Asanuma y, Furuya T, Shibata S, Shioya T, Miura M, Koyama K.
Postoperative acute pulmonary thromboembolism in patients with acute necrotizing
pancreatitis with special reference to apheresis therapy.

Ther Apher 1998 Aug;2(3):199-204

Eight patients with pancreatic abscesses secondary to acute necrotizing
pancreatitis underwent drainage of their abscesses under laparotomy. Two of them
died of acute pulmonary thromboembolism (PTE) within 1 week. Autopsy revealed a
large thrombus at the main trunk of the pulmonary artery and in the left common
iliac vein. Femoral catheter insertion/indwelling, immobilization, surgery,
increased trypsin/kinin/kallikrein, increased endotoxin, and decreased
antithrombin-III (AT-III) were present following drainage of the pancreatic
abscesses. With respect to the bedside diagnosis of acute PTE, alveolar-arterial
oxygen gradients obtained by blood gas analysis and mean pulmonary artery
pressure estimated by pulsed Doppler echocardiography are very useful. In terms
of the treatment, attention should be paid to the following to prevent deep
venous thrombosis: prophylactic administration of low molecular weight heparin
and administration of AT-III (AT-III > or = 80%), use of the subclavian vein
whenever possible as blood access for apheresis therapy, as short a compression
time as possible after removing the blood access catheter (< or =6 h), and
application of intermittent pneumatic compression devices or elastic compression
stockings on the lower extremities.