CASE 1
A 61-year-old woman patient (PADUA index: 4, Caprini index: 5)
experienced 7 days of respiratory distress. She was confirmed COVID-19
positive thanks to a real-time reverse transcription polymerase chain
reaction (rRT-PCR) test. After admission, high flow nasal cannula (HFNC)
and supportive care were performed immediately. At day 4, she complained
of fatigue of the right lower limb. Due to the low oxygen saturation, a
cranial computerized tomography (CT) scan was not performed immediately.
At day 6, a bedside chest X-ray was performed, as shown in Fig.
1A . At day 8, there was obvious edema of the right lower extremity.
Consequently, the patient was scheduled for color ultrasound (US)
detection to screen for deep venous thrombosis (DVT). The scan confirmed
that there was fresh thrombosis in the right femoral vein. She was
anticoagulated with enoxaparin sodium (4000U, q12 h). At day 10, the
patient became drowsy and had evidence of right limb hemiplegia. A
cerebral haemorrhage may have been the reason for these symptoms, a
leading cause of morbidity in COVID-19 patients 6.
Anticoagulation was consequently withheld indefinitely and recommended
implantation of an IVCF to prevent fatal PE occurrence. A CT scan of the
chest at Day 10 had showed typical COVID-19 features in the lungs
(Fig. 1B ). She was transported to the digital subtraction
angiograph (DSA) operation room for IVCF implantation. After a
successful Seldinger puncture of the left femoral vein, a permanent
VenaTech® LP IVC filter (B. Braun, Melsungen, Germany)
was placed underneath the right renal vein, as shown in Figs.
1C-1D . Antibiotic and supportive therapies were also optimised. A
repeat chest X-ray on day 13 (Fig. 1E ) had showed signs of
improvement compared to day 6. She was followed up regularly with her
blood work (Table 1 ). C-reactive protein (CRP), neutrophil
count, D-dimer, and high-sensitivity Troponin I (hsTNI) levels were all
on the rise. The lymphocyte count was however improving. This together
with hsTNI normalised at day 21. CT scan of the chest at day 23
(Fig. 1F ).
She was eventually asymptomatic and discharged at day 28. This patient
was the first case to receive DSA-guided IVCF implantation in our
COVID-19 therapy centre. The DSA operation room and equipment was
meticulously disinfected to safeguard the health of patients making use
of the service in the future.