Phẫu thuật xử trí tai biến trong can thiệp mạch lấy bỏ lưới lọc tĩnh mạch chủ dưới: Báo cáo ca lâm sàng

The management of rare complications during inferior vena cava (IVC) filter retrieval procedures presents a significant clinical challenge, often necessitating prompt and decisive intervention. While IVC filter retrieval is generally considered safe, instances of device entrapment or vascular injury can occur, demanding specialized approaches. This case report highlights the critical role of emergency surgical intervention in addressing such rare and complex complications. It describes a patient who experienced entrapment of a retrieval device within the right renal vein and the IVC during filter removal, underscoring the importance of understanding appropriate surgical strategies to ensure patient safety and preserve vital organ function, particularly in cases involving the renal vasculature.

Vascular surgeons, interventional radiologists, cardiologists, and physicians involved in the management of deep vein thrombosis, pulmonary embolism, and inferior vena cava filter procedures.

This clinical case report details the successful emergency surgical management of a rare complication encountered during inferior vena cava (IVC) filter retrieval. The patient, diagnosed with deep vein thrombosis and pulmonary thrombosis, initially underwent IVC filter placement. During a subsequent retrieval procedure, a hook-type retrieving device became entrapped within the right renal vein and the IVC. Endovascular attempts to remove the device failed, necessitating an urgent open surgical intervention. The surgical approach involved a right transabdominal incision, allowing for direct exposure and control of the renal vein and IVC. A venotomy was performed to facilitate the removal of both the entangled IVC filter and the retrieval device. Subsequent repair of the damaged renal vein and IVC was meticulously executed. Postoperatively, the patient exhibited an uneventful recovery, with no evidence of vascular complications or renal dysfunction, confirmed by Doppler ultrasound. This case emphasizes the critical importance of emergency surgery as a definitive treatment for complex IVC filter retrieval failures, especially when endovascular techniques are unsuccessful and vascular integrity is compromised. It provides valuable insights into strategic surgical planning and execution for preserving renal function and ensuring optimal patient outcomes in the face of challenging intravascular device complications. The report also implicitly reinforces the need for meticulous technique and careful imaging during endovascular procedures to minimize such iatrogenic injuries.