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Axial (B) and coronal (C and D) reformatted images with maximum intensity projection show multiple metallic fragments (from the fractured filter) at the level of the right cardiac cavities and right pulmonary artery (arrows). Note also non-homogeneous opacities in the left lower lobe (pulmonary infarction) and a deep venous catheter in the superior vena cava (arrowheads).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Gustavo Braga Mendes, Gláucia Zanetti, Edson Marchiori" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Gustavo" "apellidos" => "Braga Mendes" ] 1 => array:2 [ "nombre" => "Gláucia" "apellidos" => "Zanetti" ] 2 => array:2 [ "nombre" => "Edson" "apellidos" => "Marchiori" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S1579212919300497" "doi" => "10.1016/j.arbr.2018.07.018" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212919300497?idApp=UINPBA00003Z" ] ] "EPUB" => 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Axial (B) and coronal (C and D) reformatted images with maximum intensity projection show multiple metallic fragments (from the fractured filter) at the level of the right cardiac cavities and right pulmonary artery (arrows). Note also non-homogeneous opacities in the left lower lobe (pulmonary infarction) and a deep venous catheter in the superior vena cava (arrowheads).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">We read with great interest the original article by de Gregorio et al.,<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> who analyzed success in vena cava filter (VCF) retrieval and factors associated with retrieval failure. They also commented on complications associated with VCF placement and removal, especially those of a local nature (tilting of the inferior vena cava axis, venous wall penetration, migration, and local thrombosis). We would like to highlight another important complication related to VCF use that is of interest to pulmonologists: filter embolization.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 47-year-old woman presented to the emergency department with acute shortness of breath and chest pain. She had a past history of recurrent deep venous thrombosis, despite anticoagulation therapy. A VCF had been inserted in the infrarenal inferior vena cava 9 months previously. Computed tomography of the chest identified a thrombus in the left pulmonary artery with pulmonary opacities in the left lower lobe, and multiple metallic fragments at the level of the right pulmonary artery and right atrium (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The diagnosis of pulmonary infarction and embolization of a broken VCF was made. Given the patient's relatively young age and the possibility of future complications, the patient decided to have the fragments surgically removed. The patient recovered well and was discharged 2 weeks after surgery.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">VCF complications can occur early, during placement, or later, after positioning. Immediate complications of VCF placement include puncture site complications and mechanical failures, such as delivery system malfunction, incomplete or asymmetric deployment (opening), malpositioning, and tilting. Fatalities caused by these complications are rare.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">Late complications of VCF use may be of local origin, including inferior vena cava thrombosis, penetration of the vessel wall and injury to nearby organs, or distant, including structural failure with migration of all or part of the VCF to the right side of the heart and/or pulmonary arteries, recurrence of thrombosis and pulmonary embolism.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2,3</span></a> Distant complications are of special interest to pulmonologists.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Filter fracture occurs when the filter structure fails, leading to fragmentation and potential embolization of the fragment. Filter embolization is defined as movement of the filter after deployment to a distant anatomic site completely out of the target zone. The most common site of embolization is the right atrium, where the fragment can cause complications such as perforation of the right atrial wall, cardiac tamponade, and myocardial infarction. Another common site is the pulmonary vasculature.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The proper management of patients with intracardiac or intrapulmonary VCF migration remains speculative. Serious consideration should be given to filter removal whenever possible, regardless of the presence or absence of symptoms. Surgery should be the first option considered. Open thoracotomy has the advantage of allowing the operator to directly visualize the filter and have better control during retrieval. It also allows direct inspection of the cardiac chambers and immediate repair of any damage that has occurred. Whenever surgery is contraindicated, endovascular retrieval should be performed by an experienced endovascular team.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1250 "Ancho" => 1667 "Tamanyo" => 235063 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Axial (A) contrast-enhanced chest computed tomography image showing a filling defect (thrombus) on the left pulmonary artery. Axial (B) and coronal (C and D) reformatted images with maximum intensity projection show multiple metallic fragments (from the fractured filter) at the level of the right cardiac cavities and right pulmonary artery (arrows). Note also non-homogeneous opacities in the left lower lobe (pulmonary infarction) and a deep venous catheter in the superior vena cava (arrowheads).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Success in optional vena cava filter retrieval. An analysis of 246 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M.A. De Gregorio" 1 => "J.A. Guirola" 2 => "C. Serrano" 3 => "A. Figueredo" 4 => "W.T. Kuo" 5 => "C.A. 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Year/Month | Html | Total | |
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2024 October | 38 | 16 | 54 |
2024 September | 38 | 14 | 52 |
2024 August | 68 | 33 | 101 |
2024 July | 64 | 23 | 87 |
2024 June | 50 | 24 | 74 |
2024 May | 70 | 19 | 89 |
2024 April | 42 | 23 | 65 |
2024 March | 49 | 13 | 62 |
2024 February | 47 | 28 | 75 |
2023 March | 9 | 2 | 11 |
2023 February | 46 | 22 | 68 |
2023 January | 25 | 28 | 53 |
2022 December | 35 | 20 | 55 |
2022 November | 40 | 24 | 64 |
2022 October | 47 | 36 | 83 |
2022 September | 27 | 21 | 48 |
2022 August | 26 | 39 | 65 |
2022 July | 27 | 35 | 62 |
2022 June | 28 | 23 | 51 |
2022 May | 29 | 39 | 68 |
2022 April | 26 | 31 | 57 |
2022 March | 42 | 54 | 96 |
2022 February | 34 | 35 | 69 |
2022 January | 35 | 46 | 81 |
2021 December | 26 | 35 | 61 |
2021 November | 29 | 35 | 64 |
2021 October | 33 | 47 | 80 |
2021 September | 26 | 39 | 65 |
2021 August | 20 | 35 | 55 |
2021 July | 23 | 23 | 46 |
2021 June | 25 | 38 | 63 |
2021 May | 31 | 41 | 72 |
2021 April | 63 | 64 | 127 |
2021 March | 37 | 22 | 59 |
2020 May | 0 | 2 | 2 |
2020 March | 18 | 7 | 25 |
2020 February | 32 | 16 | 48 |
2020 January | 37 | 11 | 48 |
2019 December | 31 | 16 | 47 |
2019 November | 20 | 10 | 30 |
2019 October | 21 | 12 | 33 |
2019 September | 16 | 9 | 25 |
2019 August | 3 | 3 | 6 |
2019 May | 1 | 0 | 1 |
2019 March | 1 | 0 | 1 |