Transarterial embolization of a cervicofacial hemangioma associated with kasabach-merritt syndrome in a premature neonate

摘要

We were asked to place an IVC filter in a 46-year-old woman who presented with progression of deep vein thrombosis to symptomatic pulmonary embolism despite therapeutic anticoagulation. A commercially available Bard Meridian retrievable IVC filter was selected. These filters have shown prolonged retrieval capability based on similar designs from the same manufacturer (3). We implanted the filter via a right common femoral vein approach, with an approximate 20° tilt (Fig, a). Three months after placement, upper abdominal images from a chest computed tomography (CT) examination showed an intact filter with all 12 limbs attached. Because the patient's deep vein thrombosis burden decreased with anticoagulation and the CT scan showed no residual pulmonary embolism, we scheduled filter removal 2 weeks later.Initial imaging during the retrieval attempt displayed a fractured arm of the filter attached to the IVC wall (Fig, b). This was a surprise given that the CT scan performed a few weeks earlier had shown an intact filter. We removed the major component of the filter by using an 11-F goose neck-type snare from a vena cava filter retrieval system (Cook, Bloomington, Indiana); this component remained intact during the removal. The intravas-cular fragment adherent to the IVC was retrieved by using a 9-15-mm trilobed snare (EnSnare; Merit Medical, South Jordan, Utah). Inspection of the major filter component showed that, in fact, an additional arm was missing. On a CT angiogram of the chest, this second fractured arm was located within the right ventricle, partially penetrating the wall (Fig, c). The patient did not have any chest pain, arrhythmia, or shortness of breath related to this fragment.