Prophylactic use of the Angel® catheter in a patient with paraneoplastic syndrome scheduled for surgical tumor resection.  A case report and literature review

Dušica M. Stamenković; Vojislava Nešković; Ivan Marjanović; Aleksandar Tomić; Siniša Rusović; Vlastimir Marinković; Vladimir Bančević; Menelaos Karanikolas

doi:10.2298/VSP170115133S

Dušica M. Stamenković University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Vojislava Nešković University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Ivan Marjanović Military Medical Academy, Department of Vascular Surgery, Belgrade, Serbia
Aleksandar Tomić Military Medical Academy, Department of Vascular Surgery, Belgrade, Serbia
Siniša Rusović Military Medical Academy, Department of Radiology, Belgrade, Serbia
Vlastimir Marinković Military Medical Academy, Department of Vascular Surgery, Belgrade, Serbia
Vladimir Bančević University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Menelaos Karanikolas Washington University School of Medicine, Department of Anesthesiology, St. Louis, Missouri, USA

DOI: https://doi.org/10.2298/VSP170115133S

Keywords: neoplasms;, para neoplastic syndromes;, venous thrombosis;, pulmonary embolism, vena cava filters;, central venous catheters;, anticoagulants.

Abstract

Introductio. The Angel^® catheter (BiO2 Medical Inc, San Antonio, Texas, USA) is a novel device that combines a triple lumen central venous catheter with an inferior vena cava filter for prevention of pulmonary embolism (IVC filter-catheter). Case report. We present the case of a 53- year-old male patient with renal carcinoma and a history of recent deep venous thrombosis (DVT) on oral anticoagulation who was scheduled to undergo open radical nephrectomy. Because of concerns about the risks from documented pre-existing DVT, we decided to insert the Angel^® catheter preoperatively in order to have central venous access during surgery and also to reduce the risk of perioperative pulmonary embolism. On the first postoperative day, active gastric bleeding was detected and nadroparine was stopped. Before removal of the Angel^® catheter, a pre-removal cavagram revealed large thrombus mass in the catheter filter. Because of the presence of the thrombus mass, the catheter was removed surgically, after a permanent vena cava filter was inserted. Conclusion. This case suggests that the use of the Angel^® IVC filter/3-lumen central catheter combination could be a reasonable option for pulmonary embolism prophylaxis in the patients at a high risk for DVT, such as the patients with malignant disease, paraneoplastic syndrome and chemotherapy who need to undergo surgery.

Author Biographies

Dušica M. Stamenković, University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

Anesthesiology Departement

Staff anesthesiologist

Associate Professor

Vojislava Nešković, University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

Anesthesiology Departement

Staff anesthesiologist

Associate Professor

Ivan Marjanović, Military Medical Academy, Department of Vascular Surgery, Belgrade, Serbia

Vascular surgeon

Associate Prof.

Aleksandar Tomić, Military Medical Academy, Department of Vascular Surgery, Belgrade, Serbia

Vascular surgeon

Assoc.Prof.

Siniša Rusović, Military Medical Academy, Department of Radiology, Belgrade, Serbia

Radiologist

Vlastimir Marinković, Military Medical Academy, Department of Vascular Surgery, Belgrade, Serbia

Radiologist

Vladimir Bančević, University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

Urologist

Assoc.Prof.

Menelaos Karanikolas, Washington University School of Medicine, Department of Anesthesiology, St. Louis, Missouri, USA

Anesthesiologist

Assoc. Prof. of Anesthesiology

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