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Case Report
Percutaneous Aspiration of Inferior Vena Cava Thrombus
May 2006
Case Report. A 38-year-old man was admitted to our hospital with suspected deep vein thrombosis of the right lower limb without prior immobilization history, and a history of 18 years of 1-pack-a-day smoking as a cardiovascular risk factor. The patient had a normal hematogram, a normal thromboplastin time, an INR of 1.0 and a D-dimer level of 2,738 ng/ml (normal
Discussion. A conclusive explanation of these cancer-associated complications is difficult due to putative multiple factors, which may play a role in this setting. We assume that the pathogenesis of the two phenomena, namely the venous thrombosis and the myocardial infarction, are different. The venous thrombosis can be explained by factors of reduced blood flow due to narrowed veins resulting from the lymphadenopathies, which was not significant in our patient, and by the existence of hypercoagulability in cancer patients. On the other hand, the myocardial infarction due to in situ thrombosis could have been an adverse effect of the chemotherapy superimposed upon the cancer-induced hypercoagulopathy. Several cases of arterial occlusive events (cerebral and myocardial infarction) have been reported to be associated with the chemotherapeutic agents bleomycin, etoposide and cisplatin that were administered to our patient. The chronological factor with our patient, namely myocardial infarction just one day after the first chemotherapy cycle, supports this association.
To our knowledge, the application of the Aspirex catheter for percutaneous thrombectomy of the inferior vena cava has not been reported. Its therapeutic advantages in parallel use with lytic therapy remains to be defined.
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