重複下大静脈を有する肺塞栓症に対して一時的下大静脈フィルターを使用した1例

A Case of Pulmonary Embolism with Double Inferior Vena Cava Treated by a Temporal Vena Cava Filter

　重複下大静脈を伴った肺塞栓症の急性期に，一時的下大静脈フィルターを使用した症例を経験した．症例は49歳，女性．労作時呼吸困難を訴え，近医より紹介入院となった．肥満体型であり低酸素血症を認め，心エコーにて右心系負荷，肺血流シンチ・肺動脈造影では多発的に血流欠損・血栓像を認めたため，肺塞栓症と診断した．下肢静脈造影と下大静脈造影で，下肢深部静脈血栓と腎静脈上部に合流する重複下大静脈が認められた．急性期に一時的下大静脈フィルター（Antheor temporary vena cava filter）を腎静脈上部の下大静脈に留置し，線溶療法を施行した．10日後にも下肢深部静脈血栓の残存を認めたため，永久的フィルター（Greenfield filter）に入れ替えた．その後は肺塞栓症の再発を認めず，良好に経過して退院となった．腎静脈以下の下大静脈にフィルター留置が困難な肺塞栓症の急性期に，一時的フィルターの留置は有効であると思われた．

　We report a case of pulmonary embolism with double inferior vena cava treated by a temporal vena cava filter. A-19-year-old woman suffered from shortness of breath on effort and was introduced for hospitalization. She was obese, and her arterial blood gas analysis showed hypoxemia. Echocardiography showed right ventricle overloading. Pulmonary blood flow scintigraphy and pulmonary arteriography revealed multiple blood flow defects and thrombus, and we diagnosed a pulmonary embolism. Venography showed a deep venous thrombus of the leg and the double inferior vena cava joining above the renal veins. In the acute phase, we inserted a temporary filter (antheor temporary vena cava filter) into the vena cava above the renal veins. and performed fibrinolysis therapy. Ten days after, the second venography showed the deep vein thrombus to habe remained, so we changed from a temporary filter to a permanent filter (Greenfield filter). After that, the patient got better without complications and was discharged.

　A temporary vena cava filter was effective in this casein which filter insertion to the vena cava below the renal veins was difficult in the acute phase of the pulmonary embolism.