目的:本研究旨在描述CT静脉造影(CTV)的影像学特征以及可取回腔静脉滤器(VCF)放置后原位下腔静脉血栓形成(IVCT)的危险因素。
方法:在2018年9月至2023年6月之间,对有或没有VCF放置后原位IVCT的患者进行了一项单中心回顾性队列研究。患者基线人口统计学,下肢深静脉血栓形成(LEDVT),血栓特征,并发肺栓塞,LEDVT的合并症和危险因素,收集和分析下腔静脉(IVC)和VCF相关信息。进行单变量分析,然后进行多变量分析,以95%置信区间(CI)评估比值比(OR)。
结果:纳入了117名符合条件的患者,确定了在CTV图像上围绕VCF支撑柱和接触IVC壁的区域隔离填充缺陷,在IVC的短轴或前壁发现凝块的频率更高。单变量分析表明,原位IVCT的发生率(31.6%,37/117)与年龄密切相关(p=.001),血栓肢(左侧(p=0.001)和双侧(p=0.001)),高血压(p=.008),过滤形状(p<.001),短IVC直径(p=.009)或放大百分比(p=.004),和长IVC直径(p=.006)。多变量分析表明,双侧侧LEDVT(OR4.92;95%CI,1.56-15.51,p=.007)和短IVC放大倍数增加(OR1.01;95%CI,1.00-1.03,p=.013)在统计学上显著增加IVCT原位风险,而年龄增加(OR0.96;95%CI,0.94-0.99,p=.013)和短IVC直径(OR0.87;95%CI,0.77-0.98,p=.026)与原位IVCT的几率降低相关。
结论:原位IVCT代表过滤器与IVC壁接触点的局部隔离的填充缺陷。双侧LEDVT和短IVC放大倍数增加可能是影响原位IVCT发生的潜在危险因素。而年龄增加和IVC直径较短可能会降低IVCT的原位发生率,并且似乎是防止IVCT原位出现的保护因素。
OBJECTIVE: This study aimed to characterize radiographic characteristics on computed tomography venography and risk factors of
inferior vena cava thrombosis (IVCT) in situ after retrievable vena cava filter (VCF) placement.
METHODS: Between September 2018 and June 2023, a single-center retrospective cohort study was conducted in patients with or without IVCT in situ following VCF placement. Patient baseline demographics, presentation of lower extremity deep vein thrombosis (LEDVT), thrombus characteristics, concurrent pulmonary embolism, comorbidities and risk factors for LEDVT, and IVCT and VCF-related information were collected and analysed. Univariable analysis followed by multivariable analysis was performed to evaluate the odds ratio (OR) with a 95% confidence interval (CI).
RESULTS: One hundred and seventeen eligible patients were included, regionally isolated filling-defect surrounding the support pillars of VCF and contacting
inferior vena cava (IVC) wall on computed tomography venography images were identified, clots were more frequently found on the minor axis or anterior wall of IVC. Univariable analyses suggested that the incidence of IVCT in situ (31.6%, 37/117) was closely associated with age (P = .001), thrombus limb (left (P = .001) and bilateral side (P = .001)), hypertension (P = .008), filter shapes (P < .001), short IVC diameter (P = .009) or magnification percentage (P = .004), and long IVC diameter (P = .006). Multivariable analyses suggested that bilateral side LEDVT (OR, 4.92; 95% CI, 1.56-15.51; P = .007) and increased short IVC magnification percentage (OR, 1.01; 95% CI, 1.00-1.03; P = .013) statistically significant increase the IVCT in situ risk, whereas increased age (OR, 0.96; 95% CI, 0.94-0.99; P = .013) and short IVC diameter (OR, 0.87; 95% CI, 0.77-0.98; P = .026) were associated with decreased odds against IVCT in situ.
CONCLUSIONS: IVCT in situ represents regionally isolated filling-defect at points of filter contact with IVC wall. Bilateral side LEDVT and increased short IVC magnification percentage may be potential risk factors impacting the occurrence of IVCT in situ, while increased age and short IVC diameter may decrease the incidence of IVCT in situ and seem to be protective factor against IVCT in situ emergence.