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Vena-cava-Filter bei unfallchirurgischen Patienten

Vena cava filters in trauma patients

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Zusammenfassung

Hintergrund

Die Verfügbarkeit entfernbarer inferiorer V.-cava-Filter (IVCF) hat neue Möglichkeiten in der Prävention der Lungenembolie (LE) bei chirurgischen Patienten eröffnet. Wir haben einen zunehmenden Einsatz von IVCF in unfallchirurgischen Patienten festgestellt und deshalb den Filtergebrauch an unserer Klinik untersucht.

Patienten und Methoden

An unserer Universitätsklinik wurden im Jahr 2008 von insgesamt 85 IVCF-Empfängern 49 unfallchirurgische Fälle retrospektiv untersucht.

Ergebnisse

Von 49 Patienten mit einem IVCF hatten 33 ein Polytrauma, 13 ein schweres Schädel-Hirn-Trauma und 3 ein Spinaltrauma, davon sind 11 (22%) bis Ende 2009 nicht entfernt worden. Die Verweilzeit der entfernten IVCF betrug 12–349 Tage. Bei 3 IVCF scheiterte ein Entfernungsversuch.

Schlussfolgerung

In unserer Studie fanden wir eine hohe Zahl von IVCF, die nicht entfernt worden sind. Die Verantwortlichkeit für die Entfernung von IVCF sollte klar geregelt sein. Indikation, Vorteile, Sicherheit und auch Design sind für diesen Gebrauch noch immer umstritten. Eine randomisierte kontrollierte Studie ist nötig, um entscheiden zu können, ob und wann der Einsatz von IVCF bei unfallchirurgischen Patienten sinnvoll ist.

Abstract

Background

The introduction of removable inferior vena cava filters (IVCF) has created new options for the prevention of pulmonary embolisms in surgical trauma patients. We have observed increasing use in trauma patients.

Patients and methods

A retrospective analysis was carried out of 49 trauma patients out of 85 who received IVCFs at our level 1 trauma centre in 2008.

Results

The indications for IVCF placement were multiple trauma in 33 patients, severe head injury in 13 and spinal injury in 3 patients. Of the patients 34 underwent successful removal, 11 (22%) patients had had no retrieval attempt by December 2009 and attempts at removal were unsuccessful in 3 patients. The mean age of the patients was 33.3 years.

Conclusion

In 2008 the vast majority of IVCFs were inserted for prophylaxis in trauma patients. To increase the number of retrieved IVCFs, responsibility for the removal should be clarified in every hospital. The indications, advantages, safety and also the design of IVCFs are still under debate. A randomized controlled trial is needed to determine the appropriate use and indications for this potentially useful device in trauma patients.

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Authors and Affiliations

  1. Department of Orthopaedic and Trauma Surgery, Royal Perth Hospital, North Block, Level 5, Wellington Street, 6000, Perth, Australien

    D. Baschera, J. Sebunya & R. Zellweger

  2. TU Dresden, Dresden, Deutschland

    C. Walter

Authors
  1. D. Baschera
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  2. J. Sebunya
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  3. C. Walter
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  4. R. Zellweger
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Correspondence to D. Baschera.

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Baschera, D., Sebunya, J., Walter, C. et al. Vena-cava-Filter bei unfallchirurgischen Patienten. Unfallchirurg 113, 764–769 (2010). https://doi.org/10.1007/s00113-010-1835-3

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