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Bettseitige Implantation eines neuen passageren V.-cava-inferior-Filters

Deutsche Daten aus dem europäischen ANGEL-Register

Bedside implantation of a new temporary vena cava inferior filter

German results from the European ANGEL registry

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Zusammenfassung

Hintergrund

Die Lungenarterienembolie (LE) ist eine häufig auftretende Komplikation bei kritisch kranken Patienten. Das gleichzeitige Auftreten von LE und lebensbedrohlichen Blutungen ist ein therapeutisches Dilemma. Für diese Patientenpopulation stellen Vena-cava-Filter (VCF) eine therapeutische Option dar. Der Angel®-Katheter (Bio2 Medical Inc. San Antonio, TX, USA) ist ein neuartiger temporärer VCF, der bettseitig ohne Durchleuchtung implantiert wird.

Methodik

Das europäische Angel®-Katheter-Register ist eine multizentrische Beobachtungsstudie. In unserer Substudie wurden Patienten aus 3 deutschen Kliniken und 4 Intensivstationen eingeschlossen, die zwischen Februar 2016 und Dezember 2016 eine Angel®-Katheter-Implantation erhalten haben.

Ergebnisse

Es wurden 23 kritisch kranke Patienten (68 ± 9 Jahre, 43 % männlich) in die Studie eingeschlossen. Die Hauptindikation für die Implantation waren eine manifeste LE oder Patienten mit einem erhöhten Risiko für eine LE, in Kombination mit einer Kontraindikation für eine prophylaktische oder therapeutische Antikoagulation aufgrund eines erhöhten Risikos für eine Blutung (81 %) oder einer aktiven Blutung (13 %). In 100 % der Fälle gelang die Implantation problemlos. Während des Implantationszeitraums traten keine LE auf, wohingegen größere Thromben über 20 mm in 5 % der Fälle in der Kavographie festgestellt wurden. Die Entfernung des Filters gelang problemlos in 100 % der Fälle, während es in 3 % der Fälle zu einer Filterdislokation kam.

Diskussion

Die deutschen Daten aus dem europäischen Angel®-Katheter-Register zeigen, dass die Angel®-Katheter-Implantation eine sichere und effektive Möglichkeit ist, LE bei kritisch kranken Patienten, die eine nachgewiesene LE oder ein hohes Risiko für eine LE haben, zu verhindern, solange eine Antikoagulation kontraindiziert ist.

Abstract

Background

Pulmonary embolism (PE) is a frequently occurring complication in critically ill patients, and the simultaneous occurrence of PE and life-threatening bleeding is a therapeutic dilemma. Inferior vena cava filters (IVCF) may represent an important therapeutic alternative in these cases. The Angel® catheter (Bio2 Medical Inc., San Antonio, TX, USA) is a novel IVCF that provides temporary protection from PE and is implanted at bedside without fluoroscopy.

Material and methods

The European Angel® Catheter Registry is an observational, multicenter study. In our German substudy, we investigated patients from three German hospitals and four intensive care units, who underwent Angel® catheter implantation between February 2016 and December 2016.

Results

A total of 23 critically ill patients (68 ± 9 years, 43% male) were included. The main indication for implantation was a high risk for or an established PE, combined with contraindications for prophylactic or therapeutic anticoagulation due to either an increased risk of bleeding (81%) or active bleeding (13%). The Angel® catheter was successfully inserted in all patients at bedside. No PE occurred in patients with an indwelling Angel® catheter. Clots with a diameter larger the 20 mm, indicating clot migration, were detected in 5% of the patients by cavography before filter retrieval. Filter retrieval was uneventful in all of our cases, while filter dislocation occurred in 3% of the patients.

Conclusion

The German data from the multicenter European Angel® Catheter Registry show that the Angel® catheter is a safe and effective approach for critically ill patients with a high risk for the development of PE or an established PE, when an anticoagulation therapy is contraindicated.

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Abbreviations

CTA:

CT-Angiographie

ITS:

Intensivstation

LE:

Lungenembolie

TVT:

Tiefe Beinvenenthrombose

UH:

Unfraktioniertes Heparin

VCF:

Vena-cava-Filter

VCI:

Vena cava inferior

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Authors and Affiliations

  1. I. Medizinische Klinik, Abteilung für Kardiologie, Pneumologie, Angiologie und internistische Intensivmedizin, Universitätsklinikum Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167, Mannheim, Deutschland

    S. Baumann, T. Becher, K. Giannakopoulos, C. Jabbour, C. Fastner, I. El-Battrawy, U. Ansari, D. Lossnitzer, M. Behnes, M. Borggrefe & I. Akin

  2. Neurologische Klinik, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland

    A. Alonso

  3. Klinik für Anästhesiologie und operative Intensivmedizin, Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland

    T. Kirschning

  4. Medizinische Klinik II – Kardiologie, Nephrologie und Dialyse, Klinikum Bremerhaven, Bremerhaven, Deutschland

    R. Dissmann

  5. Klinik für Anästhesiologie und Operative Intensivmedizin, Klinikum Bremerhaven, Bremerhaven, Deutschland

    O. Kueck

  6. Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Köln, Deutschland

    D. Stern & G. Michels

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  1. S. Baumann
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  9. M. Behnes
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  14. D. Stern
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  15. G. Michels
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  16. M. Borggrefe
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Corresponding author

Correspondence to S. Baumann.

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Interessenkonflikt

S. Baumann, T. Becher, K. Giannakopoulos, C. Jabbour, C. Fastner, I. El-Battrawy, U. Ansari, D. Lossnitzer, M. Behnes, A. Alonso, T. Kirschning, R. Dissmann, O. Kueck, D. Stern, G. Michels, M. Borggrefe und I. Akin geben an, den bettseitig implantierbaren V.-cava-Filter (Angel®-Katheter) kostenfrei von der Firma Bio2 Medical Inc. (San Antonio, Texas, USA) zur Verfügung gestellt bekommen zu haben, jedoch keine Honorare oder sonstige finanzielle Zuwendungen erhalten zu haben.

Von allen beteiligten Patienten oder deren gesetzlichen Betreuer liegt eine Einverständniserklärung vor. Alle beschriebenen Untersuchungen wurden mit Zustimmung der jeweilig zuständigen Ethikkommission, im Einklang mit dem nationalen Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt.

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M. Buerke, Siegen

S. Baumann und T. Becher haben zu gleichen Teilen zu diesem Manuskript beigetragen.

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Baumann, S., Becher, T., Giannakopoulos, K. et al. Bettseitige Implantation eines neuen passageren V.-cava-inferior-Filters . Med Klin Intensivmed Notfmed 113, 184–191 (2018). https://doi.org/10.1007/s00063-017-0294-9

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