1
|
Yu Z, Lin C, Zeng X, Yang T, Lv S, Hu S, Wang D, Lang D. Application of the Double Series Filter Technique for the Treatment of Acute Inferior Vena Cava Filter-Mediated Thrombosis. Ann Vasc Surg 2024; 99:89-95. [PMID: 37977344 DOI: 10.1016/j.avsg.2023.09.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/08/2023] [Accepted: 09/16/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND In this study, we examined the safety and effectiveness of removing inferior vena cava (IVC) filters with residual acute thrombosis after endovascular therapy. METHODS A retrospective chart review of 712 patients who underwent retrievable IVC filter implantation between July 2018 and December 2022 was conducted. Residual thrombosis with the IVC filter occurred in 18 patients, and the volume of residual acute thrombosis in the IVC filter exceeded 1 mL in all cases. Angiography was performed to evaluate the size of the residual thrombosis and its position with respect to the filter. The double series filter technique (first filter, infrarenal IVC filter; second filter, suprarenal IVC filter) was used to remove the filter and thrombosis. We summarize the diagnosis, treatment, and surgical experience of these patients. RESULTS In this study, 16 of 18 patients (88.9%) demonstrated residual thrombosis in the IVC filter. One patient (5.6%) demonstrated thrombosis located both inside and floating above the filter, and one patient (5.6%) demonstrated thrombosis located both inside and underneath the filter. The technical success rate of double series IVC filter retrieval was 100%. Seventeen patients (94.4%) underwent single-stage suprarenal IVC filter retrieval, and one patient (5.6%, 1/18) underwent two-stage retrieval. In terms of residual thrombosis removal, 14 patients (77.7%) achieved complete removal and 4 patients (22.3%) achieved partial removal. Residual thrombosis could not be removed through the sheath in one patient, so femoral vein thrombectomy was performed. No other procedure-related complications were observed. The median follow-up time was 22.5 ± 6.8 months. No recurrence of thrombus symptoms was reported, and B ultrasound and computed tomography demonstrated smooth blood flow in the IVC, renal veins, and pulmonary artery. CONCLUSIONS For patients with residual acute thrombosis on the IVC filter and in whom there was absence of a more appropriate treatment after percutaneous mechanical thrombectomy or catheter-directed thrombolysis therapy, the double series IVC filter technique was a safe approach to improve the IVC filter retrieval rate in the early stage, as well as for simultaneous residual thrombus removal.
Collapse
Affiliation(s)
- Zuanbiao Yu
- Department of Vascular Surgery, Ningbo No.2 Hospital, Zhejiang, China
| | - Chen Lin
- Department of Vascular Surgery, Ningbo No.2 Hospital, Zhejiang, China
| | - Xiangman Zeng
- Department of Vascular Surgery, Ningbo No.2 Hospital, Zhejiang, China
| | - Tiequan Yang
- Department of Vascular Surgery, Ningbo No.2 Hospital, Zhejiang, China
| | - Shuyi Lv
- Department of Ultrasound Intervention, Ningbo No.2 Hospital, Zhejiang, China
| | - Songjie Hu
- Department of Vascular Surgery, Ningbo No.2 Hospital, Zhejiang, China
| | - Di Wang
- Department of Vascular Surgery, Ningbo No.2 Hospital, Zhejiang, China
| | - Dehai Lang
- Department of Vascular Surgery, Ningbo No.2 Hospital, Zhejiang, China.
