DATE OF OPERATION: MM/DD/YYYY
PREOPERATIVE DIAGNOSES: Deep venous thrombosis, pulmonary embolism, and hemodynamic collapse.
POSTOPERATIVE DIAGNOSES: Deep venous thrombosis, pulmonary embolism, and hemodynamic collapse.
OPERATION PERFORMED: Placement of inferior vena cava filter, inferior venocavogram, placement of triple lumen venous catheter, and placement of arterial line.
ANESTHESIA: Local.
COMPLICATIONS: None.
DESCRIPTION OF OPERATION: The patient was brought to the interventional radiology suite where support lines were placed and monitors were placed as well. The patient was monitored during the entire procedure by the registered nurse and attending physician. No intravenous sedation was given. The patient’s left groin was prepped and sterilely draped, and 1% lidocaine was used as a local anesthetic.
The left common femoral vein was cannulated using a needle, and a wire was advanced under fluoroscopic guidance into the inferior vena cava. A 5-French catheter was then inserted. Over the wire, a pigtail catheter was inserted into the vena cava, and inferior venocavogram was performed. This delineated the renal veins as well as the iliac vein bifurcation. There was no evidence of thrombus within the inferior vena cava, and the inferior vena cava measured approximately 18 mm in size.
Therefore, a decision was made to place a Simon Nitinol filter. The sheath was removed, and over the wire, an introducer sheath was advanced into the inferior vena cava and positioned between the renal veins and the iliac vein bifurcation. A Simon Nitinol filter was then advanced into this region and was deployed. Postdeployment film revealed excellent positioning of the vena cava catheter. Because the patient had poor intravenous access over the guidewire that had been retained, a triple lumen catheter was inserted with the tip just at the iliac vein bifurcation. It was flushed, irrigated, and aspirated quite well and was flushed with saline. It was anchored in place using a 2-0 silk suture.
The patient was also having difficulty finding a blood pressure, and therefore, an arterial line was placed. The left common femoral artery was cannulated, and a wire was advanced under fluoroscopic guidance into the aorta. Over the wire, an arterial line was placed and anchored using 2-0 silk suture. It was connected to a pressure bag. The patient tolerated these procedures well and was transferred back to the intensive care unit postoperatively.
