PDF(Pubmed)
Abstract：
A pulmonary embolism (PE) is a life-threatening complication of deep vein thrombosis (DVT). Although timely anticoagulation is the first-line treatment for DVT, an inferior vena cava (IVC) filter can be considered when anticoagulation is contraindicated. Unfortunately, IVC filters come with complications of their own, including thrombus formation in or around the filter. An 89-year-old man with a past medical history of coronary artery disease, congestive heart failure, chronic obstructive pulmonary disease, and prior DVT status post IVC filter implantation five years ago in 2018 presented with hypotension, dizziness, and syncope. Computed tomography angiography (CTA) of the chest showed bilateral PEs. Venous Doppler ultrasound of the bilateral lower extremities was negative for DVT. CT venogram was performed; however, the contrast filling was suboptimal and as such, a venous thrombosis could not be ruled out. Therefore, an inferior vena cavagram was performed through the right common femoral vein and confirmed a large thrombus positioned cephalad to the IVC filter. A thrombectomy was performed and the IVC filter was replaced given the patient was at high risk for venous thromboembolism recurrence and complications. Although an IVC filter offers some protection from recurrent PEs, it does have risks and complications. As seen in our patient, the IVC filter can be a nidus for the formation of a thrombus which has the risk of dislodging. When evaluating a patient for the source of a PE, it is important to consider prior IVC implant and perform further workups, such as a CT venogram or an inferior vena cavagram, to evaluate for thrombus in or around the filter.
摘要：
肺栓塞（PE）是深静脉血栓形成（DVT）的危及生命的并发症。尽管及时抗凝治疗是DVT的一线治疗,抗凝禁忌时,可以考虑下腔静脉(IVC)滤器.不幸的是,IVC过滤器本身也有并发症，包括过滤器内或周围的血栓形成。一名有冠状动脉疾病病史的89岁男子，充血性心力衰竭,慢性阻塞性肺疾病,和5年前2018年IVC过滤器植入后的DVT状态出现低血压，头晕,和晕厥。胸部计算机断层扫描血管造影（CTA）显示双侧PE。双侧下肢静脉多普勒超声检查DVT阴性。进行了CT静脉造影；然而，对比填充是次优的，因此，不能排除静脉血栓形成。因此,通过右股总静脉行下腔静脉造影,证实有一个位于头端IVC滤器的大血栓.考虑到患者静脉血栓栓塞复发和并发症的高风险，进行了血栓切除术并更换了IVC过滤器。虽然IVC过滤器提供了一些保护，防止复发的PE，它确实有风险和并发症。从我们的病人身上看到的,IVC过滤器可以是用于形成具有移位风险的血栓的切口。当评估患者的PE来源时，重要的是要考虑先前的IVC植入并进行进一步的检查，如CT静脉造影或下腔静脉造影，评估过滤器内或周围的血栓。
