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Article Abstract
Purpose: Inferior vena cava (IVC) filters have been used as an alternative therapy for patients with a contraindication to anticoagulation. We present a case of an IVC filter migration to the right ventricle occurring while a trauma patient was undergoing spinal surgery in the prone position. The patient provided written consent to describe this case.
Clinical Features: A 54-yr-old multiple trauma male patient with an unstable fracture of the T6 vertebra and a stable fracture of the T10 vertebra developed a pulmonary embolism secondary to a left common femoral deep vein thrombosis. An IVC filter was placed so that an intravenous unfractionated heparin infusion could be stopped two days before scheduled spinal surgery. Intraoperatively, the patient was placed in the prone position on conventional convex support pads. At the end of the procedure, he developed ventricular trigeminy which lasted three minutes. During the next 48 hr, the patient developed a fever of 39°C. An echocardiogram was performed to rule out endocarditis, and results showed that the IVC filter had migrated into the right ventricle. After a failed attempt at percutaneous removal of the filter in the catheterization laboratory, the patient was transferred to the operating room and the IVC filter was extracted through a midline sternotomy under cardiopulmonary bypass.
Conclusions: The prone position during surgery can induce anatomic and hemodynamic changes in the IVC. This may contribute to the migration of IVC filters--especially flexible retrievable filters. Careful handling and positioning of patients with IVC filters is recommended to avoid a sudden increase in IVC pressure that may predispose to IVC filter migration.
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Article Synopsis
- The study investigates sex differences in treatment approaches for pulmonary embolism (PE) among older adults, revealing that existing evidence on disparities is limited and often inconclusive due to small sample sizes and inadequate methods.
- Analysis of data from a European PE registry and US Medicare beneficiaries shows no significant overall sex differences in the use of anticoagulation or advanced therapies, although fewer women received fibrinolytic therapy compared to men with intermediate-risk PE.
- The authors suggest that future research should explore whether the observed sex disparities in treatment correlate with different clinical outcomes, especially regarding fibrinolytic therapy and advanced treatment utilization in older adults in the US.
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