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Superior vena cava syndrome due to catheter related thrombus in a patient with a permanent pacemaker.

Chandrashekarappa SM, Vayoth SO, Seetharaman M, Kumar L - Indian J Anaesth (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

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Four years earlier, she needed a permanent dual chamber pacemaker implant for symptomatic sick sinus syndrome through the left subclavian vein and was not on any antiplatelet medication... Anaesthesia was induced as per the standard protocol... The left sided IJV and subclavian vein were normal... A computerised tomography scan confirmed a thrombus extending from right IJV to subclavian vein and superior vena cava (SVC) [Figure 1a]... The central venous catheter (CVC) was removed and enoxaparin dosage increased from a prophylactic dose of 20 mg once daily to a therapeutic dose 40 mg twice daily... The patient's visual symptoms normalised in 24 h and oedema of the face and hand improved... A catheter related thrombus (CRT) develops when the thrombus originating from an indwelling catheter extends into the vessel outside the CVC and obstructs the flow within the vein... Complications associated with CRT are infection, loss of catheter function, pulmonary embolism and postthrombotic syndrome... Thrombosis of IJV is commonly reported with indwelling catheters in patients with underlying malignancies or prothrombotic states although the mean duration of indwelling catheters reported was much longer... Our patient had developed CRT and features of SVC syndrome even with near optimal positioning of the CVC [Figure 1b]... We presumed that the CVC alongside the pacemaker lead could have acted as a nidus coupled with stasis in the flow during laparoscopy predisposing to the development of IJV thrombus... We wish to highlight this case to ensure vigilance in the development of SVC syndrome in patients with pacemaker wires when CVCs are used in the perioperative period... There are no conflicts of interest.

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(a) Internal jugular vein partly occluded with thrombus, (b) central venous catheter alongside pacemaker lead
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Figure 1: (a) Internal jugular vein partly occluded with thrombus, (b) central venous catheter alongside pacemaker lead

Mentions: On 2nd post-operative day, the patient complained of blurring of vision and dizziness. On examination, oedema of her face and right upper limb were noted. Her mentation was normal and there was no evidence of involvement of cranial nerves. The fundoscopic examination was unremarkable except for pallor of bilateral optic discs. Investigations were normal other than haemoglobin of 8.2 g/dL; platelet count was 135,000/mm3. A duplex ultrasound revealed a dilated right IJV with an echogenic thrombus partially filling the lumen while IJV proximal to the thrombus was normal. The left sided IJV and subclavian vein were normal. A computerised tomography scan confirmed a thrombus extending from right IJV to subclavian vein and superior vena cava (SVC) [Figure 1a]. The central venous catheter (CVC) was removed and enoxaparin dosage increased from a prophylactic dose of 20 mg once daily to a therapeutic dose 40 mg twice daily. The patient's visual symptoms normalised in 24 h and oedema of the face and hand improved. She was discharged after a week on oral anticoagulation and advised follow-up.


Superior vena cava syndrome due to catheter related thrombus in a patient with a permanent pacemaker.

Chandrashekarappa SM, Vayoth SO, Seetharaman M, Kumar L - Indian J Anaesth (2015)

(a) Internal jugular vein partly occluded with thrombus, (b) central venous catheter alongside pacemaker lead
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697254&req=5

Figure 1: (a) Internal jugular vein partly occluded with thrombus, (b) central venous catheter alongside pacemaker lead
Mentions: On 2nd post-operative day, the patient complained of blurring of vision and dizziness. On examination, oedema of her face and right upper limb were noted. Her mentation was normal and there was no evidence of involvement of cranial nerves. The fundoscopic examination was unremarkable except for pallor of bilateral optic discs. Investigations were normal other than haemoglobin of 8.2 g/dL; platelet count was 135,000/mm3. A duplex ultrasound revealed a dilated right IJV with an echogenic thrombus partially filling the lumen while IJV proximal to the thrombus was normal. The left sided IJV and subclavian vein were normal. A computerised tomography scan confirmed a thrombus extending from right IJV to subclavian vein and superior vena cava (SVC) [Figure 1a]. The central venous catheter (CVC) was removed and enoxaparin dosage increased from a prophylactic dose of 20 mg once daily to a therapeutic dose 40 mg twice daily. The patient's visual symptoms normalised in 24 h and oedema of the face and hand improved. She was discharged after a week on oral anticoagulation and advised follow-up.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Four years earlier, she needed a permanent dual chamber pacemaker implant for symptomatic sick sinus syndrome through the left subclavian vein and was not on any antiplatelet medication... Anaesthesia was induced as per the standard protocol... The left sided IJV and subclavian vein were normal... A computerised tomography scan confirmed a thrombus extending from right IJV to subclavian vein and superior vena cava (SVC) [Figure 1a]... The central venous catheter (CVC) was removed and enoxaparin dosage increased from a prophylactic dose of 20 mg once daily to a therapeutic dose 40 mg twice daily... The patient's visual symptoms normalised in 24 h and oedema of the face and hand improved... A catheter related thrombus (CRT) develops when the thrombus originating from an indwelling catheter extends into the vessel outside the CVC and obstructs the flow within the vein... Complications associated with CRT are infection, loss of catheter function, pulmonary embolism and postthrombotic syndrome... Thrombosis of IJV is commonly reported with indwelling catheters in patients with underlying malignancies or prothrombotic states although the mean duration of indwelling catheters reported was much longer... Our patient had developed CRT and features of SVC syndrome even with near optimal positioning of the CVC [Figure 1b]... We presumed that the CVC alongside the pacemaker lead could have acted as a nidus coupled with stasis in the flow during laparoscopy predisposing to the development of IJV thrombus... We wish to highlight this case to ensure vigilance in the development of SVC syndrome in patients with pacemaker wires when CVCs are used in the perioperative period... There are no conflicts of interest.

No MeSH data available.


Related in: MedlinePlus