腔静脉滤器植入后流场PIV测试及对下腔静脉影响的研究
发布时间：2018-08-05 15:32
【摘要】：目的:目前对腔静脉滤器使用能有效减少致死性肺栓塞的发生国内外已有共识,但有报道及我们临床中发现滤器置入存在一些并发症如腔静脉滤器血栓形成,滤器的移位、倾斜、阻塞等,本研究通过建立滤器植入后的腔静脉体外物理模型,采用粒子图像测速技术(particle image velocimetry,PIV)进行检测,观察植入的滤器对腔静脉流场的影响,并通过动物实验进行观察滤器植入后下腔静脉的病理性变化及滤器表面覆盖组织情况。方法:1.回顾性分析2008年6月至2014年6月期间成功回收的164例可回收下腔静脉滤器(OPTEASE),观察取出的可回收下腔静脉滤器粘附血栓大小、部位等特点,并分析滤器继发血栓形成与滤器倾斜度、钩端贴壁、滤器置入后腔静脉扩张率、留置时间、抗凝的相关性。2.选取2010年1月~2013年1月行OPTEASE植入后100例患者的影像学资料,分别测量滤器植入后滤器体部固定段、锥形部中点及邻近段正常下腔静脉直径,根据这些数据按照1:1的比例,制作滤器植入后腔静脉的体外物理管状模型。3.循环液采用黏度与人体血液相似的35%的甘油水溶液,采用PIV测试技术,对制作的物理模型进行流场测试,观察该模型的滤器植入段局部流场中流体流速变化以及涡量的分布等。4.选用健康成年Beagle犬共20只,4只为对照组,余16只为滤器植入组。麻醉后通过股静脉为入路进行操作,滤器组将可回收下腔静脉滤器(OPTEASE)植入下腔静脉肾下段1cm处。术后2周、4周、8周、12周后分4批行彩超检查、双源CT扫描及重建,后处死动物,第批4只,取出包括滤器植入段的下腔静脉及邻近的正常下腔静脉1cm,通过肉眼观察、光学显微镜以及扫描电镜检查,对滤器支柱的内膜覆盖情况进行观察并分析,比较术后2周、4周、8周、12周的滤器表面覆盖的新生内膜情况。结果:1.本组临床病例滤器相关性血栓形成率为31.1%,当滤器最大倾斜度≥15°、钩端贴壁、滤器置入后腔静脉扩张率≥50%、滤器留置时间2周,其滤器相关性血栓形成率分别为70.3%、79.6%、64.7%和86.2%,与对照组相比,滤器血栓形成的差异均有明显统计学意义(p0.001)。而血栓平均长度分别为8.6±1.7mm、5.3±1.4mm、10.1±2.2mm和3.6±0.9mm,滤器最大倾斜度≥15°和滤器置入后腔静脉扩张率≥50%与滤器置留时间2周相比血栓长度差异有统计学意义(p0.05)。2.成功制成滤器植入后的腔静脉体外物理模型,滤器植入前下腔静脉血流为层流为主,滤器植入后滤器段下腔静脉明显扩张,血流减慢,滤器倾斜角0°、5°、10°时滤器内仍有层流为主,轴流未见偏离,血流对血管壁的剪切力低;滤器倾斜角15°、钩端贴壁时滤器内层流消失,轴流偏离,血流对血管壁的剪切力明显增高,滤器偏向侧形成血流郁滞区及涡流。3.滤器组16只实验犬均成功植入下腔静脉滤器,术后彩色多普勒检查发现术前下腔静脉肾下段血管平均直径为13.47?0.38mm,滤器植入后2、4、8、12周下腔静脉明显扩张,平均直径为17.81?0.47mm、17.70?0.46mm、17.65?0.40mm及17.39?0.56mm。滤器植入前、后比较下腔静脉直径有明显差异(p㩳0.001);术前下腔静脉平均血流速度为45.6?1.69cm/s,术后滤器内轴流平均流速2、4、8、12周分别为23.3?2.01cm/s、23.4?1.8cm/s、25.5?2.3cm/s及25.4?3.4cm/s,滤器植入前、后比较下腔静脉内血流速度有明显差异(p㩳0.001);而维持血流速度的压力梯度术前为0.844?0.078mmhg,术后2、4、8、12周分别为0.186?0.036mmhg、0.190?0.035mmhg、0.197?0.034mmhg及0.212?0.058mmhg,滤器植入前、后比较下腔静脉内血流压力梯度有明显差异(p㩳0.001),对照组术前、术后无变化。4.滤器组术后双源ct扫描及多维重建检查发现ctv显示滤器植入段下腔静脉扩张,滤器处腰椎静脉丛侧支血管开放,2周时4例滤器全部支撑杆均局限在ivc管腔内;4周时1例滤器支撑杆大部分穿出ivc壁;8周时2例滤器支撑杆大部分穿出ivc壁,2例滤器支撑杆完全在ivc管腔以外,在滤器支撑柱突出管腔处,静脉壁增厚,其中有1例下腔静脉内发现有条状血栓形成;12周时4例滤器支撑杆W4完全在ivc管腔以外,静脉壁呈偏心性增厚,下腔静脉内均可发现条状血栓形成。ct仿真内窥镜成像(ctve)发现滤器支撑柱固定处内腔面凹陷,邻近支撑柱两侧血管内膜明显增厚,形成嵴突起,滤器植入处下腔静脉内腔面凹凸不平,并见有条状血栓漂浮,而邻近正常血管内腔内光滑,对照组术前、术后无变化。5.大体及镜下观察发现术后2、4、8、12周下腔静脉外膜完整,滤器组均未见穿破下腔静脉突入周围组织脏器,术后2周滤器支撑柱大部分陷入血管壁内,滤器表面覆盖半透明的薄层组织,滤器与血管壁分离容易;术后4、8、12周滤器支撑柱已经完全嵌入在增生的内膜下,滤器表面覆盖组织增厚,厚度不均,滤器钩端与血管壁粘连,术后4周剥离滤器困难,并撕裂少许内膜组织,术后8周滤器附着少许血栓,剥离滤器极困难,撕裂较多内膜组织,术后12周滤器附着血栓增多,滤器的支撑柱及钩端全部陷入血管壁内,增生的内膜覆盖较厚,腔静脉内腔面粗糙不平,滤器不能剥离腔静脉,强行剥离则撕断腔静脉。而术后8、12周滤器表面增生的内膜较术后2、4周肉眼观察明显增厚。术后2周镜下发现滤器植入处见内皮细胞变扁,内弹力层变薄,血管壁内见裂隙形成,滤器支撑柱接触处内皮细胞损伤,内膜下胶原纤维暴露。术后8、12周滤器表面内膜层纤维组织明显增生,局灶胶原化,增生的内膜成分主要为平滑肌细胞、胶原纤维和少量的巨噬细胞所组成。滤器抽取后的空洞周围可见大量胶原纤维增生,排列紊乱,血管壁间见大量裂隙形成,引起血管壁结构损伤。对照组术前、术后无变化。6.扫描电子显微镜观察术后2周滤器表面见条索状、粗细不等的胶原纤维相互交织,并见少许内细胞覆盖。术后4周滤器表面胶原纤维增粗、聚集,部分为胶原纤维覆盖。术后8周滤器表面胶原纤维明显增粗、增厚,并有血小板粘附,大部分为胶原纤维覆盖。术后12周滤器表面被增生内膜基本覆盖,胶原纤维增生、堆积,并有血小板及红细胞沉积形成血栓。术后2、4、8、12周的滤器血栓捕获区表面的新生内膜覆盖率分别是(14.34?8.85)%、(29.52?12.38)%、(62.63?12.94)%、和(68.88?10.74)%。术后2周、术后4周与术后8、12周组间差异有统计学意义(p0.001);术后8周与12周组间差异无统计学意义(p0.05);术后2、4、8、12周滤器侧支撑柱表面的内膜覆盖率分别是(42.57?8.20)%、(93.58?5.46)%、100%、和100%,术后2周与术后4、8、12周组间差异有统计学意义(P0.001),术后4周、8周、12周组间差异无统计学意义(P0.05)。结论:1.滤器植入后使腔静脉局部扩张,血流减慢,通过PIV测试发现滤器倾斜角大于15°时,滤器内层流消失,轴流偏离,滤器偏向侧形成湍流及涡流,血流对血管壁的剪切力增强。表明滤器植入后对腔静脉血流有阻挡作用,随着倾斜角的增大,滤器对腔静脉的流速、流态、轴流偏离及血管壁的切应力产生影响,是继发腔静脉血栓,引起腔静脉阻塞的危险因素。2.植入腔静脉滤器的动物实验影像检查提示滤器植入后腔静脉扩张,血流减慢,并见腰椎侧支血管开放,表明滤器对腔血流有阻拦作用。大体及镜下发现滤器植入后血管壁内胶原组织增生,产生丛多裂隙改变,引起血管壁损伤及重塑,滤器植入时间的延长,滤器表面胶原纤维交织、增厚,并激发血小板、红细胞贴附,继发血栓形成,此型滤器植入后8周出现滤器表面内膜增生明显,侧支撑柱及钩端完全包埋于增生的内膜下,并易继发血栓形成,取出滤器极困难,并撕裂内膜组织。
[Abstract]:Objective: at present, the use of the vena cava filter can effectively reduce the occurrence of fatal pulmonary embolism at home and abroad. However, it is reported that some complications such as thrombus formation of the vena cava filter, the displacement of the filter, the tilt and obstruction are found in the filter, and the external physical model of the vena cava after the filter is established in this study. Particle image velocimetry (PIV) was used to detect the effect of the implanted filter on the flow field of the vena cava, and the pathological changes of the inferior vena cava and the surface of the filter were observed through animal experiments. 