| |
Collapse
|
2
|
Mihm AE, Bacchus A, Harb KJ, Menear RA, Nisly SA. Direct oral anticoagulants versus warfarin for the treatment of inferior vena cava thrombus. Eur J Haematol 2023; 111:909-913. [PMID: 37688288 DOI: 10.1111/ejh.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 08/24/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of direct oral anticoagulants (DOACs) compared to warfarin in patients with inferior vena cava (IVC) thrombus. METHODS This was a single-system, retrospective cohort study of hospitalized adult patients with IVC thrombus treated with a DOAC or warfarin therapy. The primary efficacy endpoint was the thrombus resolution on imaging, and the primary safety endpoint was major bleeding, both assessed within 6 months of hospital discharge. Secondary endpoints included hospitalization for a bleeding-related event, pulmonary embolism, or death within 6 months of hospital discharge. RESULTS A total of 33 patients were included in the study. Twenty-three (70%) patients received a DOAC, and 10 (30%) received warfarin. Of the 10 patients with repeat imaging available, complete resolution was noted in two (33%) DOAC patients and no warfarin patients (p = .5). Major bleeding occurred in two (8.7%) DOAC patients and one (10%) warfarin patient (p = .9). No significant differences in secondary endpoints were observed between groups. CONCLUSIONS There were no differences in efficacy and safety between patients receiving DOACs or warfarin for the treatment of IVC thrombus, although results are limited by the small patient population and number of patients with repeat imaging available.
Collapse
Affiliation(s)
- Alexandra E Mihm
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
- Wingate University School of Pharmacy, Wingate, North Carolina, USA
| | - Arefa Bacchus
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Kathleen J Harb
- High Point University Fred Wilson School of Pharmacy, High Point, North Carolina, USA
| | - Richard A Menear
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
- High Point University Fred Wilson School of Pharmacy, High Point, North Carolina, USA
| | - Sarah A Nisly
- Department of Pharmacy, Atrium Health Wake Forest Baptist, Winston-Salem, North Carolina, USA
- Clinical Education Alliance, Reston, Virginia, USA
| |
Collapse
|
3
|
Wang Y, Gu J, Lu L, Yang Y, Zhang W, Huang C. Endovascular Strategy for Inferior Vena Cava Thrombosis Secondary to Deep Venous Thrombosis of the Lower Extremities: Early Experience From Two Centres. Vasc Endovascular Surg 2023; 57:689-696. [PMID: 36997158 DOI: 10.1177/15385744231167668] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023]
Abstract
PURPOSE To evaluate the safety, feasibility and technical aspects of endovascular treatments for inferior vena cava (IVC) thrombosis secondary to deep venous thrombosis of the lower extremities. MATERIALS AND METHODS A retrospective study of patients from two centres who received endovascular treatment for IVC thrombosis from January 2015 to December 2020. Under the protection of the IVC filter, all lesions were treated with manual aspiration thrombectomy (MAT) followed by catheter-directed thrombolysis (CDT). Technical aspects, complications, IVC patency, Venous Clinical Severity Score (VCSS) score and Villalta score were recorded during the follow-up observation. RESULTS Endovascular procedures including MAT and CDT were performed successfully in 36 patients (97.3%). The average duration of the endovascular procedure was 71 minutes (range: 35-152 min). To protect against fatal pulmonary artery embolism, 33 filters (91.7%) were deployed in the inferior renal IVC, while three patients (8.3%) received filter implantation in the retrohepatic IVC. No severe complications occurred during the procedure. In the follow-up observations, the cumulative primary and secondary patency rates in IVC were 95% and 100%, respectively. The patency rates for the iliac vein were as follows: a primary patency rate of 77% and a secondary patency rate of 85%. The average VCSS score was 5.9 ± 2.6, and the Villalta score was 3.9 ± 2.2. The rate of post thrombotic syndrome is 22% in our study as assessed by the villalta score (Villalta score>4). CONCLUSIONS Endovascular treatment for IVC thrombosis secondary to DVT of the lower extremities is feasible, safe, and effective. This strategy alleviates venous insufficiency and results in a high patency rate in IVC.
