永久性下腔静脉滤器放置预防肺栓塞

目的评价永久性下腔静脉滤器置入术在下肢深静脉血栓形成(DVT)患者中预防肺栓塞(PE)的有效性和安全性。方法 48例下肢深静脉血栓形成(DVT)患者全部行永久性下腔静脉滤器置入术,采用B/BRAUN VENA TECHTM LP滤器,滤器均位于肾静脉水平以下的下腔静脉中。结果 48例滤器经健侧股静脉穿刺置入,手术均获成功,无滤器释放不全、穿孔、脱落、移位、出血和滤器释放通路血栓形成。术后随访48例,随访时间1~26个月,未出现滤器移位、倾斜、下腔静脉血栓形成和肺栓塞(PE)。结论永久性下腔静脉滤器置入术可以安全和有效预防肺栓塞(PE)的发生,且手术操作简便,并发症少。     

下腔静脉滤器预防致死性肺栓塞

目的:评价置入下腔静脉滤器预防因下肢静脉血栓脱落引起肺栓塞的效果和安全性。材料和方法:40例下肢深静脉血栓患者,男23例,女17例,年龄31～79岁,中位年龄58岁。经下肢静脉造影证实有股髂静脉血栓,病变位于左下肢26例,右下肢10例,双下肢4例,同时16例经多普勒检查诊断。经股静脉或颈静脉穿刺置入下腔静脉滤器,术后分别于1,6,12个月摄腹部平片复查,以后每年复查腹部平片,观察滤器的位置、形态变化。结果:放置滤器42枚,经颈静脉穿刺4例,经右股静脉28例,经左股静脉10例,包括钛质Greenfieldfilter(TKG)14例,Bird'snestfilter(BNF)12例,Si-mon镍钛下腔静脉滤器10例,Tulip滤器3例(2枚已取出),Trapease滤器3例。滤器位于双肾静脉水平以下的腔静脉内。无严重并发症发生。随访发现2例TKG向足侧移位,1例TKG向头侧移位,2例BNF跨度增大,腹部CT,腔静脉造影发现一只脚穿透腔静脉壁,未出现任何症状,4例TKG和1例SNF发生滤器偏斜,角度小于15°。无1例发生腔静脉阻塞或复发肺栓塞。结论:置入下腔静脉滤器预防肺栓塞是安全、有效的方法。     

Bilateral proximal deep vein thrombosis and COVID‐19 in a patient with absence of inferior vena cava: A case report and review of literature

Bilateral proximal deep vein thrombosis (DVT) in the lower extremities of young patients should raise suspicion over pro‐thrombotic conditions and venous anatomical abnormalities, even in the presence of other precipitating factors, such as viral infection. The authors present a 33‐year‐old man with bilateral DVT and absence of inferior vena cava (AIVC), who also had concurrent COVID‐19, and discuss the management of this patient.     

Guidelines and the use of inferior vena cava filters: a review of an institutional experience

Summary.  Background and objectives:  Based on the American College of Chest Physicians 2004 antithrombotic therapy for venous thromboembolism (VTE) and the Eastern Association for the Surgery of Trauma 2002 guidelines, placement of an inferior vena cava (IVC) filter is indicated in patients who either have, or are at high risk for, VTE, but have a contraindication or failure of anticoagulation. Our aim is to compare clinical characteristics and outcomes of patients receiving IVC filters within-guidelines (WG) and outside-of-guidelines (OOG). Methods:  The 558 patients who received an IVC filter were divided into two groups called WG or OOG. The WG group met the criteria described above and the OOG group did not have a contraindication to or a failure of anticoagulation. Results:  The WG group had 362 patients and the OOG group had 196 patients. The OOG group had one (0.5%) patient with post-filter pulmonary embolism (PE), two (1%) with IVC thrombosis, and seven (3.6%) with deep vein thrombosis (DVT). The WG group had five (1.4%) patients with post-filter PE, 13 (3.6%) with IVC thrombosis, and 34 (9.4%) with DVT. All patients who developed post-filter PE had a DVT before filter placement, and patients who did not have a prior VTE event were at a significantly lower risk of developing post-filter IVC thrombosis and PE. Conclusion:  Our data do not support the use of an IVC filter outside of guidelines in patients without prior VTE who can tolerate anticoagulation because of the low risk of developing PE.     

