Download IVC Filter-case-review

XXXX XXXX
DOB: 11/21/XXXX
XXXXX XXXX - Case Report
Parameter
Date of IVC Filter Placement
Reason for IVC Filter Placement
Findings
Procedure Name
Did the pre-image the vena cava to determine
size and any anomalies?
What was the size of the vena cava?
Was placement done with fluoroscopic
guidance?
Did they confirm good placement with
imaging?
Was placement infrarenal?
Was patient told it was retrievable?
Implant Details:
Device Failure and Complications
Did one of the struts fracture?
Did the entire device migrate? Where? (Heart,
Lungs)
Did the device tilt and have a strut(s) perforate
the IVC?
Device Removal
Was the device removed in full? Open
procedure?
Failed Removal Attempt
If Yes, is patient put on lifetime
anticoagulation?
If Yes, is patient now stuck with it for life?
XX/XX/YYYY
Prophylaxis for Gastric LapBand Surgery to
prevent embolic problems.
NA.
NA
NA
Yes.
Yes.
Yes
Yes (Per intake sheets)
Bard’s Recovery IVC filter
Lot #: GFPDXXXX
Ref #: RXXXXX
No
Yes, the entire device migrated towards the
heart (Right atrium)
The device was tilted during placement. The
IVC fitter wires were visible as they had
eroded through the right atrial wall near the
inferior vena cava
Yes. Open procedure (Cardiopulmonary
Bypass Surgery) on 04/30/YYYY
No
Yes
No
1 of 4
XXXX XXXX
DOB: 11/21/XXXX
MEDICAL SUMMARY
Client: XXXXX XXXX
DOB: 11/21/YYYY
Brief Case Summary: XXXXX XXXX, 37-year-old male with a history of pacemaker
implanted, had a Bard’s Recovery IVC filter placed on 08/04/YYYY on the right femoral vein as
a prophylaxis to prevent embolic problems. Due to his morbid obesity, he underwent LapBand
gastric surgery on 08/17/YYYY. On 04/26/YYYY, he developed chest pain and shortness of
breath and went to ER and was diagnosed with large pulmonary emboli attached to the
pacemaker wire. On 04/30/YYYY, fluoroscopy imaging showed migration of the filter to the
right atrium. Subsequently, an emergent pulmonary thromboembolectomy, retrieval of migrated
IVC filter, cardiopulmonary bypass (Open procedure) was performed and the filter was removed.
Past Medical History: Diabetes mellitus, lower extremity venous stasis, obstructive sleep apnea
gastroesophageal reflux disease, pneumonia, Shortness of breath, morbid obesity, and pulmonary
embolism on Coumadin therapy.
Surgical History: Cardiac Pace maker (06/YYYY), IVC filter (XXXX), Gastric surgery in
(XXXX).
Family History: Positive for hypertension, diabetes mellitus, dyslipidemia heart disease, gall
bladder disease. Brother known hyper coagulopathy
Social History: Smokes 6-7 cigarettes per day, alcohol on occasion. Unmarried and works as a
DJ and dances.
Allergy: Vicodin
DATE
07/07/YYYY
PROVIDE
R
XXXXX,
M.D.
OCCURRENCE/TREATMENT
Pre-operative Evaluation for IVC Filter placement:
HPI: Patient who was asked to evaluate on behalf of Dr. Gensar for evaluation for
possible preoperative temporary inferior vena cava filter. The patient is being evaluated
for a Lap Band procedure due to his morbid obesity.
PDF
REF
423
Impression:
1. Morbid obesity with multiple medical problems as result of his obesity.
2. History of pulmonary embolism on coumadin therapy.
08/04/YYYY
XXXXX
Medical
Center
XXXXX,
M.D.
I recommended placement of a temporary inferior vena cava filter prior to the
surgical intervention.
Operative report:
Pre & Post-operative Diagnosis: Morbid obesity, history of pulmonary embolus.
Anesthesia: Sedation/local
Procedure performed: Placement of temporary inferior vena cava filter. Venogram,
inferior vena cava. Catheter placement, inferior vena cava.
Description of procedure: Using an ultrasound, an 18 gauge needle was inserted into the
right common femoral vein and a J-wire was advanced into the inferior vena cava under
direct fluoroscopic guidance. A 6 French sheath was placed in the inferior vena cava
2 of 4
59,
431,
465,
448
XXXX XXXX
DATE
PROVIDE
R
DOB: 11/21/XXXX
OCCURRENCE/TREATMENT
PDF
REF
under direct ultrasound guidance over a wire. The inner dilator was removed, the catheter
sheath was then brought down to the distal inferior vena cava and a venogram was
performed, which documented the location of the renal veins and the confluence of the
iliac veins. A recovery filter by Bard was advanced through the sheath into proper
position at the L3 position and was deployed. A completion venogram demonstrated
opposition of the catheter to the caval wall. There was a slight tilt within the inferior
vena cava filter, but other than the slight tilt it was in satisfactory position. The
sheath was removed and direct pressure was held on the right groin. There was good
hemostasis. A band-aid was placed in the puncture site and the patient was taken to
recovery.
