Development of a postoperative occlusive thrombus at the site of an implanted inferior vena cava filter: A case report.
Development of a postoperative occlusive thrombus at the site of an implanted inferior vena cava filter: A case report.
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在植入的下腔静脉过滤器部位开发术后闭塞血栓：病例报告。
DOI：
10.1097/md.0000000000009675
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发表时间：
2018-01
期刊：
影响因子：
1.6
通讯作者：
Yorozuya T
中科院分区：
文献类型：
--
作者：
Kukida A;Takasaki Y;Nakata M;Nishihara T;Kitamura S;Fujii S;Watanabe Y;Yorozuya T
尽管放置下腔静脉（IVC）滤器是为了防止致命性肺栓塞（PE），但已报告了与IVC滤器相关的几种并发症。我们描述了一例症状性PE，其起源是腹腔镜辅助全胃切除术（LATG）后放置IVC滤器形成的闭塞性IVC血栓。一位71岁的男性在全身麻醉下接受了LATG。他13年前植入了下腔静脉滤器。手术前4天，用普通肝素静脉输注代替口服华法林停药。进行了拟定手术，总共花费了404分钟，包括374分钟的气腹时间。 手术后，患者出现严重寒战反应，需要频繁推注抗高血压药物。在术后第三天，他主诉在短距离散步后呼吸困难，随后失去意识。虽然他自发恢复，不需要任何复苏努力，我们进行了计算机断层扫描（CT）检查疑似PE。CT显示，从IVC滤器到左髂总静脉的静脉内空间存在大量血栓，外周肺动脉中存在几处栓塞缺损。建立了抗凝治疗，在前四天每天两次口服10 mg阿哌沙班，随后减少至5 mg。 术后第17天，超声血管检查证实深静脉血栓（DVT）完全消失。由于IVC滤器本身可能是DVT的潜在来源，因此我们应在围手术期对既往植入过IVC滤器的患者进行仔细管理。
Although an inferior vena cave (IVC) filter is placed to prevent fatal pulmonary embolism (PE), several complications associated with an IVC filter have been reported. We describe a case with symptomatic PE, of which the origin was an occlusive IVC thrombus that developed from the placement of an IVC filer after a laparoscopy-assisted total gastrectomy (LATG). A 71-year-old man underwent LATG under general anesthesia alone. He had an IVC filter implanted 13 years ago. An intravenous infusion of unfractionated heparin was substituted for the discontinuation of oral warfarin four days before the surgery. The proposed operation was performed and took a total of 404 minutes including the total duration of pneumoperitoneum that took 374 minutes. After the surgery, he experienced severe shivering reactions that required frequent bolus infusions of antihypertensive drugs. On the third postoperative day, he complained of dyspnea after taking a short walk, and subsequently lost consciousness. While he spontaneously recovered without requiring any resuscitation efforts, we performed computed tomography (CT) examination for suspected PE. The CT showed that a massive thrombus was occupying the intravenous space from the IVC filter to the left common iliac vein with several embolic defects in the peripheral pulmonary arteries present. An anticoagulant therapy was established with 10 mg of oral apixaban given twice a day for the first four days, followed by a reduction to 5 mg. On the 17th postoperative day, an ultrasound vascular examination confirmed the complete disappearance of deep venous thrombus (DVT). As an IVC filter itself may be a potential source of DVT, we should carefully manage patients with a previously implanted IVC filter throughout the perioperative period.