PULMONER EMBOLÝ RÝSKÝNÝ ÖNLEMEDE ÝNFERÝOR VENA KAVA FÝLTRESÝ UYGULAMALARIMIZ

Derin ven trombozu (DVT)'nun en ciddi ve ölümcül komplikasyonu halen pulmoner emboli (PE)'dir. Pulmoner emboli profilaksisinde kullanýlan yöntemlerden biri de vena kava inferior filtresi (VKF) uygulanmasýdýr. 1999-2000 yýllarýnda Ýstanbul Týp Fakültesi Genel Cerrahi Anabilimdalý Travma ve Acil Cerrahi Servisinde yatýrýlan 12 (8 erkek, 4 kadýn) hastaya VKF uygulandý. Filtrelerin 10'u kalýcý, 2'si geçici tipte idi. Spinal kord travmasý sonrasý geliþen kalýcý nörolojik defisitli (parapleji veya kuadripleji) 8 hastaya kalýcý filtre uygulandý. Kalýcý filtre uygulanan iki hastada ise malignite mevcuttu. Ýleri evre serviks kanseri olan ilk olguda alt ekstremitede DVT geliþti ve kanama riski yüksek olduðundan VKF uygulandý. Mesane kanseri olan diðer hastada ise düþük molekül aðýrlýklý heparin (DMAH) kullanýrken DVT geliþmiþti. Daha kýsa süreli PE profilaksisi gerektiren iki hastaya ise geçici VKF uygulandý. Bu olgulardan birincisinde, kapalý kafa travmasý (subaraknoidal kanama) tanýsýyla yatmakta iken 8. gününde alt ekstremitede DVT geliþti ve yüksek kanama riski olduðu için filtre uygulandý. Ýkinci olguda ise kafa travmasý (subdural hematom+subaraknoidal kanama) ve multipl alt ekstremite fraktürleri mevcuttu.Filtre uygulamasý Ýstanbul Týp Fakültesi Radiodiagnostik ABD'nda gerçekleþtirildi. (Resim 1). Kalýcý filtrelerde (LGM Venatech (B.Braun)) giriþ yolu olarak sað femoral ven kullanýldý. Geçici filtreler (Proliser Cordis (Johnson and Johnson Company)) ise sað internal juguler ven yolu ile uygulandý. Kalýcý filtre uygulanan iki politravma hastasý sepsis ve multiorgan yetmezliði gibi PE dýþý nedenlerle kaybedildi. Diðerlerin ortalama 7,6 aylýk takiplerde VKF uygulanmasý ile ilgili komplikasyon veya pulmoner emboli geliþmedi. Daha geniþ olgu serisine ve uzun sureli takibe ihtiyaç olmakla birlikte, PE'yi önlemede VKF'nin etkili ve güvenli bir seçenek olduðunu düþünmekteyiz.

OUR EXPERIENCE WITH THE ROLE OF INFERIOR VENA CAVA FILTER IN THE PREVENTION OF PULMONARY EMBOLISM RISK

The most serious and fatal complication of deep venous thrombosis (DVT) is still accepted as pulmonary embolism (PE). One of the methods used for PE prophylaxis is inferior vena cavafilter (VCF). Between 1999 and 2000, VCF is used in 12 patients (8 male, 4 female) who were hospitalized in Trauma and Surgical Emergency Service of Istanbul Medical Faculty. 10 of the VCF used were permanent and 2 of them were temporary filters. 8 permanent filter were applied to patients with life-long paraplegia or quadriplegia due to spinal cord injury. Two patients to whom permanent filters were applied had malignancy. Patient who had the diagnosis of late stage cervical carcinoma, had DVT. In this patient, because of the high bleading risk, we applied permanent filter. In the other patient, who had the diagnosis bladder carcinoma, had DVT despite the usage of low moleculer weight heparin. In two patients who needed short term PE prophylaxis, had temporary VCF. In one of these patients, primary diagnosis was subarachnoidal hemorrhage due to head trauma. In the 8. day of hospitalization, DVT occured. Because of high risk of intracranial bleedy, VCF was performed. The second patient had the diagnosis of subdural hematom and subarachnoidal hemorrhage due to head trauma and multiple lower extremity fractures. VCF were applied in Istanbul Medical Faculty, Department of Radiology. For canmdation line of permanent VCF (LGM Venatech - B.Braun) right femoral vein was used. For temporary filters (Proliser Cordis -Johnson and Johnson Company), right internal juguler vein was the preferred way. Two multitravma patients who had permanent filters died due to sepsis and multiorgan failure. In the follow up of other patients during the average period of 7,6 months, any problem due VCF application or by related complication and PE did not occur. Although larger patient groups with follow up period are necessary to evaluate better, we think that in PE prophylaxis, VCF is safe and effective modality.