Treatment and prevention of Mobin-Uddin umbrella misplacement

Interruption of the blood flow in the inferior vena cava by a Mobin-Uddin umbrella has become a popular method of preventing recurrent pulmonary emboli. Although infrequent, complications are significant. An umbrella device was inserted in the right renal vein of a patient; the management of this complication is discussed. Immediate operative removal of the device with renal vein repair is recommended. Postoperative intravenous pyelogram and frequent urinalyses should be obtained to document continued renal vein patency and adequate renal function. Occurrence of this complication can be minimized by using a preinsertion cavogram to define anomalies of the venous system. Also, recent availability of an applicator that permits venacavography at the time of umbrella insertion should be of great assistance.