1. retrospective analysis of the period from June 2008 to June 2014. 164 cases of the recovery of the inferior vena cava filter (OPTEASE) were recovered, and the size and location of the recoverable inferior vena cava filter were observed. The secondary thrombus formation and the gradient of the filter, the Leptospira wall, the dilation rate of the vena cava after the filter, the retention time, and the correlation of anticoagulant.2. were selected to select OP in January 2010 ~2013. The imaging data of 100 patients after TEASE implantation were measured. The diameter of the normal inferior vena cava in the midpoint and adjacent segment of the filter was measured respectively. According to the ratio of 1:1, the external physical tubular model of the vena cava after the filter implanted into the vena cava was used as the 35% Gump of the human blood similar to the human blood. In the oil and water solution, the PIV test technique was used to test the flow field of the physical model. 20 healthy adult Beagle dogs were selected to observe the flow velocity changes in the local flow field and the distribution of the vorticity in the local flow field of the filter. 4 of the control groups were used as the control group and the other 16 were implanted into the filter. The femoral vein was used as the approach after anesthesia. The filter group was implanted the inferior vena cava filter (OPTEASE) into the inferior vena cava subrenal segment 1cm. 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the operation, color Doppler ultrasound was divided into 4 batches, double source CT scan and reconstruction, and then the animals were killed, 4 were taken out of the inferior vena cava including the filter implant segment and the adjacent normal inferior vena cava 1cm. The optical microscope was observed by the naked eye. Optical microscope was used for optical microscopy. And scanning electron microscopy (SEM) examination and analysis of the intima coverage of the filter support, compared with the 2 weeks, 4 weeks, 8 weeks and 12 weeks of the neointima on the filter surface. Results: 1. the incidence of thrombus formation was 31.1% in the 1. clinical cases, the maximum slope of the filter was more than 15 degrees, the Leptospira was adhered to the wall, and the dilatation rate of the vena cava after the filter was placed. 50% and 2 weeks, the filter related thrombus formation rate was 70.3%, 79.6%, 64.7% and 86.2%, respectively. Compared with the control group, the difference in the formation of the filter was statistically significant (p0.001). The average length of the thrombus was 8.6 + 1.7mm, 5.3 + 1.4mm, 10.1 + 2.2mm and 3.6 + 0.9mm, the maximum gradient of the filter was more than 15 degrees and the filter was placed. The dilation rate of the posterior vena cava was more than 50% and the length of the filter was 2 weeks. The difference in the length of the thrombus was statistically significant (P0.05).2. was successfully made into the external physical model of the vena cava after the filter implantation. The blood flow of the inferior vena cava was mainly laminar flow before the filter implantation. The lower cavity vein, the blood flow slowed down, the tilt angle of the filter was 0, 5 degrees, after the filter implantation. There is still laminar flow in the filter at 10 degrees, the axial flow is not deviated, the shear force of blood flow to the blood vessel wall is low, the tilt angle of the filter is 15 degrees, the inner flow of the filter is disappeared, the axial flow deviates, the shear force of the blood flow to the blood vessel wall is obviously increased, and the blood flow stagnation area and the.3. filter group of the filter are successfully implanted into the inferior vena cava. The filter, postoperative color Doppler examination revealed that the mean diameter of the inferior vena cava was 13.47? 0.38mm before operation, and the vena cava dilated obviously at 2,4,8,12 weeks after the filter implantation. The average diameter was 17.81? 0.47mm, 17.70? 0.46mm, 17.65? 