[Value of a long duration temporary caval filter in critical thrombo-embolic situations].
In the event of proximal venous thrombosis with a risk of pulmonary embolism, contraindications to or complications of anticoagulant treatment are not uncommon in surgical or intensive care units. These are worrying but temporary situations and represent a classic indication for partial interruption of the inferior vena cava, for which permanent caval filters are not usually suitable. Temporary filters are an attractive option in this context, as long as they are safe and stable, can be left in place long enough to permit normalization of the thrombosis and anticoagulation problems and can then be removed in all circumstances, whether or not they have trapped a thrombus while in place. Most temporary filters do not meet all these criteria and nor do permanent filters with a removal option. We tested the new Tempofilter II filter with increased stability, which has a smooth geometry and can be implanted for up to 6 weeks, in 13 patients. We selected two documented cases concerning, firstly, a contraindication to anticoagulants and, secondly, recurrent thrombosis in heparin-induced thrombopenia. In both cases, the filter trapped a thrombus and prevented a pulmonary embolism, which would have been poorly tolerated and difficult to treat. The filters were removed without any difficulty after 4 and 6 weeks. We did not observe any complications related to infection or migration. Monitoring is recommended throughout the implantation period, in order to identify any clots trapped in the filter and to monitor their lysis or non-emboligenic fibrous structure, authorising removal of the filter.
Bovyn
G
G
Service d'anesthésie-réanimation, centre hospitalier, BP 2367, 22023 Saint-Brieuc 1, France. gilles.bovyn@ch-stbrieuc.fr
Catroux
B
B
Lenot
B
B
Marjot-Zimbacca
F
F
Boujonnier
C
C
Lavaud
F
F
D000368:Aged; D000925:Anticoagulants / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005264:Femoral Fractures / Q000150:complications; D006406:Hematoma / Q000601:surgery; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000517:prevention & control; D012008:Recurrence; D013921:Thrombocytopenia / Q000097:blood / Q000139:chemically induced / Q000150:complications; D013923:Thromboembolism / Q000628:therapy*; D016306:Vena Cava Filters / Q000009:adverse effects
D000925:Anticoagulants; D006493:Heparin