Turk Gogus Kalp Dama 2012;20(2):367-369 367 Türk Göğüs Kalp Damar Cerrahisi Dergisi Turkish Journal of Thoracic and Cardiovascular Surgery doi: 10.5606/tgkdc.dergisi.2012.071 Deep venous thrombosis in the right upper extremity after removal of the Swan-Ganz thermodilution catheter Swan-Ganz termodilüsyon kateterinin çıkarılmasını takiben gelişen sağ üst ekstremite derin ven trombozu Orhan Gökalp, 1 Ufuk Yetkin, 1 Murat Aksun, 3 Müge Dinçsoy Gürçınar, 2 Ali Gürbüz 1 1 Department of Cardiovascular Surgery, İzmir Atatürk Training and Research Hospital, İzmir, Turkey; 2 Department of Radiodiagnostics, Bilrad Imaging Center, İzmir, Turkey; 3 Department of Anesthesiology, İzmir Atatürk Training and Research Hospital, İzmir, Turkey Kateter ile ilişkili santral ven trombozu, Swan-Ganz ter- modilüsyon kateterizasyon işlemi sonrasında sıkça görülen bir komplikasyondur. Bu yazıda, Swan-Ganz termodilüs- yon kateteri çıkarılmasını takiben sağ üst ekstremitede derin ven trombozu gelişen 73 yaşında bir kadın olguyu güncel literatür bilgisi ışığında sunmayı amaçladık. Anahtar sözcükler: Komplikasyon; derin ven trombozu; Swan- Ganz termodilüsyon kateteri; üst ekstremite. Catheter-related central vein thrombosis is a frequently seen complication of Swan Ganz thermodilution catheterization procedure. In this article, we aimed to present a 73-year-old female case with deep venous thrombosis in the right upper extremity after removal of the Swan-Ganz thermodilution catheter in the light of current literature data. Key words: Complication; deep venous thrombosis; Swan-Ganz thermodilution catheter; upper extremity. Received: August 17, 2009 Accepted: November 20, 2009 Correspondence: Ufuk Yetkin, M.D. İzmir Atatürk Eğitim ve Araştırma Hastanesi, Kalp ve Damar Cerrahisi Kliniği, 35360 Basın Sitesi, İzmir, Turkey. Tel: +90 232 - 244 44 44 / 2448 e-mail: ufuk_yetkin@yahoo.fr The Swan-Ganz pulmonary artery thermodilution catheter is the most frequent material used during and after cardiac surgery to monitor the patient in the early period because it gives so much information to surgical and anesthesia teams along with intensive care staff. Its placement and use carry potential risks that require immediate management. [1] CASE REPORT Our case involved a 73-year-old female whose past medical history was significant because of a myocardial infarction experienced a year earlier. She underwent a successful coronary bypass surgery to two vessels at our clinic. Perioperatively, a Swan-Ganz thermodilution catheter (Edwards Lifesciences, 7F 110 cm) was inserted into the right internal jugular vein for invasive hemodynamic monitorization. She was discharged on the seventh postoperative day. On the fifth day after discharge, she was readmitted to our hospital with complaints of pain and enlargement in the right arm (Figure 1). Color Doppler ultrasound revealed that the right axillary and subclavian veins were completely filled with non-compressible thrombus material which doubled the size of the accompanying arteries. The venous system located within the cubital fossa and the forearm was patent (Figures 2 and 3). Our opinion is that the major responsible factor for the thrombosis in our patient was the thrombogenic stimulus of the catheter itself. She was then rehospitalized, and antithrombotic therapy was initiated. She was heparinized, and the activated clotting time (ACT) values were kept between 200 and 250 seconds. Oral warfarin was added on the first treatment day, and an international normalized ratio (INR) level of 2-2.5 was maintained. She showed a dramatic relief in symptoms and was discharged on the sixth day of hospitalization for ambulatory therapy. Serum protein C and S levels were within normal limits while searching for a thrombophilic state. A control Doppler ultrasound examination was repeated on the 15 th day after the onset of symptoms, and this showed revascularization anterior to the thrombosed subclavian vein (Figure 4) and posterior to the thrombosed axillary vein (Figure 5). Flow rates were detected to be low in the revascularization areas, and the new venous structures were thin in calibration. No thrombus was detected within the distal deep venous segments. Case Report / Olgu Sunumu