0.40mm and 17.39? 0.56mm. filters were implanted before, and the inferior vena cava diameter was significantly different (P? 0.001); before operation, the inferior vena cava was significantly different (P? 0.001). The mean velocity of blood flow in the vena cava was 45.6? 1.69cm/s. The average axial flow velocity in the postoperative filter was 23.3? 2.01cm/s, 23.4? 1.8cm/s, 25.5? 2.3cm/s and 25.4? 3.4cm/s. The velocity of the blood flow in the inferior vena cava was significantly different (P? 0.001) before the filter was implanted (P? 0.001), and the pressure gradient of the blood flow velocity was 0.844? 0.078mmhg, and postoperative 2,4 The 8,12 weeks were 0.186? 0.036mmhg, 0.190? 0.035mmhg, 0.197? 0.034mmhg and 0.212? 0.058mmhg. The pressure gradient in the inferior vena cava was significantly different (P? 0.001) before the filter was implanted (P? 0.001). Before operation, the double source CT scan and multidimensional reconstruction of the.4. filter group found CTV display filter implantation in the inferior vena cava after the operation. On the filter, the collateral vessels of the lumbar plexus were open. At 2 weeks, all the support rods of the 4 filters were confined to the IVC cavity. At 4 weeks, 1 of the filter support rods were mostly through the IVC wall; 2 cases of filter support rods were mostly through the IVC wall at 8 weeks, 2 of the filter support rods were completely outside the IVC cavity, and the vein wall thickened at the filter support column. The vein wall thickened, among them the wall thickened. Among them, the venous wall thickened. Among them, the venous wall thickened. Among them, venous wall thickened. Among them, venous wall thickened. Among them, venous wall thickened. Among them, venous wall thickened. Among them, venous wall thickened. Among them vein walls thickened. Among them, venous walls thickened. 1 cases of inferior vena cava were found to form a strip of thrombus; at 12 weeks, 4 cases of filter support rod W4 were entirely outside the IVC cavity, the wall of the vein was eccentric thickening, and a.Ct simulation endoscope imaging (CTVE) found in the inferior vena cava found the inner cavity surface of the filter support column was concave, and the intima intima on both sides of the adjacent support column was thickened obviously. The internal cavity of the inferior vena cava of the filter implants was uneven, and there was a bar like thrombus floating in the inferior vena cava, and the adjacent normal intravascular cavity was smooth. Before operation, no change of.5. in the control group was observed and the external membrane of the vena cava was intact in 2,4,8,12 weeks after operation. The filter group did not penetrate the inferior vena cava into the surrounding tissue, 2 after the operation. The filter's surface covered most of the vascular wall, the filter surface covered with a translucent thin layer of tissue, and the filter was easily separated from the vascular wall. After the operation, the 4,8,12 week filter support column had been completely embedded under the hyperplastic intima. The thickness of the filter surface was thickened, the thickness of the filter was uneven, the hook end of the filter was adhered to the wall of the vessel, and the filter was difficult to be stripped 4 weeks after the operation. Tearing a little intima tissue, a little thrombus was attached to the filter 8 weeks after the operation. The dissection filter was very difficult to tear more intima tissue. The filter attached more thrombosis after 12 weeks. The support column and the hook end of the filter were all trapped inside the vessel wall. The intima of the hyperplasia was thick, the inner cavity of the vena cava was rough, the filter could not peel off the vena cava and forced exfoliation. 