Fatal pulmonary embolism following spinal surgery in a patient with permanent inferior vena cava filter placement

Abstract

It has been proven that the use of an inferior vena cava filter (IVCF) is effective in decreasing the incidence of pulmonary embolism (PE) in high-risk spinal surgery patients. A case of fatal PE after spinal surgery in a 78-year-old woman who had a history of pulmonary hypertension due to peripheral PE treated with a permanent IVCF and anticoagulant therapy for 3 years is reported. The patient had experienced an episode of recurrent PE during the withdrawal of anticoagulants, but she had uneventfully undergone two orthopedic surgeries with a preoperative unfractionated heparin infusion instead of oral warfarin. Three months after the second operation, she underwent posterior lumbar spinal fusion. The following morning, she suddenly complained of chest discomfort and dyspnea with SpO(2) 78 %. An electrocardiogram showed a right bundle branch block. Then, 30 min later, she suddenly lost consciousness, and her carotid pulse was not palpable. The patient died 2 h and 30 min after onset. Acute PE probably occurred because of a massive thrombus above the IVCF. This case suggests that the efficacy of long- term use of a permanent IVCF is limited in cases when anticoagulants must be withdrawn, such as for orthopedic surgery.

Are there any risk factors for developing complications with the use of retrievable vena cava filters in orthopaedic surgery?

“…Furthermore, patients that received permanent filters had significantly higher VTE incidence than those receiving retrievable ones. We consider that elderly patients, as the population described within this study, in the setting of long anesthesia-time, plays a major role in the settlement TED-related complications following spinal procedures [45][46] .…”

Massive Pulmonary Embolism after Prolonged Spinal Fusion Surgery and the Golden Hour

“…Pulmonary embolism after spinal surgery is not uncommon [1][2][3]. Apart from stasis and the general hypercoagulable state during surgery [4,5], specific problems arise during orthopedic surgery.…”