Acute and Critical Care

Management of Upper Extremity Deep Vein Thrombosis with a Superior Vena Cava Filter - A Case Report -: Wooil Kwon, Ho Geol Ryu, Hannah Lee, Yongjae Yoo; Korean J Crit Care Med. 2013;28(1):59-63.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.59

Abstract PDF: Upper extremity deep vein thrombosis (UEDVT) is relatively uncommon and superior vena cava (SVC) filter placements are not often encountered due to strict indication. A 33-year old male with underlying protein C/S deficiency and secondary liver cirrhosis was admitted because of hematemesis. The patient was conservatively managed, but underwent elective splenectomy to prevent aggravation of gastric varix. During postoperative care, the patient underwent cholecystectomy for acalculous cholecystitis. During the postoperative course, UEDVT was detected and heparinization was initiated. The patient experienced repeated attacks of severe dyspnea, which was accompanied by chest pain that lasted for 3 to 10 minutes. Repeated episodes of pulmonary thromboembolism were suspected and SVC filter was placed. Warfarin treatment was initiated and the SVC filter was removed about one month later. The case highlights the clinical significance of UEDVT and reports rare case of SVC filter placement. Intensivists should have comprehensive understanding of UEDVT and its management.

Perioperative Management for the Patient with May-Thurner Syndrome: A Case Report: Soo Kyung Lee, Eun Joo Choi, Kun Il Kim, Young Mi Kim, Hyun Choi, Hyun Soo Moon; Korean J Crit Care Med. 2008;23(2):115-119.; DOI: https://doi.org/10.4266/kjccm.2008.23.2.115

Abstract PDF: May-Thurner syndrome is an anatomic variant in which the left common iliac vein is compressed by the right common iliac artery. The most frequent clinical presentation is deep vein thrombosis of the left lower extremity. We report the perioperative management in a patient with May-Thurner syndrome undergoing an open reduction of a tibia fracture. The patient developed deep vein thrombosis of the left lower extremity and had an endovascular stent placed approximately 1 year earlier. An important aspect of the perioperative management in a patient with May-Thurner syndrome is to prevent deep vein thrombosis. We monitored the activated clotting time during the intraoperative period.

Pulmonary Embolism Detected in the General Ward after Operation: A Case Report: Se Hyun Lew, Jong Hun Jun, Hee Koo Yoo, Yong Ho Kim; Korean J Crit Care Med. 2004;19(1):38-41.

Abstract PDF: Pulmonary embolism is a common medical complication following major orthopedic procedures of the lower extremities and a leading cause of morbidity and mortality. However, the clinical manifestations of pulmonary embolism are nonspecific and it may be difficult to diagnose. An 82 years old female with severe restrictive pulmonary disease received the elective operation for the fracture of left femur neck under combined spinal-epidural anesthesia. During the operation, we sometimes gave her oxygen via face mask and maintained oxygen saturation of more than 80% which was measured by a pulse oxymeter. The operation and anesthesia was performed uneventfully. On the seventh postoperative day, she showed tachycardia suddenly and cardiac arrest later on the electrocardiogram. After cardiopulmonary resuscitation, she was transferred to intensive care unit and checked by a computed tomography and echocardiography. She was diagnosed with pulmonary embolism and deep vein thrombosis and treated with heparin and urokinase. But she did not improve and died.

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