Seldomly these thrombi can be extensive enough to lead to severe symptoms that result in anuria, right heart failure, pulmonary emboli and cardiac arrest. The most common complaints are bilateral lower extremity swelling, back pain, and cramping. Although both are rare causes of thrombosis, the usual symptoms are ambiguous and can vary based on acuity. Along with coronary artery bypass, Nazzal et al., reiterated the complications of IVC filters, one of which is thrombosis. Multiple recent research reviews support this notion, showing an increase incidence of IVC thrombosis with patients undergoing open coronary bypass when compared to other general surgeries (2.5%, 0.4%, p < 0.05). Inferior vena cava (IVC) thrombosis is a rare but known complication of both IVC filter placement and open coronary artery bypass. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use. Other therapies have been described but because of its rarity, they are only described in case reports. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. Conclusionĭespite being a rare complication, IVC thrombosis can have detrimental effects. The thrombectomy was successful and he was able to recover and was discharged from the hospital. 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. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. We present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. 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. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. 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. Inferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery.
0 Comments
Leave a Reply. |