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Войти в исследования Annals of vascular surgery · 2026
Endovascular Intervention Reduces Thrombosis Risk in Retrievable Inferior Vena Cava Filters: A Multicenter Propensity-Matched Analysis.
СтатьяМногоцентровое исследованиеНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Wang Xiao-Nan, Zhang Hao, Li Xiao-Ye, Xia Shi-Bo, Guo Ming-Jin, Chang Wen-Kai, Ding Ming-Chao, Lu Qingsheng, Zhang Lei
Аннотация
BACKGROUND: Current guidelines recommend retrievable inferior vena cava filters (RIVCFs) placement prior to endovascular intervention (EI) for deep vein thrombosis (DVT), yet the impact of EI on RIVCF-related thrombosis/trapped embolus (T/TE) remains controversial.
METHODS: In this prospective registry-based study (ChiCTR1800014252), 2,773 patients undergoing RIVCF placement across 103 Chinese centers (2018-2019) were stratified into EI (n = 1,472) and no-EI (n = 1,301) groups. Propensity score matching (1:1) balanced 23 baseline variables (e.g., DVT acuity and anticoagulation). The primary end point was RIVCF T/TE (defined as inferior vena cava obstruction or thrombus >5 cm above the filter), validated by core-lab adjudicated imaging (computed tomography/angiography). All treating physicians from the 103 participating centers received unified standardized training on the clinical selection criteria for EI and non-EI therapy prior to the study initiation, ensuring consistent intercenter decision-making. The selection of therapeutic modalities was further based on individualized clinical characteristics, including the anatomical location of DVT, thrombus burden, presence of procedural contraindications, and patient's informed consent after full risk-benefit explanation.
RESULTS: After matching (n = 1,007 per group), EI was associated with a 46% lower risk of RIVCF T/TE (8.9% vs. 14.0%, P < 0.001; odds ratio = 0.54, 95% confidence interval: 0.41-0.71). Symptomatic pulmonary embolism rates were comparable (1.2% vs. 2.8%, P = 0.07). No brand-specific differences in T/TE incidence were observed (P = 0.32).
CONCLUSION: This study challenges the necessity of routine RIVCF placement before EI, demonstrating that EI itself reduces thrombosis risk. These findings advocate for selective filter use, potentially sparing patients from device-related complications.
METHODS: In this prospective registry-based study (ChiCTR1800014252), 2,773 patients undergoing RIVCF placement across 103 Chinese centers (2018-2019) were stratified into EI (n = 1,472) and no-EI (n = 1,301) groups. Propensity score matching (1:1) balanced 23 baseline variables (e.g., DVT acuity and anticoagulation). The primary end point was RIVCF T/TE (defined as inferior vena cava obstruction or thrombus >5 cm above the filter), validated by core-lab adjudicated imaging (computed tomography/angiography). All treating physicians from the 103 participating centers received unified standardized training on the clinical selection criteria for EI and non-EI therapy prior to the study initiation, ensuring consistent intercenter decision-making. The selection of therapeutic modalities was further based on individualized clinical characteristics, including the anatomical location of DVT, thrombus burden, presence of procedural contraindications, and patient's informed consent after full risk-benefit explanation.
RESULTS: After matching (n = 1,007 per group), EI was associated with a 46% lower risk of RIVCF T/TE (8.9% vs. 14.0%, P < 0.001; odds ratio = 0.54, 95% confidence interval: 0.41-0.71). Symptomatic pulmonary embolism rates were comparable (1.2% vs. 2.8%, P = 0.07). No brand-specific differences in T/TE incidence were observed (P = 0.32).
CONCLUSION: This study challenges the necessity of routine RIVCF placement before EI, demonstrating that EI itself reduces thrombosis risk. These findings advocate for selective filter use, potentially sparing patients from device-related complications.