Life-threatening intracardiac cement embolisms after percutaneous kyphoplasty: a case report and literature review

BackgroundPercutaneous kyphoplasty is a popular technique in the treatment of osteoporotic vertebral fractures, but intracardiac cement embolism can be a life-threatening complication.Case presentation: The authors present a case involving a patient who developed dyspnea and chest tightness after percutaneous kyphoplasty. Echocardiography and chest computed tomography confirmed several foreign bodies in the right atrium and pulmonary arteries causing cardiac perforation and pericardial tamponade. Conservative treatment was administered, and the patient died of respiratory and heart failure.ConclusionsThe present case highlights that surgical removal may be the first-choice treatment for symptomatic intracardiac cement embolism.     

Contrast-enhanced ultrasonography of intraluminal inferior vena cava leiomyosarcoma: A case report

Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare and fatal disease. Imaging is the main diagnostic method. CT and MRI images of IVC leiomyosarcoma have been published, but ultrasonographic features have been scarcely described, especially with contrast-enhancement. We report the case of a patient in whom ultrasonography incidentally revealed a mass in the IVC. Contrast-enhanced ultrasonography showed heterogeneous enhancement in the arterial phase with some irregular non-enhanced areas, and mild clearance in the venous phase. The location and nature of the lesion as shown by ultrasonography were confirmed by CT and MRI.     

原发性下腔静脉平滑肌肉瘤1例

患者女,55岁,间歇性右上腹疼半年。体检腹软,未触及包块。实验室检查未见异常。超声诊断:下腔静脉实性占位。CT检查:肝门至肾门水平下腔静脉走行区见一不规则形软组织密度肿块,边缘略呈分叶状,大小约9.0cm×4.5cm×4.5cm(图1),增强扫描呈不均匀强化,下腔静脉管腔增粗,胰头受压移位(图2)。CT诊断:下腔静脉占位性病变,平滑肌肉瘤可能性大。MR下腔静脉及门静脉成像:下腔静脉平肾门至第二肝门水平明显扩张,最宽处直径约4.5cm,其内见大小约9.0cm×4.5cm×4.5cm略长T2信号,增强扫描呈不均匀异常强化,门静脉主干及其分支未见异常(图3)。MR诊断:…     

Endovascular therapy for floating thrombus in the inferior vena cava

ObjectiveWe aimed to summarize the clinical characteristics of floating thrombus in the inferior vena cava (IVC).MethodsFrom January 2014 to June 2019, four patients with floating thrombus in the IVC were admitted to our hospital and underwent intracavitary therapy. Diagnosis, therapy, and clinical characteristics of floating thrombus were summarized.ResultsThree patients presented with pulmonary embolism. Three of the patients had a floating thrombus discovered by inferior venacavography and one was found by contrast-enhanced computed tomography. Two patients had deep venous thrombosis in the lower extremities. One patient had a double IVC, one had left iliac vein compression syndrome, and one had right renal phlebothrombosis. The four patients underwent implantation of a temporary IVC filter and were treated with anti-coagulation, debulking, and thrombolysis. All four patients achieved satisfactory results.ConclusionsFloating thrombus in the IVC is often caused by spread of branch vein thrombosis, and is more likely to lead to pulmonary embolism. Anti-coagulant therapy and debulking under the protection of filters can achieve satisfactory clinical results.     

Deep vein thrombosis in patient with left-sided inferior vena cava draining into the hemiazygos vein: A case report

BACKGROUNDAbnormalities of the inferior vena cava (IVC) are uncommon, and in many cases they are asymptomatic. Even so, it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals. In the present report, we describe a rare anatomical variation of the IVC.CASE SUMMARYA 66-year-old male was admitted to the hospital due to deep vein thrombosis of the right lower extremity. Upon contrast-enhanced computed tomography imaging, we found that this patient presented with a case of left-sided IVC draining into the hemiazygos vein, while his hepatic vein was directly draining into the atrium.CONCLUSIONCases of left-sided IVC can increase patient susceptibility to thromboembolism owing to the resultant changes in blood flow and/or associated vascular compression.     