2 weeks after the operation, the endothelial cells became flat, the inner elastic layer became thinner, the internal elastic layer became thinner, the inner wall of the vascular wall was formed, the endothelial cells in the contact area of the filter support column were damaged and the intima collagen fibers were exposed. The 8,12 week filter table after the operation was observed at 2 weeks after the operation. The intima fibrous tissue was obviously proliferated and collagenated. The endometrium was composed mainly of smooth muscle cells, collagen fibers and a small number of macrophages. A large number of collagen fibers proliferated around the cavity after the filter extraction. After 2 weeks after the operation, the surface of the filter was observed on the surface of the filter, and the collagenous fibers were interwoven with each other in 2 weeks. The collagen fibers on the surface of the filter were thickened, aggregated and covered with collagen fibers at 4 weeks after the operation. The collagen fibers on the surface of the filter were thickened, thickened and adhered to platelets on the surface of the filter 8 weeks after the operation. Most of these were covered with collagen fibers. 12 weeks after the operation, the surface of the filter was basically covered by the hyperplasia intima, collagen fibrils proliferated and accumulated, with platelets and red blood cells deposited to form thrombus. The neointimal coverage on the surface of the filter area on the 2,4,8,12 week after the operation was (14.34? 8.85)%, (29.52? 12.38)%, (62.63? 12.94)%, and (68.88? 10.74)%). There was a significant difference between the 2 weeks after the operation and the 4 weeks after the operation (p0.001), and there was no significant difference between the 8 and 12 weeks after the operation (P0.05), and the intimal coverage on the surface of the lateral support column on the 2,4,8,12 weeks after the operation was (42.57? 8.20)%, (93.58? 5.46), 100%, and 100%, and there was a statistically significant difference between groups after the operation and 4,8,12 weeks after the operation. (P0.001), there was no significant difference between the 4 weeks, 8 weeks and 12 weeks after the operation (P0.05). Conclusion: after the 1. filter was implanted, the vena cava was localized and the blood flow was slowed down. The inner flow of the filter was lost, the axial flow deviated, the flow of the filter was deviated from the filter device, and the shear force of the blood flow to the blood vessel wall increased. After implantation, the vena cava blood flow is obstructed. With the increase of inclination, the flow velocity, flow pattern, axial flow deviation and the shear stress of the vessel wall are influenced by the filter. It is a secondary vena cava thrombus and the risk factor of cava cava obstruction. The animal experimental imaging of the.2. implantation vena cava filter indicates that the filter is implanted into the vena cava after the filter is implanted. Dilation, slow flow of blood flow, and opening of the collateral vessels of the lumbar spine showed that the filter was blocking the blood flow of the cavity. In general and under the microscope, the collagen tissue in the wall of the vessel was proliferated after the filter was implanted, the plexus was changed, the vascular wall was damaged and remolded, the time of the filter implantation was prolonged, the collagen fiber was interwoven, thickened, and platelets were stimulated. Red blood cells were attached and secondary thrombosis was formed. The intimal hyperplasia of the filter surface was obvious at 8 weeks after the filter. The lateral support column and the hook end were completely buried under the intima of the hyperplasia, and the thrombosis was easily secondary. The filter was very difficult to remove the filter and tear the intima tissue.
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R563.5