Collapse
Affiliation(s)
- Yue Wang
- Department of Vascular Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Jingxiao Gu
- Department of Vascular Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Liu Lu
- Department of Breast Surgery, Affiliated Maternity and Child Health Care Hospital of Nantong University Nantong, Nanchang, China
| | - Yadan Yang
- Department of Vascular Surgery, Affiliated Hospital of Nantong University, Nantong, China
| | - Wenwen Zhang
- Department of Vascular Surgery, The Second Affiliated Hospital of Nanchang University Medical School, Nanchang, China
| | - Chen Huang
- Department of Vascular Surgery, Affiliated Hospital of Nantong University, Nantong, China
| |
Collapse
|
4
|
Tanaka M, Dai R, Randhawa A, Smolinski-Zhao S, Wu V, Walker TG, Daye D. Catheter Directed Thrombectomy and Other Deep Venous Interventions in Cancer Patients. Tech Vasc Interv Radiol 2023; 26:100900. [PMID: 37865450 DOI: 10.1016/j.tvir.2023.100900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
Treating cancer patients with deep venous thrombosis/venous thromboembolism (DVT/VTE) can be challenging as patients are frequently unable to receive the standard therapy of anticoagulation due to the increased risk of bleeding complications seen in this population. Similarly, the hesitation of interventionalists to use thrombolytic agents due to bleeding risks limits percutaneous intervention options as well. Further, outcome data and guidelines do not exist for oncologic patients and often treatment is tailored to patient-specific factors after multidisciplinary discussion. This article reviews specific factors to consider when planning percutaneous treatment of cancer patients with DVT/VTE, focusing on the iliocaval system.
Collapse
Affiliation(s)
- Mari Tanaka
- Department of Radiology - Interventional Radiology, Massachusetts General Hospital, Boston, MA
| | - Rui Dai
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Animan Randhawa
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | | | - Vincent Wu
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - T Gregory Walker
- Department of Radiology, Massachusetts General Hospital, Boston, MA
| | - Dania Daye
- Department of Radiology, Massachusetts General Hospital, Boston, MA.
| |
Collapse
|
5
|
Liu B, Cui YZ, Wang SQ, Chen YQ, Wang Y, Sun XF. Calcified thrombus of the inferior vena cava and hepatic veins in acute promyelocytic leukemia: A case report and literature review. Pediatr Blood Cancer 2023:e30387. [PMID: 37114723 DOI: 10.1002/pbc.30387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/29/2023]
Affiliation(s)
- Bo Liu
- Department of Cadre's Wards Ultrasound Diagnostics, Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, China
| | - Ying-Zhu Cui
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Shou-Qing Wang
- Department of Cadre's Wards Ultrasound Diagnostics, Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, China
| | - Yong-Qi Chen
- Department of Cadre's Wards Ultrasound Diagnostics, Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, China
| | - Yue Wang
- Department of Pediatrics Hematology, The First Hospital of Jilin University, Changchun, China
| | - Xiao-Feng Sun
- Department of Cadre's Wards Ultrasound Diagnostics, Ultrasound Diagnostic Center, The First Hospital of Jilin University, Changchun, China
| |
Collapse
|
6
|
Gong M, Kong J, Shi Y, Zhao B, Liu Z, He X, Gu J. Risk factors and a predictive model for nonfilter-associated inferior vena cava thrombosis in patients with lower extremity deep vein thrombosis. Front Cardiovasc Med 2023; 9:1083152. [PMID: 36712257 PMCID: PMC9875588 DOI: 10.3389/fcvm.2022.1083152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/29/2022] [Indexed: 01/12/2023] Open
Abstract
