What should be done when a patient gets a DVT in the neck after coronary bypass surgery?
Seems like an SVC filter should be placed?
For this article I consulted with Seyed-Mojtaba Gashti, MD, a board certified vascular surgeon with Broward Health Medical Center in Florida.
Following coronary bypass surgery (a.k.a. CABG), it’s possible for a patient to develop a DVT in the neck.
This happened to my mother following her CABG. “She has a big DVT,” I was told by the nurse after results of the ultrasound came in.
But nothing was done. At the time, I didn’t know about the SVC filter, which is designed to prevent a dislodged portion of a DVT from entering the lungs and becoming a pulmonary embolus.
After learning about the SVC filter, I’ve always wondered what the doctors’ responses would have been had I insisted on an SVC filter placement for my mother.
“Most of these DVTs would be labeled as provoked, most often secondary to central venous catheters,” says Dr. Gashti.
“Generally these are focal and limited to the site of the catheter (most often in the internal jugular vein). These can be watched.
“But if the thrombus extends to the subclavian/innominate veins, then most physicians would consider anticoagulation if there are no contraindications.”
Following CABG, a patient can bleed to death from anticoagulant drugs.
“If anticoagulation is contraindicated, then an SVC filter would be indicated,” says Dr. Gashti. SVC stands for superior vena cava, a large vein that transports de-oxygenated blood from the upper body to the heart.
“The SVC is much shorter than the IVC [inferior vena cava], and therefore placement of a filter in the SVC is technically more challenging.
“You have to make sure the length is adequate. Currently there are no filters in the market indicated for SVC and if you place one, it would be off label. I have only placed a handful of these in 14 years of practice.”