The use of inferior vena cava filter as a treatment modality for massive pulmonary embolism. A case series and review of pathophysiology

K. S. Deshpande, C. Hatem, M. Karwa, H. Ulrich, T. K. Aldrich, V. Kvetan

Research output: Contribution to journalArticle

9 Scopus citations

Abstract

The use of inferior vena cava (IVC) filter for massive pulmonary emboli (PE) with cardiopulmonary instability has not been clinically studied. We present a case series of six such patients who received an IVC filter with anticoagulation rather than thrombolysis because of high risk of bleeding. Acute pulmonary embolectomy was considered, but was not possible for a variety of individual clinical situations. These six hospitalized patients prospectively followed during their admission. They were triaged to three medical intensive care units (ICUs) and one surgical ICU in three university teaching hospitals. One patient was transferred from another institution. All six patients had severe hypoxia and tenuous cardiopulmonary status. All required high inspiratory oxygen and hemodynamic support; two required mechanical ventilation and vasopressors. An IVC filter was placed emergently and anticoagulation was started immediately. All six patients had resolution of pulmonary thromboemboli (PTE) on anticoagulation while the IVC filter prevented further PE. All six patients were discharged home in their pre-critical illness state. None of the patients suffered complications from this therapy and had excellent resolution of cardiopulmonary collapse. The IVC filter placement prevented further major embolic events while the PTE resolved with anticoagulation. An IVC filter should be considered as an adjunct to anticoagulation therapy for those patients with massive PE and cardiopulmonary instability who are not candidates for thrombolysis, and acute pulmonary embolectomy is not readily available or is of very high risk.

Original languageEnglish (US)
Pages (from-to)984-989
Number of pages6
JournalRespiratory Medicine
Volume96
Issue number12
DOIs
StatePublished - Dec 1 2002

Keywords

  • Bleeding
  • Cardiopulmonary failure
  • Inferior vena cava filter
  • Massive pulmonary embolus
  • Right ventricular failure
  • Thrombolysis

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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