下腔静脉滤器置入应用于下肢深静脉血栓形成的临床分析

目的 探讨下腔静脉滤器(VCF)置入联合抗凝溶栓治疗下肢深静脉血栓形成(DVT)的效果及防治肺动脉栓塞的意义.方法 回顾性分析2009年1月至2011年9月我院收治的DVT患者115例,选择27例适合行VCF置入的患者,在数字减影血管造影术下行VCF置入,术后给予溶栓、抗凝等治疗.结果 27例患者下腔静脉内均成功置入VCF,经溶栓、抗凝后患肢肿胀明显消退,术后无肺栓塞及滤器置入相关并发症发生.结论 VCF置人联合抗凝溶栓治疗DVT疗效好且安全,VCF置入可有效预防下肢深静脉血栓患者肺栓塞的发生.     

Preoperative intravascular ultrasonographic evaluation of leiomyosarcoma of the inferior vena cava: A case report

Leiomyosarcoma of the inferior vena cava is a rare malignant tumor originating from smooth muscle cells of the vascular media. Its preoperative diagnosis by conventional noninvasive examinations such as abdominal ultrasonography, X-ray computed tomography, and magnetic resonance imaging, may be difficult because of their nonspecific findings. We present the case of a 72-year-old woman with leiomyosarcoma of the inferior vena cava diagnosed by intravascular ultrasonography.     

Anesthetic management for intraoperative acute pulmonary embolism during inferior vena cava tumor thrombus surgery: A case report

BACKGROUNDAcute pulmonary embolism (APE) is a rare and potentially life-threatening condition, even with early detection and prompt management. Intraoperative APE required specific ways for detecting since classic symptoms of APE in the awake patient could not be observed or self-reported by the patient under general anesthesia.CASE SUMMARYA 44-year-old man with a history of hepatic cell carcinoma was admitted for radical nephrectomy and tumor thrombectomy due to a newly found kidney tumor with inferior vena cava (IVC) tumor thrombus. APE that occurred during tumor thrombectomy with hypercapnia and desaturation. The capnography combined with the transesophageal echocardiography (TEE) provided a crucial differential diagnosis during the operation. The patient was continuously managed with aggressive intravenous fluid resuscitation and blood transfusion under continuous cardiac output monitoring to maintain hemodynamic stability. He completed the surgery under stable hemodynamics and was extubated after percutaneous mechanical thrombectomy by a certified cardiologist. There were no significant symptoms and signs or obvious discomfort in the patient’s self-report during visits to the general ward.CONCLUSIONUnder general anesthesia for IVC tumor thrombus surgery, a sudden decrease in end-tidal carbon dioxide is the initial indicator of APE, which occurs before hemodynamic changes. When intraoperative APE is suspected, TEE is useful in the diagnosis and monitoring before computer tomography pulmonary angiogram. Timely clinical impression and supportive treatment and intervention should be conducted to obtain a better prognosis.     

Management of inferior vena cava injury and secondary thrombosis after percutaneous nephrolithotomy: a case report

Percutaneous nephrolithotomy (PCNL) remains an important method for treating upper urinary calculi. However, bleeding and peripheral vascular injury are serious complications of PCNL. Injury of the inferior vena cava accompanied by secondary thrombosis has rarely been reported clinically. We treated a patient who experienced bleeding during PCNL to establish a channel. A catheter was used to make a renal fistula, and the inferior vena cava was implanted. The wound was fixed and compressed by balloon injection, and secondary thrombosis and repeated infection occurred after the operation. A filter was then placed, the water balloon was released, and the fistula was removed. The anti-bacterial and anticoagulant filter was removed. This major complication was successfully managed. In our patient, during PCNL, the renal fistula entered the inferior vena cava by mistake. If this issue cannot be treated in time, it can easily lead to the formation of secondary thrombosis. A fistula can be extracted through an inferior vena cava filter, and anticoagulant treatment and other conservative treatment regimens can be used to treat patients in this situation. These treatments avoid the possibility of further damage from open surgery.     

