Chassin-Trubert Lucien, Prouse Giorgio, Ozdemir Baris Ata, Lounes Youcef, Alonso William, Clapiès Myriam, Alric Pierre, Canaud Ludovic
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
Department of Thoracic and Vascular Surgery, Arnaud de Villeneuve Hospital, Montpellier, France.
Ann Vasc Surg. 2019 Jul;58:383.e1-383.e6. doi: 10.1016/j.avsg.2018.11.021. Epub 2019 Feb 11.
The aim of this article is to report a case of filter-associated inferior vena cava (IVC) thrombosis with perforation of the duodenum and penetration of a vertebral body by the filter struts.
A 37-year-old woman with a medical history of Behcet's disease treated with corticosteroids underwent placement of a retrievable IVC filter because of recurrent iliofemoral venous thrombosis regardless of therapeutic levels of anticoagulation. Despite a correct positioning of the filter, the second follow-up computed tomography scan, performed at 1 year, showed a complete thrombosis of the infrarenal IVC segment, with perforation of the vessel wall by the filter struts and penetration in the duodenum. The patient remained asymptomatic. Open surgical removal of the filter with resection of the affected vena cava without vascular reconstruction was planned. The operation was performed under general anesthesia, surgical exposure was performed through a small midline laparotomy, and a duodenal Kocher maneuver was then performed to expose the IVC. The filter struts were found to have completely passed the cava wall in multiple directions. 2 struts penetrated through the duodenal serosa and 1 strut was embedded in the L3 periosteum. The IVC filter was successfully removed en bloc with the segment of the thrombosed and retracted IVC. The stumps were closed with 3-0 running polypropylene sutures and the duodenal lesions were closed with vicryl seromuscular sutures. No vascular reconstruction was necessary due to the marked development of collateral venous circulation. The patient was discharged home on postoperative day 6 and is doing well 6 months after surgery.
Patients with IVC penetration of filter struts are usually asymptomatic, as was our patient. However, a high level of clinical suspicion for perforation should be maintained when facing nonspecific abdominal or back pain, and in episodes of gastrointestinal bleeding in patients with an IVC filter. We recommend that patients with implanted IVC filters, even those who are asymptomatic, should receive regular imaging follow-up, and retrievable filters should be removed as soon as they are no longer needed.
本文旨在报告一例滤器相关的下腔静脉（IVC）血栓形成，并伴有十二指肠穿孔及滤器支脚穿透椎体的病例。
一名37岁患有白塞病且接受过皮质类固醇治疗的女性，因尽管抗凝治疗达到治疗水平但仍反复出现髂股静脉血栓形成，接受了可回收式IVC滤器植入术。尽管滤器位置正确，但在术后1年进行的第二次计算机断层扫描显示肾下IVC段完全血栓形成，滤器支脚穿透血管壁并刺入十二指肠。患者仍无症状。计划进行开放性手术取出滤器，并切除受累的下腔静脉，不进行血管重建。手术在全身麻醉下进行，通过小的中线剖腹术进行手术暴露，然后进行十二指肠 Kocher 手法以暴露IVC。发现滤器支脚已从多个方向完全穿过腔静脉壁。2个支脚穿透十二指肠浆膜，1个支脚嵌入L3骨膜。IVC滤器与血栓形成且收缩的IVC段成功整块取出。残端用3-0聚丙烯连续缝线缝合，十二指肠病变用薇乔浆肌层缝线缝合。由于侧支静脉循环显著发育，无需进行血管重建。患者术后第6天出院，术后6个月情况良好。
正如我们的患者一样，滤器支脚穿透IVC的患者通常无症状。然而，当面对非特异性腹痛或背痛以及IVC滤器患者出现胃肠道出血时，应保持高度的临床怀疑以诊断穿孔。我们建议，即使是无症状的植入IVC滤器的患者也应接受定期影像学随访，并且一旦不再需要，应尽快取出可回收滤器。
