Assessment and Management of Thrombus Captured in a Temporary Vena Cava Filter: Venography and Transesophageal Echography

Kurobe Hirotsugu, Kitaichi Takashi, Tominaga Takashi, Kanemura Takayuki, Kanbara Tamotsu, Ichikawa Yoichi, Shimahara Yusuke, Motoki Tatsuo, Sugano Mikio, Urata Masahisa, Masuda Yutaka, Hori Takaki, Kitagawa Tetsuya

doi:10.7134/phlebol.15-3-253

The purpose of this retrospective study is to establish the management guideline for captured thrombus in a temporary vena cava filter. Fourteen patients with high risk of acute pulmonary thromboembolism during surgical treatment underwent implantation of a temporary vena cava filter (Antheor^TM) immediately before treatments, and were enrolled in this study.The captured thrombus was assessed by venography the next day after treatments (group V: 10 patients), by intraoperative transesophageal echography (2 patients), and by no examination (2 patients).Among patients in group V, a shaded defect of more than 10mm in diameter was shown in 3 cases. The filter captured an old thrombus of 30×15mm, which was removed under general anesthesia, together through right jugular venotomy. Red thrombus of 10 or 15mm in diameter was encased in the filter sheath and removed. A floating tumoral thrombus of 30×20mm of renal cell carcinoma was detected at the just-caudal site of the filter by transesophageal echography, and subsequently removed through IVC-tomy. There was no symptomatic pulmonary thromboembolism during/after the surgical treatment.In conclusion, a temporary vena cava filter is very useful in preventing catastrophic pulmonary thromboembolism during/after surgical treatment. To assess the problematic thrombus captured in the filter, a venography after treatment or an intraoperative transesophageal echography should be performed according to the individual situation. We think that a potentially fresh thrombus of less than 15 mm in diameter can be safely encased in the filter sheath and removed. However, immediate removal operation is preferable for thrombus more than 30mm in diameter, which is a potentially tumoral thrombus or an old thrombus. The management guideline for captured thrombus with 15-30mm in diameter remains to be determined.

Assessment and Management of Thrombus Captured in a Temporary Vena Cava Filter: Venography and Transesophageal Echography

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