[Abstract]:Objective: at present, the use of the vena cava filter can effectively reduce the occurrence of fatal pulmonary embolism at home and abroad. However, it is reported that some complications such as thrombus formation of the vena cava filter, the displacement of the filter, the tilt and obstruction are found in the filter, and the external physical model of the vena cava after the filter is established in this study. Particle image velocimetry (PIV) was used to detect the effect of the implanted filter on the flow field of the vena cava, and the pathological changes of the inferior vena cava and the surface of the filter were observed through animal experiments. 1. retrospective analysis of the period from June 2008 to June 2014. 164 cases of the recovery of the inferior vena cava filter (OPTEASE) were recovered, and the size and location of the recoverable inferior vena cava filter were observed. The secondary thrombus formation and the gradient of the filter, the Leptospira wall, the dilation rate of the vena cava after the filter, the retention time, and the correlation of anticoagulant.2. were selected to select OP in January 2010 ~2013. The imaging data of 100 patients after TEASE implantation were measured. The diameter of the normal inferior vena cava in the midpoint and adjacent segment of the filter was measured respectively. According to the ratio of 1:1, the external physical tubular model of the vena cava after the filter implanted into the vena cava was used as the 35% Gump of the human blood similar to the human blood. In the oil and water solution, the PIV test technique was used to test the flow field of the physical model. 20 healthy adult Beagle dogs were selected to observe the flow velocity changes in the local flow field and the distribution of the vorticity in the local flow field of the filter. 4 of the control groups were used as the control group and the other 16 were implanted into the filter. The femoral vein was used as the approach after anesthesia. The filter group was implanted the inferior vena cava filter (OPTEASE) into the inferior vena cava subrenal segment 1cm. 2 weeks, 4 weeks, 8 weeks, and 12 weeks after the operation, color Doppler ultrasound was divided into 4 batches, double source CT scan and reconstruction, and then the animals were killed, 4 were taken out of the inferior vena cava including the filter implant segment and the adjacent normal inferior vena cava 1cm. The optical microscope was observed by the naked eye. Optical microscope was used for optical microscopy. And scanning electron microscopy (SEM) examination and analysis of the intima coverage of the filter support, compared with the 2 weeks, 4 weeks, 8 weeks and 12 weeks of the neointima on the filter surface. Results: 1. the incidence of thrombus formation was 31.1% in the 1. clinical cases, the maximum slope of the filter was more than 15 degrees, the Leptospira was adhered to the wall, and the dilatation rate of the vena cava after the filter was placed. 50% and 2 weeks, the filter related thrombus formation rate was 70.3%, 79.6%, 64.7% and 86.2%, respectively. Compared with the control group, the difference in the formation of the filter was statistically significant (p0.001). The average length of the thrombus was 8.6 + 1.7mm, 5.3 + 1.4mm, 10.1 + 2.2mm and 3.6 + 0.9mm, the maximum gradient of the filter was more than 15 degrees and the filter was placed. The dilation rate of the posterior vena cava was more than 50% and the length of the filter was 2 weeks. The difference in the length of the thrombus was statistically significant (P0.05).2. was successfully made into the external physical model of the vena cava after the filter implantation. The blood flow of the inferior vena cava was mainly laminar flow before the filter implantation. The lower cavity vein, the blood flow slowed down, the tilt angle of the filter was 0, 5 degrees, after the filter implantation. There is still laminar flow in the filter at 10 degrees, the axial flow is not deviated, the shear force of blood flow to the blood vessel wall is low, the tilt angle of the filter is 15 degrees, the inner flow of the filter is disappeared, the axial flow deviates, the shear force of the blood flow to the blood vessel wall is obviously increased, and the blood flow stagnation area and the.3. filter group of the filter are successfully implanted into the inferior vena cava. The filter, postoperative color Doppler examination revealed that the mean diameter of the inferior vena cava was 13.47? 