Brodmann M, Gary T, Pilger E
Division of Angiology, Department of Internal Medicine, Medical University Graz, Austria.
Vasa. 2010 Feb;39(1):111-4. doi: 10.1024/0301-1526/a000014.
Anticoagulation still remains the primary therapy for venous thromboembolism (VTE) in order to prevent the most life-threatening form of VTE, pulmonary embolism (PE). Nevertheless in some patients anticoagulation is impossible. Then vena caval filters serve as a valuable second line therapy against the most feared complication of VTE, fatal PE. We want to present a patient with preceding PE and DVT in whom for the perioperative period a temporary vena caval filter was placed and who showed the complication of a nearly fatal PE. A seventy-two year-old white male was admitted for thrombolytic therapy for massive pulmonary embolism, which was performed successfully. Some hours later the patient developed gastrointestinal bleeding. An adenocarcinoma of the colon was diagnosed and an end-to-end hemicolectomy performed. A temporal caval filter (Gunther filter) was placed in the infrarenal vena cava for the perioperative period. Seven days later the patient syncopated with acute massive onset of dyspnea. A helix computertomography scan of the lung showed again massive central pulmonary embolism with right heart enlargement. An immediate pulmonary embolectomy had to be performed. Subsequent venal cavography revealed a thrombosed vena caval filter and a thrombus proximal to the filter. This case report should emphasize the fact that although a vena cava filter might be of high benefit in patients with contraindication for anticoagulation to prevent recurrent PE, in some cases it can be insufficient and lead to enormous complications.
为预防静脉血栓栓塞症（VTE）最危及生命的形式——肺栓塞（PE），抗凝治疗仍是主要疗法。然而，部分患者无法进行抗凝治疗。此时，腔静脉滤器作为预防VTE最可怕并发症——致命性PE的重要二线治疗手段发挥作用。我们想介绍一位既往有PE和深静脉血栓形成（DVT）的患者，其在围手术期置入了临时腔静脉滤器，并出现了近乎致命性PE的并发症。一名72岁白人男性因大面积肺栓塞接受溶栓治疗入院，溶栓治疗成功。数小时后，患者出现胃肠道出血。诊断为结肠癌并进行了端端半结肠切除术。围手术期在肾下腔静脉置入了临时性腔静脉滤器（Gunther滤器）。7天后，患者突发晕厥，伴有急性严重呼吸困难。肺部螺旋计算机断层扫描再次显示大面积中央型肺栓塞伴右心扩大。必须立即进行肺动脉血栓切除术。随后的腔静脉造影显示腔静脉滤器血栓形成，且滤器近端有血栓。本病例报告应强调，尽管腔静脉滤器对有抗凝禁忌证的患者预防复发性PE可能有很大益处，但在某些情况下它可能并不充分，并导致严重并发症。