Pulmonary embolism caused by postpartum ovarian vein thrombophlebitis after vaginal delivery: Case report and brief review of the literature

Puerperal ovarian vein thrombophlebitis is a rare pathology. We present the case of a 23-year-old female who presented with fever and cough that occurred after vaginal delivery and persisted after several courses of antibiotics between the 2nd and 20th day postpartum. CT pulmonary angiography revealed right subsegmental pulmonary embolism. An abdominal ultrasonographic examination led to the diagnosis of ovarian vein thrombosis. She was treated with warfarin for 2 weeks with a good response. Our case highlights the importance of prompt ultrasonographic diagnosis and clinical treatment of ovarian vein thrombosis to prevent morbidity and mortality.     

Ruptured inferior vena cava aneurysm in the setting of mural vascular malformation: A case report

Aneurysm of the inferior vena cava is a rare anomaly with a very few reported cases worldwide. We report the case of a 26-years-old man with acute severe abdominal pain and hypovolemic shock following an episode of syncope. Ultrasonography showed a fusiform aneurysmal dilation of the infra-hepatic inferior vena cava (IVC), with a large saccular portion at its posterolateral wall and mural thrombosis. Abdominal computed tomography scan revealed extension to the right renal vein and adhesion to the right kidney. The saccular aneurysm and the right kidney were resected, and anatomopathological examination revealed a cavernous hemangioma. All symptoms disappeared after surgery. This is the first reported case of symptomatic congenital saccular aneurysm of the IVC due to mural vascular malformation and with involvement of the right kidney leading to nephrectomy.     

Aneurysm of the inferior vena cava: case report

Venous aneurysms are uncommon. Despite their infrequency, venous aneurysms can present with significant clinical complications such as thrombosis, pulmonary embolism, and death. In this report, we present the case of a thrombosed inferior vena cava aneurysm discovered in a 16-year-old male who had deep vein thrombosis of the right lower extremity. Thrombosis of the inferior vena cava is uncommon in the pediatric population. Therefore, congenital abnormalities such as an inferior vena cava aneurysm should be considered when evaluating pediatric patients who present with deep vein thrombosis.     

可回收型下腔静脉滤器用于预防下肢静脉血栓脱落导致肺栓塞的临床价值分析

目的分析可回收型下腔静脉滤器(IVCF)应用于下肢静脉血栓脱落所导致的肺栓塞(PE)的效果及其安全性。方法选取2008年1月至2013年6月间收治的41例行可回收型IVCF置入术患者(可回收型IVCF组)以及35例行永久性IVCF植入术的静脉血栓栓塞症患者(永久性IVCF组),回顾性分析其临床资料。比较两组治疗后的效果以及近期和远期并发症情况和死亡人数。结果两组术后0~6周和7周至2年病死率差异无统计学意义(P0.05)。可回收型IVCF组慢性血栓后综合征、下腔静脉阻塞和血栓形成的发生率明显低于永久性IVCF组(P0.05)。两组出血发生率差异无统计学意义(P0.05)。结论可回收型IVCF置入效果好,且出现并发症的发生率明显少于永久性VCF组,值得临床上的推广应用。     

Retrievable inferior vena cava filter to prevent pulmonary embolism in patients with fractures and deep venous thrombosis of lower extremities: a single-center experience

ObjectiveTo evaluate the effectiveness of inserting a retrievable inferior vena cava filter (IVCF) to prevent pulmonary embolism (PE) in patients with bone fractures and acute deep venous thrombosis (DVT) before major orthopedic surgery.MethodsClinical data of patients with fractures and acute DVT who underwent IVCF insertion were analyzed. The patients were divided into above-knee DVT (AKDVT), popliteal vein thrombosis (PVT), and below-knee DVT (BKDVT) groups.ResultsAn IVCF was successfully implanted in 964 patients, among whom 929 were followed up (335, 470, and 124 in AKDVT, PVT, and BKDVT groups, respectively). There was no significant difference in the incidence of filter thrombosis among the groups (11.04%, 11.70%, and 8.06%, respectively). No symptomatic PE occurred during follow-up. The mean filter indwelling time was 18.4 ± 4.3 days, and the total filter removal rate was 76.87%. There was no significant difference in the rate of filter implantation, retrieval, complications, or mortality among the groups.ConclusionsRetrievable filters can effectively prevent PE before orthopedic surgery in patients with fractures and acute DVT of the lower limbs. AKDVT more readily forms a ≥1-cm thrombus in the IVCF than does BKDVT, and PVT more readily forms a <1-cm thrombus than does AKDVT.