filters.After a mean 22 months follow-up,no pulmonary embolism occurred,but symptomatic DVT were revealed in 26 patients,and the conditions were improved after anticoagulation treatment.Conclusions The application of Uni-fuse thrombolysis catheter increases the success rate of filters retrieving,double-snare-technique helps retrieve seriously tilted filters and decrease long-term complications of permanent filters.
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Objective To evaluate feasibility of flap fenestration in management of the condition that a stent-graft is wrongly deployed in false lumen of aortic dissection.Methods A retrospective analysis was conducted on a case of Stanford type B aortic dissection who was confirmed that the stent-graft had been wrongly deployed in false lumen of aortic dissection by CT angiography (CTA) after endovascular repair.Thereafter,an additional surgical management was carried out.At length,flap fenestration at 2 cm below pre-deployed stent-graft was performed using an Outback catheter so as to link false and true lumens.Successively,another stent-graft was placed via the access to draw blood flow from false lumen back to true lumen and then coil embolization was performed for distal breach of the dissection.Results Surgery was carried out under local anesthesia,with operation duration of 170 minutes and intraoperative blood loss of 350 ml.The chest and back pain disappeared after operation.The patient commenced to take food and take off-bed activity at the very day of operation in absence of paraplegia,visceral ischemia,or other complications.Aortic CTA at postoperative one week showed ideal positioning of stent-graft,fluent blood flow of aorta and major visceral artery,and vanishing of false lumen.Conclusions Flap fenestration at far-end of pre-deployed stent-graft so as to draw blood flow back to true lumen by connecting the new placed stent graft to pre-deployed stent-graft is an effective treatment for mis-deployment of stentgraft in false lumen of aortic dissection.Outback catheter for flap fenestration is characterized by accurate location and high safety.
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Objective To evaluate the efficacy of endovenous laser treatment(EVLT) in the treatment of varicose veins in lower limbs. Methods A total of 450 cases of varicose veins in lower limbs(606 limbs) received EVLT with 940 nm diode laser under a continuous mode from October 2003 to February 2006.All the patients were evaluated with color ultrasonography after the operation.Results The follow-up duration was 2～29 months(mean,16 months).Satisfactory effects were achieved in XXX cases,with varicose veins subsided and sense of swelling and heaviness significantly relieved.In 49 cases accompanying active ulcers before operation,the ulcer healed within 10 days after operation in 44 cases and within 16 days in 5 cases.Five cases experiencing a heat injury were dismissed from hospital on the 7th day after operation.Conclusions EVLT is a minimally invasive operation possessing safety,simple performance,and effectiveness,and without leaving any scar.It is an ideal method in the treatment of varicose veins of lower limbs.