0.38mm before operation, and the vena cava dilated obviously at 2,4,8,12 weeks after the filter implantation. The average diameter was 17.81? 0.47mm, 17.70? 0.46mm, 17.65? 0.40mm and 17.39? 0.56mm. filters were implanted before, and the inferior vena cava diameter was significantly different (P? 0.001); before operation, the inferior vena cava was significantly different (P? 0.001). The mean velocity of blood flow in the vena cava was 45.6? 1.69cm/s. The average axial flow velocity in the postoperative filter was 23.3? 2.01cm/s, 23.4? 1.8cm/s, 25.5? 2.3cm/s and 25.4? 3.4cm/s. The velocity of the blood flow in the inferior vena cava was significantly different (P? 0.001) before the filter was implanted (P? 0.001), and the pressure gradient of the blood flow velocity was 0.844? 0.078mmhg, and postoperative 2,4 The 8,12 weeks were 0.186? 0.036mmhg, 0.190? 0.035mmhg, 0.197? 0.034mmhg and 0.212? 0.058mmhg. The pressure gradient in the inferior vena cava was significantly different (P? 0.001) before the filter was implanted (P? 0.001). Before operation, the double source CT scan and multidimensional reconstruction of the.4. filter group found CTV display filter implantation in the inferior vena cava after the operation. On the filter, the collateral vessels of the lumbar plexus were open. At 2 weeks, all the support rods of the 4 filters were confined to the IVC cavity. At 4 weeks, 1 of the filter support rods were mostly through the IVC wall; 2 cases of filter support rods were mostly through the IVC wall at 8 weeks, 2 of the filter support rods were completely outside the IVC cavity, and the vein wall thickened at the filter support column. The vein wall thickened, among them the wall thickened. Among them, the venous wall thickened. Among them, the venous wall thickened. Among them, venous wall thickened. Among them, venous wall thickened. Among them, venous wall thickened. Among them, venous wall thickened. Among them, venous wall thickened. Among them vein walls thickened. Among them, venous walls thickened. 1 cases of inferior vena cava were found to form a strip of thrombus; at 12 weeks, 4 cases of filter support rod W4 were entirely outside the IVC cavity, the wall of the vein was eccentric thickening, and a.Ct simulation endoscope imaging (CTVE) found in the inferior vena cava found the inner cavity surface of the filter support column was concave, and the intima intima on both sides of the adjacent support column was thickened obviously. The internal cavity of the inferior vena cava of the filter implants was uneven, and there was a bar like thrombus floating in the inferior vena cava, and the adjacent normal intravascular cavity was smooth. Before operation, no change of.5. in the control group was observed and the external membrane of the vena cava was intact in 2,4,8,12 weeks after operation. The filter group did not penetrate the inferior vena cava into the surrounding tissue, 2 after the operation. The filter's surface covered most of the vascular wall, the filter surface covered with a translucent thin layer of tissue, and the filter was easily separated from the vascular wall. After the operation, the 4,8,12 week filter support column had been completely embedded under the hyperplastic intima. The thickness of the filter surface was thickened, the thickness of the filter was uneven, the hook end of the filter was adhered to the wall of the vessel, and the filter was difficult to be stripped 4 weeks after the operation. Tearing a little intima tissue, a little thrombus was attached to the filter 8 weeks after the operation. The dissection filter was very difficult to tear more intima tissue. The filter attached more thrombosis after 12 weeks. The support column and the hook end of the filter were all trapped inside the vessel wall. The intima of the hyperplasia was thick, the inner cavity of the vena cava was rough, the filter could not peel off the vena cava and forced exfoliation. 