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December 23, 2005
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Natalie Marks, MD, Fred Usoh, MD, Anil Hingorani, M.D., Enrico Ascher, MD, Richard Schutzer, MD, Manikyam Mutyala, MD, Alexander Shiferson, MD, William Yorkovich, RPA, Theresa Jacob, PHD.
Maimonides Medical Center, Brooklyn, NY, USA.
PURPOSE:The safety and efficacy of SVC filters in the prevention of pulmonary embolism (PE) in patients with upper extremities deep venous thrombosis (UEDVT) in whom anticoagulation is contraindicated or ineffective have been well described. However, there have been very few documented cases of complications resulting from this procedure. Between January 1994 and March 2005, we have successfully placed a total of 153 Trapeze® (Cordis, a Johnson & Johnson Company) and Greenfield® (Boston Scientific: One Boston Scientific Place Natick, MA 0760-1537) SVC filters. Herein, we describe two cases of cardiac tamponade following the placement of SVC filters in two young males.
METHODS/RESULTS: The first case was a 43- year old man with a history of recurrent lower extremity DVTs, PE, IVC filter and antiphospholipid syndrome. He presented to an outside hospital with one-week history of progressive chest pain on inspiration along with upper and lower extremity swelling. He was transferred to Maimonides for SVC filter placement. Preoperative duplex demonstrated acute DVTs extending from the left internal jugular vein with a free floating component extending down to the junction between the internal jugular and the subclavian vein. Subsequently, a SVC Trapeze filter was placed. The patient was restarted on lovenox 5hours later. Post-operative day one, he was noted to have increasing shortness of breath and became hemodynamically unstable. A transesophageal echocardiogram revealed cardiac tamponade. Patient subsequently underwent a median sternotomy for the repair of SVC perforation. The patient was discharged on lovenox.
The second case was a 47 year-old male with a week history of progressive left arm swelling and pain. Duplex revealed left subclavian and axillary DVT. The patient developed PE while on heparin. Patient then underwent placement of a SVC Greenfield filter. To rule out thoracic outlet syndrome, on postoperative day #4, the patient was brought back to the operating room for left upper extremity venography, suction thrombectomy and thrombolysis with TPA. The patient was brought back twice to the operating room for repositioning of the infusion catheter. Six days after placement of the SVC filter, the patient experienced left sided chest pain, shortness of breath and EKG changes. Echocardiogram demonstrated cardiac tamponade. Pericardiocentesis was performed, and the thrombolysis was discontinued. The rest hospital course was uneventful, and patient was discharged on lovenox and coumadin.
CONCLUSION: Cardiac tamponade is a rare complication that one must be aware of after the placement of SVC filters.
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Cardiac Tamponade Following The Placement of SVC Filter in Two Young Males
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Natalie Marks, MD, Fred Usoh, MD, Anil Hingorani, M.D., Enrico Ascher, MD, Richard Schutzer, MD, Manikyam Mutyala, MD, Alexander Shiferson, MD, William Yorkovich, RPA, Theresa Jacob, PHD.
Maimonides Medical Center, Brooklyn, NY, USA.
PURPOSE:The safety and efficacy of SVC filters in the prevention of pulmonary embolism (PE) in patients with upper extremities deep venous thrombosis (UEDVT) in whom anticoagulation is contraindicated or ineffective have been well described. However, there have been very few documented cases of complications resulting from this procedure. Between January 1994 and March 2005, we have successfully placed a total of 153 Trapeze® (Cordis, a Johnson & Johnson Company) and Greenfield® (Boston Scientific: One Boston Scientific Place Natick, MA 0760-1537) SVC filters. Herein, we describe two cases of cardiac tamponade following the placement of SVC filters in two young males.
METHODS/RESULTS: The first case was a 43- year old man with a history of recurrent lower extremity DVTs, PE, IVC filter and antiphospholipid syndrome. He presented to an outside hospital with one-week history of progressive chest pain on inspiration along with upper and lower extremity swelling. He was transferred to Maimonides for SVC filter placement. Preoperative duplex demonstrated acute DVTs extending from the left internal jugular vein with a free floating component extending down to the junction between the internal jugular and the subclavian vein. Subsequently, a SVC Trapeze filter was placed. The patient was restarted on lovenox 5hours later. Post-operative day one, he was noted to have increasing shortness of breath and became hemodynamically unstable. A transesophageal echocardiogram revealed cardiac tamponade. Patient subsequently underwent a median sternotomy for the repair of SVC perforation. The patient was discharged on lovenox.
The second case was a 47 year-old male with a week history of progressive left arm swelling and pain. Duplex revealed left subclavian and axillary DVT. The patient developed PE while on heparin. Patient then underwent placement of a SVC Greenfield filter. To rule out thoracic outlet syndrome, on postoperative day #4, the patient was brought back to the operating room for left upper extremity venography, suction thrombectomy and thrombolysis with TPA. The patient was brought back twice to the operating room for repositioning of the infusion catheter. Six days after placement of the SVC filter, the patient experienced left sided chest pain, shortness of breath and EKG changes. Echocardiogram demonstrated cardiac tamponade. Pericardiocentesis was performed, and the thrombolysis was discontinued. The rest hospital course was uneventful, and patient was discharged on lovenox and coumadin.
CONCLUSION: Cardiac tamponade is a rare complication that one must be aware of after the placement of SVC filters.
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