Neuhaus ProtectTM挿入後に生じたフィルター内の大量血栓，下大静脈の血栓性閉塞に対してウロキナーゼが有効であった急性肺塞栓症の1例

A Case of Acute Pulmonary Thromboembolism Successfully Treated with Urokinase for Massive Thrombus in the Filter and Thromboocclusion of the Inferior Vena Cava,Occurring after Insertion of a “Neuhaus Protect” Filter

要旨

　患者は61歳，女性．突然の胸背部痛と呼吸困難にて入院．造影胸部CTと肺動脈造影で肺動脈に広範な血栓像を認め，肺塞栓症と診断した．入院当日，パミテプラーゼによる血栓溶解療法と急性期再発予防目的で一時的下大静脈フィルター(Neuhaus Protect^TM)を挿入し，ヘパリンおよびワルファリンの投与を行った．10日後，静脈造影にてフィルター内の大量血栓および下大静脈の閉塞が確認され，ウロキナーゼを投与した．第18病日，下大静脈およびフィルター内の血栓溶解は著明に進んでおり，下大静脈の血流も再開していたため，安全にNeuhaus Protectを抜去することが可能となり，Greenfield下大静脈フィルターを留置した．一時的下大静脈フィルター挿入後に生じるフィルター内の大量血栓，下大静脈閉塞に対する処置は確立したものがなく，ウロキナーゼによる血栓溶解療法は有効と考えられ，報告した．

Summary

　A 61-year-old woman complaining of sudden chest and back pain and dyspnea was admitted to our hospital. The chest computed tomography and angiograms showed pulmonary thromboembolism. She was treated with pamitepulase, heparin and warfarin,and a temporary inferior vena cava (IVC) filter (Neuhaus Protect^TM) was inserted in order to prevent recurrence of acute pulmonary thromboembolism at the acute phase. After 10 days, the venography showed a massive thrombus in the filter and occlusion of IVC, and she was treated with urokinase. On the 18th hospital day, the thrombolysis of both IVC and the filter was markedly accelerated and the flow of IVC was reperfused. Thus, we were able to safely remove the Neuhaus Protect and emplace a Greenfield IVC filter. There are few reports about management for massive thrombus in the filter and occlusion of IVC occurring after insertion of a temporary IVC filter. Treatment by urokinase may be an effective therapy in such cases.