Kukida Ayako, Takasaki Yasushi, Nakata Mio, Nishihara Tasuku, Kitamura Sakiko, Fujii Sonoko, Watanabe Yuji, Yorozuya Toshihiro
Department of Anesthesia and Perioperative Medicine Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, Japan.
Medicine (Baltimore). 2018 Jan;97(3):e9675. doi: 10.1097/MD.0000000000009675.
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.
尽管放置下腔静脉（IVC）滤器是为了预防致命性肺栓塞（PE），但与IVC滤器相关的几种并发症已有报道。我们描述了一例有症状的PE病例，其栓子起源于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。
一名71岁男性仅在全身麻醉下接受了LATG。他13年前植入了IVC滤器。术前4天停用口服华法林，改用静脉输注普通肝素。拟行手术共进行了404分钟，包括气腹总时长374分钟。术后，他出现严重寒战反应，需要频繁静脉推注降压药物。术后第3天，他在短距离行走后出现呼吸困难，随后失去意识。虽然他在无需任何复苏措施的情况下自行恢复，但我们对疑似PE进行了计算机断层扫描（CT）检查。
CT显示巨大血栓占据了从IVC滤器到左髂总静脉的静脉腔，外周肺动脉存在多个栓塞缺损。
开始抗凝治疗，前4天每天口服阿哌沙班10 mg，分两次服用，之后减至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，我们应在围手术期对先前植入IVC滤器的患者进行仔细管理。
