腕頭静脈部での急性血栓性閉塞に対し上大静脈に下大静脈フィルターを留置し有効であった2例

Two Cases in which the Inferior Vena Cava Filter was used Effectively in Relieving Superior Vena Cava Syndrome in Acute Thrombus in the Brachiocephalic Vein

要旨　患者は38歳の先天性プロテインC欠損症の女性と，67歳の胃癌術後で内頸静脈への中心静脈栄養施行中の男性の2例である．ともに造影CTで発見され，1例は肺血栓塞栓症がすでに起こっていた．2例とも抗凝固療法を行う前にCook社製のギュンター下大静脈フィルター(IVCF)の頸部からのアプローチ用のものを大腿アプローチより留置し，2週間以内にこのIVCFを回収し得た．IVCFの長期留置では深部静脈血栓症がむしろ増えるとの報告もあり，上大静脈部に留置した今回の場合，フィルター部で閉塞すれば上大静脈症候群になることもあり回収が望ましいと思われる．内頸静脈や鎖骨下静脈へのカテーテル留置に伴う医原性血栓性閉塞は日常診療上でも稀ではないが，その対処法は確立されていない．今回われわれは，回収可能型フィルターの使用が有効であった症例を経験したため，報告する．

Summary

　The patients were a 38-year-old woman with congenital protein C deficiency, and a 67-year-old man cancer patient receiving central venous nutrition through the internal jugular vein. The thrombi in both cases were detected during CT and one case was already suffering from pulmonary thromboembolism. For both cases, from the femoral vein we used the Gunter inferior vena cava filter(IVCF) for the cervical approach (made by Cook Co.)before beginning anticoagulation and we were able to take it out within two weeks. Because there is a report that deep vein thrombosis increases with long-term use of IVCF, in this case where the superior vena cava was affected. We thought we might be able to relieve the superior vena cava syndrome by removing the IVCF. Internal jugular vein and subclavian vein-related occlusion is not rare, in common practice, when thrombus captured in a catheter is introduced inadvertently. Treatment for this has not yet been established.