Hussain Syed M, McLafferty Robert B, Schmittling Zachary C, Zakaria Aamir M, Ramsey Don E, Larson Jennine L, Hodgson Kim J
Department of Surgery, Division of Vascular Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794, USA.
Vasc Endovascular Surg. 2005 Jul-Aug;39(4):367-70. doi: 10.1177/153857440503900412.
The purpose of this paper is to report the complication of perforation of the superior vena cava (SVC) leading to cardiac tamponade after the insertion of a Trapease IVC filter in the SVC position. A 29-year-old man was hit by motor vehicle and sustained numerous injuries including a left skull fracture, intracerebral hemorrhage, and left open tibial shaft fracture. During his hospitalization, he developed an extensive symptomatic right upper extremity deep venous thrombosis involving the brachial, axillary, subclavian, internal jugular, and brachiocephalic veins. Owing to an intracerebral bleed, anticoagulation was contraindicated. Therefore, a Trapease filter (Cordis Inc.) was placed in the SVC via the left subclavian vein. Four hours later, the patient became hypotensive with associated tachycardia and tachypnea. Computed tomography of his chest revealed a hematoma around the SVC, a moderate amount of fluid within the pericardium, and a moderate-sized right pleural effusion. The patient was taken to the operating room and a pericardial window was performed. Approximately 500 cc of blood was evacuated from the pericardium and immediate improvement in vital signs was noted. The patient was discharged from the hospital 2 weeks later and at 6-month follow-up had made full recovery. This is the first case of SVC perforation leading to cardiac tamponade after the insertion of a Trapease filter. Owing to the rigid structure of the filter and associated motion of the SVC and pericardium, the Trapease filter may be contraindicated in the SVC.
本文旨在报告在将Trapease下腔静脉滤器置于上腔静脉（SVC）位置后发生上腔静脉穿孔并导致心脏压塞的并发症。一名29岁男性遭遇机动车撞击，身负多处损伤，包括左颅骨骨折、脑内出血和左胫骨开放性骨折。在住院期间，他出现了广泛的有症状的右上肢深静脉血栓形成，累及肱静脉、腋静脉、锁骨下静脉、颈内静脉和头臂静脉。由于脑内出血，抗凝治疗存在禁忌。因此，通过左锁骨下静脉将Trapease滤器（Cordis公司）置于上腔静脉。4小时后，患者出现低血压，伴有心动过速和呼吸急促。胸部计算机断层扫描显示上腔静脉周围有血肿、心包内有中等量液体以及中等量的右侧胸腔积液。患者被送往手术室并进行了心包开窗术。从心包中抽出了约500毫升血液，生命体征立即得到改善。患者于2周后出院，6个月随访时已完全康复。这是Trapease滤器置入后发生上腔静脉穿孔导致心脏压塞的首例病例。由于滤器的刚性结构以及上腔静脉和心包的相关运动，Trapease滤器可能不适用于上腔静脉。