2 weeks after the operation, the endothelial cells became flat, the inner elastic layer became thinner, the internal elastic layer became thinner, the inner wall of the vascular wall was formed, the endothelial cells in the contact area of the filter support column were damaged and the intima collagen fibers were exposed. The 8,12 week filter table after the operation was observed at 2 weeks after the operation. The intima fibrous tissue was obviously proliferated and collagenated. The endometrium was composed mainly of smooth muscle cells, collagen fibers and a small number of macrophages. A large number of collagen fibers proliferated around the cavity after the filter extraction. After 2 weeks after the operation, the surface of the filter was observed on the surface of the filter, and the collagenous fibers were interwoven with each other in 2 weeks. The collagen fibers on the surface of the filter were thickened, aggregated and covered with collagen fibers at 4 weeks after the operation. The collagen fibers on the surface of the filter were thickened, thickened and adhered to platelets on the surface of the filter 8 weeks after the operation. Most of these were covered with collagen fibers. 12 weeks after the operation, the surface of the filter was basically covered by the hyperplasia intima, collagen fibrils proliferated and accumulated, with platelets and red blood cells deposited to form thrombus. The neointimal coverage on the surface of the filter area on the 2,4,8,12 week after the operation was (14.34? 8.85)%, (29.52? 12.38)%, (62.63? 12.94)%, and (68.88? 10.74)%). There was a significant difference between the 2 weeks after the operation and the 4 weeks after the operation (p0.001), and there was no significant difference between the 8 and 12 weeks after the operation (P0.05), and the intimal coverage on the surface of the lateral support column on the 2,4,8,12 weeks after the operation was (42.57? 8.20)%, (93.58? 5.46), 100%, and 100%, and there was a statistically significant difference between groups after the operation and 4,8,12 weeks after the operation. (P0.001), there was no significant difference between the 4 weeks, 8 weeks and 12 weeks after the operation (P0.05). Conclusion: after the 1. filter was implanted, the vena cava was localized and the blood flow was slowed down. The inner flow of the filter was lost, the axial flow deviated, the flow of the filter was deviated from the filter device, and the shear force of the blood flow to the blood vessel wall increased. After implantation, the vena cava blood flow is obstructed. With the increase of inclination, the flow velocity, flow pattern, axial flow deviation and the shear stress of the vessel wall are influenced by the filter. It is a secondary vena cava thrombus and the risk factor of cava cava obstruction. The animal experimental imaging of the.2. implantation vena cava filter indicates that the filter is implanted into the vena cava after the filter is implanted. Dilation, slow flow of blood flow, and opening of the collateral vessels of the lumbar spine showed that the filter was blocking the blood flow of the cavity. In general and under the microscope, the collagen tissue in the wall of the vessel was proliferated after the filter was implanted, the plexus was changed, the vascular wall was damaged and remolded, the time of the filter implantation was prolonged, the collagen fiber was interwoven, thickened, and platelets were stimulated. Red blood cells were attached and secondary thrombosis was formed. The intimal hyperplasia of the filter surface was obvious at 8 weeks after the filter. The lateral support column and the hook end were completely buried under the intima of the hyperplasia, and the thrombosis was easily secondary. The filter was very difficult to remove the filter and tear the intima tissue.
【学位授予单位】：苏州大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R563.5
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