静脉血栓栓塞症(VTE),包括深静脉血栓形成(DVT)和肺栓塞(PE),是一种普遍的心血管疾病,仅次于心肌梗死和中风,全球排名第三。静脉血栓栓塞的风险随着年龄的增长而上升,对人口老龄化的关注日益增加。急性PE,高发病率和高死亡率,强调早期诊断和干预的必要性。本文综述了急性PE的预后因素。将其归类为低风险,中等风险,以及基于血流动力学稳定性和右心室应变的高风险。及时分类对于分诊和治疗决策至关重要。在当代景观中,低风险PE患者通常接受直接口服抗凝剂(DOACS)治疗,并迅速出院接受门诊随访.中危和高危患者可能需要先进的治疗,如全身溶栓,导管溶栓,机械血栓切除术,和IVC过滤器放置。后者,特别是IVC过滤器,见证了使用量的增加,不断发展的类型,如可检索和可转换的过滤器。然而,人们担心并发症和需要及时取回。这篇综述探讨了IVC过滤器在急性PE管理中的作用。解决他们的适应症,类型,并发症,和检索注意事项。围绕IVC过滤器使用的持续辩论,尤其是那些不那么常规适应症的患者,反映了进一步研究和数据的需要。尽管有并发症,最近的研究表明,临床上重要的问题是罕见的,引发了关于在特定PE案例中适当和安全使用IVC过滤器的讨论。审查最后强调了当前的趋势,知识的差距,以及推进IVC过滤器在未来急性PE管理中的作用的潜在途径。
Venous thromboembolism (VTE), comprising deep venous thrombosis (DVT) and pulmonary embolism (PE), is a prevalent cardiovascular condition, ranking third globally after myocardial infarction and stroke. The risk of VTE rises with age, posing a growing concern in aging populations. Acute PE, with its high morbidity and mortality, emphasizes the need for early diagnosis and intervention. This review explores prognostic factors for acute PE, categorizing it into low-risk, intermediate-risk, and high-risk based on hemodynamic stability and right ventricular strain. Timely classification is crucial for triage and treatment decisions. In the contemporary landscape, low-risk PE patients are often treated with Direct Oral Anticoagulants (DOACS) and rapidly discharged for outpatient follow-up. Intermediate- and high-risk patients may require advanced therapies, such as systemic thrombolysis, catheter-directed thrombolysis, mechanical thrombectomy, and IVC filter placement. The latter, particularly IVC filters, has witnessed increased usage, with evolving types like retrievable and convertible filters. However, concerns arise regarding complications and the need for timely retrieval. This review delves into the role of IVC filters in acute PE management, addressing their indications, types, complications, and retrieval considerations. The ongoing debate surrounding IVC filter use, especially in patients with less conventional indications, reflects the need for further research and data. Despite complications, recent studies suggest that clinically significant issues are rare, sparking discussions on the appropriate and safe utilization of IVC filters in select PE cases. The review concludes by highlighting current trends, gaps in knowledge, and potential avenues for advancing the role of IVC filters in future acute PE management.