Department of General Surgery, Mercy Health St. Elizabeth Youngstown Hospital, 1044 Belmont Ave, Youngstown, OH, USA.
J Cardiothorac Surg. 2021 Aug 9;16(1):226. doi: 10.1186/s13019-021-01605-9.
Inferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery. Often only mild symptoms arise from these thrombi; however, due to the chronic nature of some thrombi and the recanalization process, more serious complications can arise. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. In this case, we present a 65-year-old male who underwent IVC filter placement and open-heart surgery who later developed extensive femoral and iliocaval thrombosis leading to right heart failure, which required thrombus extraction with an AngioVac suction device.
We present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. He progressed to right heart failure and worsening cardiogenic shock despite therapeutic anticoagulation and was taken for a suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) aspiration thrombectomy device. The thrombectomy was successful and he was able to recover and was discharged from the hospital.
Despite being a rare complication, IVC thrombosis can have detrimental effects. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. Other therapies have been described but because of its rarity, they are only described in case reports. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use.
下腔静脉血栓形成被认为是下腔静脉滤器放置和冠状动脉旁路手术后的并发症。这些血栓通常只会引起轻微的症状;然而，由于一些血栓的慢性性质和再通过程，可能会出现更严重的并发症。尽管抗凝治疗仍然是治疗的金标准，但有些患者无法接受抗凝治疗。在这种情况下，我们报告了一位 65 岁男性患者，他接受了下腔静脉滤器放置和心脏直视手术，后来发展为广泛的股静脉和髂静脉血栓形成，导致右心衰竭，需要使用 AngioVac 抽吸装置提取血栓。
我们报告了一位 65 岁男性患者，他表现为双侧肺栓塞，伴有广泛的右下肢深静脉血栓形成。经调查，他患有缺血性心脏病，并接受了五支冠状动脉旁路手术，术前放置了下腔静脉滤器。术后第 3 至 4 天，他出现失代偿，诊断为下腔静脉血栓形成。尽管进行了抗凝治疗，但他仍进展为右心衰竭和心源性休克，并接受了 AngioVac（AngioDynamics，Latham，NY）抽吸血栓切除术装置进行抽吸血栓切除术。血栓切除术成功，他得以康复并出院。
尽管这是一种罕见的并发症，但下腔静脉血栓形成可能会产生有害影响。本例说明了术后下腔静脉血栓形成如何导致死亡。金标准是抗凝治疗，但尽管如此，该患者仍持续出现心源性休克恶化。已经描述了其他治疗方法，但由于其罕见性，仅在病例报告中描述。本病例表明，AngioVac 装置是治疗下腔静脉血栓形成的一种成功治疗选择，并可能有未来的应用前景。
