Pulmonary vein thrombosis as a possible cause of embolic internal carotid artery occlusion under anticoagulation therapy: case report

Kishida, Natsue; Fukuda, Hitoshi; Chin, Masaki; Handa, Akihiro; Yamagata, Sen

doi:10.3995/jstroke.36.275

Cited by 10 publications

(2 citation statements)

References 4 publications

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“…In agreement with our experience, there have been several reports of systemic thrombosis even with anticoagulation therapy. 4,11 Hence, the risk of systemic thrombosis should always be considered in patients with thrombosis in the PV stump even under anticoagulant therapy, and treatment, including surgical removal of the thrombus, should be carefully assessed. 12 Although some guidelines recommend plain CT after lobectomy, whether contrast-enhanced CT should be performed after lobectomy remains debatable.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary vein thrombosis after lobectomy with vein stump closure by ligation

Miyoshi

Nishikawa

Tamari

et al. 2018

Asian Cardiovasc Thorac Ann

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Objectives Thrombosis in the pulmonary vein stump after a left upper lobectomy is a rare but potentially life-threatening complication, and the pulmonary vein stump length plays an important role here. We assessed the frequency and risk factors for thrombosis in patients undergoing lobectomy with division of the superior pulmonary vein using ligation. Methods We retrospectively reviewed 425 patients with primary lung cancer who underwent lobectomy or bilobectomy in our institution from 2008 to 2016, with contrast-enhanced chest computed tomography within a year after lobectomy. The superior pulmonary vein was divided by thread ligation, while the inferior pulmonary vein was divided using a linear stapler. The pulmonary vein stump length was measured using contrast-enhanced chest computed tomography. Results Four (0.9%) of the 425 patients experienced thrombosis in the pulmonary vein stump within 6 months after lobectomy. All 4 patients had undergone a left upper lobectomy, and 4.1% of this subset developed thrombus. One patient with a thrombus in the pulmonary vein stump experienced renal and cerebral infarction after a left upper lobectomy. The left superior pulmonary vein stump was significantly longer than the other pulmonary vein stumps. Conclusions Thrombosis in the pulmonary vein stump occurred in 4.1% of patients undergoing a left upper lobectomy with pulmonary vein stump closure by thread ligation, which is a relatively low frequency. Superior pulmonary vein stump closure using thread ligation might help prevent pulmonary vein stump thrombus after a left upper lobectomy.

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Section: Discussionmentioning

confidence: 99%

Pulmonary vein thrombosis after lobectomy with vein stump closure by ligation

Miyoshi

Nishikawa

Tamari

et al. 2018

Asian Cardiovasc Thorac Ann

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“…There were two patients that developed a first episode of thrombosis despite being on anticoagulant therapy [ 2 , 7 ]. One patient [ 2 ] was taking anticoagulation therapy at baseline because of atrial fibrillation and developed thrombosis on the 50th postoperative day. The patient was receiving adjuvant chemotherapy, which may be a risk factor for thrombus formation as indicated in a previous report [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Recurrent cerebral attack caused by thrombosis in the pulmonary vein stump in a patient with left upper lobectomy on anticoagulant therapy: case report and literature review

2017

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BackgroundThrombus formation in the pulmonary vein stump after pulmonary resection has recently been identified as a cause of systemic thrombosis including brain infarction. However, there is limited research focusing on the clinical course of pulmonary vein stump thrombus, and optimal treatment and prevention strategies of this important complication have not been established.Case presentationA 77-year-old woman was diagnosed with lung cancer of the left upper lobe, cT4N2M0, cStage IIIB. As the tumor was considered to be completely resectable, the patient underwent a left upper lobectomy with angioplasty of the left pulmonary artery. The final pathological stage was pT4N2M0, pStage IIIB. The patient developed paralysis of the right upper limb and dysarthria on the 8th postoperative day. Diffusion-weighted magnetic resonance imaging (MRI) of the brain showed multiple high-intensity signals in the area of the left middle cerebral artery, which were not detected on preoperative MRI. She was diagnosed with a cerebral infarction and started on acute-phase treatment including anticoagulation with continuous intravenous heparin infusion. The neurological symptoms improved the following day. Contrast-enhanced chest CT scan revealed thrombus in the left superior pulmonary vein stump measuring 10 mm in diameter. She had no comorbidity related to the cerebral attack. After the treatment was initiated, her symptoms became stable. However, symptoms of altered consciousness, dysarthria, and hemiparesis re-occurred on the 19th postoperative day and improved within an hour. The thrombus in the left superior pulmonary vein stump disappeared on follow-up contrast-enhanced chest CT performed the same day.ConclusionsThis is the first report of recurrent brain attack caused by thrombosis in the pulmonary vein stump in a patient receiving anticoagulant therapy. The present case suggests the possibility of thrombus mobilization causing recurrent systemic thrombosis, and this important complication needs to be considered in future clinical practice.

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Stagnating blood flow related to thrombus formation in pulmonary vein stump after left upper lobectomy

Nakano

Kaneda

Murakawa

2023

Gen Thorac Cardiovasc Surg

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Objectives A thrombus can occur in the stump of the pulmonary vein after left upper lobectomy, potentially causing postoperative cerebral infarction. This study aimed to verify the hypothesis that stagnation of blood flow inside the pulmonary vein stump causes thrombus formation. Methods The three-dimensional geometry of the pulmonary vein stump after left upper lobectomy was recreated using contrast-enhanced computed tomography. Blood flow velocity and wall shear stress (WSS) inside the pulmonary vein stump were analysed using the computational fluid dynamics (CFD) method and compared between the two groups (those with or without thrombus). Results The volumes of average flow velocity per heartbeat < 10 mm/s, 3 mm/s, 1 mm/s (p-values 0.0096, 0.0016, 0.0014, respectively) and the volumes where flow velocity was always below the three cut-off values (p-values 0.019, 0.015, 0.017, respectively) were significantly larger in patients with a thrombus than in those without thrombus. The areas of average WSS per heartbeat < 0.1 Pa, 0.03 Pa, 0.01 Pa (p-values 0.0002, < 0.0001, 0.0002, respectively), and the areas where WSS was always below the three cut-off values (p-values 0.0088, 0.0041, 0.0014, respectively) were significantly larger in patients with thrombus than in those without thrombus. Conclusions The area of blood flow stagnation in the stump calculated by CFD method was significantly larger in patients with than in those without thrombus. This result elucidates that stagnation of blood flow promotes thrombus formation in the pulmonary vein stump in patients who undergo left upper lobectomy.

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Pulmonary vein thrombosis as a possible cause of embolic internal carotid artery occlusion under anticoagulation therapy: case report

Cited by 10 publications

References 4 publications

Pulmonary vein thrombosis after lobectomy with vein stump closure by ligation

Pulmonary vein thrombosis after lobectomy with vein stump closure by ligation

Recurrent cerebral attack caused by thrombosis in the pulmonary vein stump in a patient with left upper lobectomy on anticoagulant therapy: case report and literature review

Stagnating blood flow related to thrombus formation in pulmonary vein stump after left upper lobectomy

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