胃癌症例における予防的下大静脈フィルター留置の功罪

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  • A CASE OF ADVANCED GASTRIC CANCER ASSOCIATED WITH INFERIOR VENA CAVA THROMBOSIS-ADVANTAGES AND DISADVANTAGES OF THE PREVENTIVE INFERIOR VENA CAVA FILTER-

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A 54-year-old man admitted to the hospital because of epigastralgia was found to have advanced bleeding gastric cancer at the antrum of the stomach. Abdominal CT scan showed para-aortic lymph node swelling (#16b1) stenosing the inferior vena cava (IVC) and IVC thrombosis distal to the right renal vein. Anticoagulant therapy was immediately started and sustained until the third day when we had to cease it because of bleeding from the main tumor. To prevent pulmonary embolism, an IVC filter was placed and chemotherapy was started. Ten days later from ceasing the anticoagulant therapy, an IVC thrombus developed, which extended to the left femoral vein causing remarkable swelling of the left leg. Distal gastrectomy was subsequently attempted and IVC and femoral vein thrombi were removed by a Fogarty catheter. In spite of anticoagulant therapy restarted soon hereafter, thrombosis developed again to the bilateral femoral veins. The thrombi were again removed by a Fogarty catheter. Local throm-bolitic therapy by continuous infusion of urokinase with systemic heparin therapy was started, which was switched to oral warfarin. After discharge, he received chemotherapy on out-patient basis.<br> In the reported case of advanced gastric cancer with concomitant bleeding lesion and IVC thrombo-sis, pulmonary thromboembolism was avoided by using the IVC filter, but IVC thrombosis recurred twice after the replacement of the IVC filter. We should recognize the reciprocal effects of the IVC filter.

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