PROBLEMS OF ENDOVASCULAR PREVENTION OF THROMBOEMBOLISM OF THE PULMONARY ARTERY BYVOLAN (SHUTTLE COCK) CAVE FILTERS

V.B. Gervaziev, A.A. Karpenko
Chair of Hospital Surgery, Altai State Medical University,
Barnaul, Russia

The universal cava-fllters Volan (n=190) were implanted into the inferior vena cava (180 patients) with the purpose of secondary (101 patients suffering from thromboembolism of the pulmonary artery) and primary (79 patients with acute iliofemoral phlebothrombosis) endovascular prevention of pulmonary embolism. In 77 patients, the cava-filters were implanted into the permanent position. In 92 patients, they were removed within the period from 1 to 8 months. Chronic experiments with Volan cava-fllter (VCF) implantation were made in 13 dogs, with the observation period lasting from 1 to 8 months. Results: Thromboembolibm of the pulmonary artery (TEPA) recurred in 1 female patient and eventuated in lethal outcome because of undiagnosedsuprarenal mural embologenous thrombosis of the inferior vena cava (IVC). Thromboses of that vein were identified in 18 patients (10%) including 6 (7.5%) patients who underwent filter implantation for primary prevention of TEPA. In 10 patients, caval throboses occurred within the time up to 3 months whereas in 8 patients, they were recorded after 3 months. Following filter removal 2 patients showed TEPA, primary and recurrent. These 2 patients as well as 7 out of the 8 patients with IVC thrombosis were found to have thrombophilia of different genesis. Iliocav-agraphy, computed tomography and duplex scanning employed for patient examination and in animal experiments recognised 1-3 mm emergence of filter arms through the venous wall, mural thrombosis and fibrin deposition on prolonged filter stay in the venous lumen. Conclusion: The data presented herein suggest that VCF may be used according to the broadened indications (TEFA, acute iliofemoral phlebothrombosis) to prevent pulmonary embolism. It is desirable that these filters should be implanted temporarily, namely for I to 3 months. VCF implantation into the permanent position is indicated in thrombophilic conditions.

P. 130

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