Usoh Fred, Hingorani Anil, Ascher Enrico, Shiferson Alexander, Tran Victor, Patel Nirav, Marks Natalie
Division of Vascular Sugery, Department of Surgery, Maimonides Medical Center, Brooklyn, NY, USA.
Vascular. 2009 Jan-Feb;17(1):44-50. doi: 10.2310/6670.2008.00076.
Although the utility of the superior vena cava (SVC) filter remains controversial, the safety and efficacy of SVC filters in patients with upper extremity deep venous thrombosis in whom anticoagulation is contraindicated or ineffective have been well described. However, few complications have been reported. Herein we describe a series of three cases of SVC perforation in three young males following the placement of SVC filters. All three patients had deep venous thrombosis on upper extremity duplex ultrasonography and contraindication to anticoagulation (n = 1) or failure of anticoagulation (n = 2). Cardiac tamponade was demonstrated on transthoracic echocardiography in all three cases. The pericardial effusion was evacuated with either median sternotomy or pericardiocentesis in two cases. One of the patients died of cardiac arrest, and an autopsy showed aortic perforation in addition to the SVC perforation. This patient underwent chest compression following the cardiac arrest. One patient was lost to follow-up, and the other patient remained asymptomatic at the 1-year follow-up. This is the first case of SVC perforation that is associated with aortic perforation after the placement of an SVC filter. Owing to this occurrence, one has to be aware of these life-threatening complications when placing an SVC filter, especially in males less than 60 years of age.
尽管上腔静脉（SVC）滤器的效用仍存在争议，但SVC滤器在抗凝治疗禁忌或无效的上肢深静脉血栓形成患者中的安全性和有效性已有充分描述。然而，报道的并发症很少。在此，我们描述了3例年轻男性在放置SVC滤器后发生SVC穿孔的病例。所有3例患者上肢双功超声检查均有深静脉血栓形成，且存在抗凝治疗禁忌（1例）或抗凝治疗失败（2例）。所有3例经胸超声心动图均显示心包填塞。2例患者通过正中胸骨切开术或心包穿刺术抽出心包积液。其中1例患者死于心脏骤停，尸检显示除SVC穿孔外还有主动脉穿孔。该患者心脏骤停后接受了胸外按压。1例患者失访，另1例患者在1年随访时仍无症状。这是首例放置SVC滤器后发生与主动脉穿孔相关的SVC穿孔病例。鉴于此情况，放置SVC滤器时必须意识到这些危及生命的并发症，尤其是在年龄小于60岁的男性患者中。