08/04/YYYY
04/26/YYYY
XXXX
XXXXX,
M.D.
04/28/YYYY
XXXX
XXXXX,
M.D.
04/29/YYYY
XXXX M
Witt, M.D.
04/30/YYYY
04/30/YYYY
XXXX
Wellness,
M.D.
XXXXX
Health
Center
Radiology report- Infrarenal IVC filter percutaneous placement
This procedure was performed in the hospital operating room. Therefore, to see the
operative report for the results of any fluoroscopy or the interpretation of any imaging
done in association with this procedure.
Implant Details:
Filter vena cava
Description: Bard
Ref #: Rf048f
Lot #: GFPD4713
Echo report:
Indications: Pericardial Effusion And Chest Pain
Impression: Pacer wire seen in right ventricle. Appears to have large mass attached
to pacer wire mostly within right atrium. Right ventricular systolic pressure is
estimated to be 45rnmHg consistent with moderate pulmonary hypertension. No
significant pericardial effusion.
Transesophageal Echo report:
Impression: Echogenic mobile mass large extending from Right Atrium (RA) to
Right Ventricle (RV) almost obstructing the Tricuspid Valve (TV). Pacer in Right
Heart. Small pericardial effusion noted.
CT Abdomen and Pelvis
Findings: There is a small pericardial effusion. The patient has a gastric Lap-Band in
place. Accompanying tubing is noted extending out subcutaneously over the left anterior
abdominal wall. IVC shows no evidence of any filter. The iliac and femoral vessels
appear unremarkable. Small umbilical hernia with mesenteric fat is demonstrated.
Degenerative changes are seen in the spine.
Impression:
1. There is pleural reaction in both lung bases with infiltrates, scarring or atelectasis
present at the bases as well.
2. No IVC filter is demonstrated.
3. No definite venous thrombus is seen on this study.
Chest Fluoroscopy-IVC filter migration
Impression: Inferior vena cava filter migrated to the right atrium.
Surgical Consultation for emergent pulmonary embolectomy and retrieval of
capsularis IVC filter:
HPI: The patient became acutely hemodynamically unstable and was transferred from
3 of 4
438439
71-72
73-75
48-50
51-52
92-94,
250252
XXXX XXXX
DATE
PROVIDE
R
DOB: 11/21/XXXX
OCCURRENCE/TREATMENT
PDF
REF
telemetry to the coronary care unit.
XXXX
XXXXX,
M.D.
04/30/YYYY
XXXXX
Health
Center
XXXX
XXXXX,
M.D.
Impression :
1. Migrated IVC filter into the heart.
Plan: I recommend that he undergo emergent pulmonary thromboembolectomy, retrieval
of migrated IVC filter, cardiopulmonary bypass, possible circulatory arrest, and
intraoperative transesophageal Echocardiography.
Operative notes:
Procedure performed: Cardiopulmonary bypass, relief of pericardial tamponade,
and evacuation of hemopericardium, removal of displaced IVC filter, right atrial
thrombectomy, and intraoperative transesophageal Echocardiography.
Anesthesia : General endotracheal
89-91,
160,
232
Indications: The filter migrated into the right atrium and eroded the right atrial wall
resulting in hemopericardium and pericardial tamponade.
Procedure: Intraoperative Transesophageal Echocardiography showed a large, dense
thrombus and echogenic wires in the right atrium. An incision was made from the sternal
notch to the xiphoid. The sternum was opened longitudinally with a sternal saw.
Hemostasis was obtained with electrocautery and bone wax at the sternal edges. The
patient was systemically heparinized. The pericardium was opened longitudinally and
tented anterior with Ethibond stay stitches.
05/08/YYYY
XXXXX
Health
Center
Approximately 800cc of dark blood was evacuated from the pericardial cavity. The heart
was covered with a fibrinous exudate. The IVC fitter wires were visible as they had
eroded through the right atrial wall near the inferior vena cava. The aortic cannula
was inserted first followed by superior and inferior vena caval cannulas. An antegrade
cardioplegic cannula was placed in the ascending aorta. Cardiopulmonary bypass was
instituted. The aorta was crossclamped and the patient was given 900cc of cold
cardioplegia in an antegrade fashion. There was prompt cardiac arrest/ice was placed on
the heart for further myocardial protection. A phrenic nerve protector pad was used. The
superior vena cava and inferior vena cava were occluded around the cannulas. A right
atriotomy was performed. The inferior vena cava filter and organized thrombus were
removed. Some more thrombus was removed from the pacemaker wire. The right
atrial wall perforations were repaired with #5-0 Prolene stitches in a Figure-of-eight
fashion. The right atrial incision was closed in 2 layers using #5-0 Prolene sutures.
Discharge Summary
Discharge diagnoses
1. Bilateral pulmonary embolism with right lower extremity deep venous thrombosis on
admission
2. IVC filter displaced: Hemopericardium: Cardiac tamponade status post removal of
displaced IVC, right arteriotomy and right thrombectomy and relief of pericardial
tamponade on 04/30/10.
3. Hypercoagulable state with elevated homocysteine.
4. History of second-degree block Mobitz II status post pacemaker placement in XXXX.
Discharged: Home
4 of 4
237239;