phenprocoumon and Aortic-Diseases

Topics: Aortic Diseases; Arterial Occlusive Diseases; Aspirin; Blood Vessel Prosthesis; Combined Modality Therapy; Female; Humans; Iliac Artery; Male; Middle Aged; Phenprocoumon; Polytetrafluoroethylene; Postoperative Complications; Prosthesis Design; Survival Rate

In a 50-year-old woman, admitted because of a renal infarction, a 10-cm long floating, highly mobile thrombus with a diameter of 15-20 mm in the descending aorta was detected by transoesophageal echocardiography and magnetic resonance imaging. She was a poor surgical candidate due to obstructive lung disease and obesity. Under intravenous heparinization with prothrombin time test values between 80 and 100 s, followed by oral anticoagulation with international normalized ratio values between 3.0 and 4.0, the thrombus resolved after 10 weeks and no recurrence occurred over the next 30 months.

Topics: Administration, Oral; Aorta, Thoracic; Aortic Diseases; Drug Administration Schedule; Drug Therapy, Combination; Female; Heparin; Humans; Infusions, Intravenous; Middle Aged; Phenprocoumon; Thrombosis

A 39-year-old woman complained of dyspnoea and increasing abdominal pressure sensation. A Greenfield filter had been implanted into her inferior vena cava (IVC) 4 years previously because of pulmonary embolism from a deep vein thrombosis after a hysterectomy with abscess formation. Physical examination revealed neck vein congestion, jaundiced sclerae, a tense abdominal wall, ascites and a soft machinery murmur in the paraumbilical region.. Transaminase activities were slightly raised (GOT 38 U/I, GPT 20 U/I), but total bilirubin and direct bilirubin were markedly elevated (2.9 mg/dl and 1.1 mg/dl, respectively). There was no evidence of cholestasis or decreased liver synthesis. Ultrasound showed marked dilatation of the IVC and hepatic veins, and echocardiography revealed right ventricular enlargement with grade II tricuspid regurgitation. Calculated pulmonary arterial systolic pressure averaged 50 mmHG. Colour-coded Doppler sonography demonstrated an aorto-caval shunt at the level of the filter in the IVC and penetration of a filter strut into the aortic lumen.. After removing the ascitic fluid by fluid and sodium restriction, and administration of an aldosterone antagonist and a loop diuretic, the A-V fistula was closed surgically and the filter removed. Three months after operation she was put on phenprocoumon (Quick value 20-30%). At the latest outpatient examination, 6 months after the operation, she was free of symptoms.. As filter implantation in the IVC may produce severe complications, indications for it need to be demonstrated by further studies of its efficacy.

Topics: Adult; Anticoagulants; Aorta, Abdominal; Aortic Diseases; Arteriovenous Fistula; Chronic Disease; Echocardiography; Female; Follow-Up Studies; Heart Failure; Humans; Phenprocoumon; Time Factors; Ultrasonography, Doppler, Color; Vena Cava Filters; Vena Cava, Inferior