Journal of JCIC

Online edition: ISSN 2432–2342
JCIC学会事務局 JCIC学会事務局
〒162-0801東京都新宿区山吹町358-5アカデミーセンター Academy Center, 358-5 Yamabuki-cho, Shinju-ku, Tokyo 162-0801, Japan
Journal of JCIC 8(1): 10-13 (2023)


Fontan術後の深部静脈血栓症吸引の際にAgilis™ NxT Steerable Introducerが有用であった1例Transcatheter deep vein embolectomy with Agilis NxT steerable introducer after Fontan operation

大阪母子医療センター 小児循環器科Department of Pediatric Cardiology, Osaka Women’s and Children’s Hospital

受付日:2023年2月20日Received: February 20, 2023
受理日:2023年5月23日Accepted: May 23, 2023
発行日:2023年9月30日Published: September 30, 2023

Fontan手術後の合併症として血栓塞栓症があり,脳梗塞,肺塞栓,Fontan循環破綻などをきたす.血栓吸引の報告があるが,そのデバイス選択は施設ごとに異なる.症例は22歳女性.Ebstein病に対して,5歳時にFontan手術を施行した.発症4日前から左頸部・腋窩・前腕に疼痛,左上肢の腫脹があり緊急受診した.無名静脈から左内頚静脈・鎖骨下静脈に巨大血栓認め,左胸水貯留を認めた.緊急で経カテーテル的血栓溶解・吸引術を施行した.まずFOUNTAIN Infusion catheter, ウロキナーゼを用い血栓溶解術を施行,次に7 Fr Eliminate+(内腔1.3 mm)で血栓吸引を行うもいずれも効果はなかった.そのため内腔が8.5 Fr(2.8 mm),可変シースであるAgilis NxT Steerable Introducerを用いることにより有効な血栓吸引が可能となり,内頚静脈・鎖骨下静脈へのアプローチも容易であった.血栓吸引により十分な開通が得られた.先端が柔らかく,内腔が大きい可変シースが大きな血栓を吸引でき,シースだけで目標血管に安全に到達できる点で有用であった.

Complications after Fontan surgery include thromboembolism, which can lead to cerebral infarction, pulmonary embolism, and Fontan circulation collapse. Transvenous embolectomy has been reported, but the choice of device varies from institution to institution. Our case is a 22-year-old female who underwent Fontan surgery at age 5 for Ebstein’s disease. She was urgently seen for pain in the left neck, axilla, and forearm, and swelling in the left upper extremity 4 days before the onset of the disease. A huge thrombus was found in the left internal jugular vein, subclavian vein, and innominate vein, and a left pleural effusion was observed. She underwent emergency transcatheter thrombolysis and aspiration. Thrombolysis and aspiration using a FOUNTAIN® Infusion catheter and urokinase, and 7 Fr Eliminate®+ (1.3 mm lumen) were not effective. The Agilis NxT Steerable Introducer with 8.5 Fr (2.8 mm) lumen and deflectable sheath enabled effective thrombus aspiration and easy approach to each vein. Sufficient patency was achieved by thrombus aspiration. The steerable sheath with a soft tip and large lumen was useful for aspirating large thrombi and safely reaching the target vessel with only the sheath.

Key words: Fontan operation; embolectomy; aspiration; steerable introducer

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