Objective Nonfilter-associated inferior vena cava thrombosis (IVCT) is an under-recognized but severe state of venous thromboembolism. The aims of this study were to investigate risk factors and develop a prediction model based on clinical data and imaging findings to evaluate the probability of IVCT in patients with lower extremity deep vein thrombosis (LEDVT). Methods A single-center retrospective cohort study was conducted. We analyzed the clinical data and multimodal imaging findings of consecutive patients with confirmed LEDVT between February 2016 and January 2022. The demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed using an independent t-test, Chi-square test, Fisher's exact test, and regression analysis to determine the univariable and multivariable associations and to establish a predictive model to assess the probability of IVCT. Results A total of 267 eligible patients were included, of whom 40 were in the IVCT group and 227 were in the non-IVCT group. The incidence of nonfilter-associated IVCT was 15.0% (40/267). Age < 63.5 years [odds ratio (OR) 2.54; 95% confidence interval (CI), 1.10-5.85, p = 0.029], male sex (OR 2.82; 95% CI, 1.19-6.72, p = 0.019), proximal DVT (OR 8.21; 95% CI, 1.01-66.76, p = 0.049), bilateral DVT (OR 7.30; 95% CI, 3.28-16.21, p < 0.001), and D-dimer >4.72 μg/ml (OR 4.64; 95% CI, 1.80-11.72, p = 0.001) were risk factors for IVCT's occurrence. Then, we established a prediction model based on these risk factors. The diagnostic efficiency [area under the curve (AUC) of receiver operating characteristic (ROC) curve was 0.858] for predicting IVCT was superior to that of isolated risk factors, including age < 63.5 years (AUC of ROC curve was 0.624) or D-dimer >4.72 μg/ml (AUC of ROC curve was 0.656). Conclusion Age < 63.5 years, male sex, proximal LEDVT, bilateral LEDVT and D-dimer >4.72 μg/ml were risk factors. The diagnostic efficiency of the predictive model for predicting IVCT was superior to that of a single risk factor alone. It may be used for predicting the probability of nonfilter-associated IVCT in patients with LEDVT.
Collapse
|
7
|
Wang B, Jiang C, Zhang Y, Li X, Xu H. Outcome of anticoagulation with rivaroxaban in patients with non-retrieved inferior vena cava filters for the prevention of filter thrombosis: a retrospective cohort study. BMC Cardiovasc Disord 2022; 22:406. [PMID: 36089586 PMCID: PMC9464391 DOI: 10.1186/s12872-022-02849-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 09/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Non-retrieved inferior vena cava filter (IVCF) is associated with some severe complications, such as filter thrombosis. The aim of this retrospective cohort study was to evaluate the outcome of rivaroxaban for the prevention of filter thrombosis in patients with non-retrieved IVCF.
Methods
The study based on the VTE registry databases was limited to patients with non-retrieved IVCF treated at Nanjing Drum Tower Hospital from January 2012 to December 2017. Outcomes included filter thrombosis, total bleeding events, death.
Results
A total of 202 patients were enrolled in the study and divided into rivaroxaban group and warfarin group. Mean follow-up period of the two groups was 57.4 ± 20.8 and 62.2 ± 23.0 months, respectively. In risk factors for VTE, transient factors (P = 0.008) and history of VTE (P = 0.028) were statistically different between the two groups. A total of 13 (6.4%) patients developed filter complications, of which 4 (3.5%) and 5 (5.7%) patients in rivaroxaban group and warfarin group developed filter thrombosis, respectively, without significant difference (P = 0.690). The total bleeding events in rivaroxaban group, including major bleeding and clinically relevant and non-major (CRNM) bleeding, were significantly lower than that in warfarin group (P = 0.005). Adjusting for hypertension, transient risk factors, history of VTE and cancer, no differences in the hazard ratio for outcomes were notable.
Conclusions
It is necessary to perform a concomitant anticoagulation in patients with non-retrieved filters. Rivaroxaban can be an alternative anticoagulant option for the prevention of filter thrombosis.
Collapse
|
8
|
Cheong I. Multiple organ dysfunction due to inferior vena cava thrombosis diagnosed by point-of-care ultrasound in the intensive care unit. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:940-941. [PMID: 35584041 DOI: 10.1002/jcu.23235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 04/25/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
We describe the case of a 75-years-old woman with history of left renal cell carcinoma that presented multiple organ dysfunction due to IVCT diagnosed by point-of-care ultrasound (POCUS) in the intensive care unit (ICU).
Collapse
Affiliation(s)
- Issac Cheong
- Department of Critical Care Medicine, Sanatorio De los Arcos, Buenos Aires, Argentina
- Argentinian Critical Care Ultrasonography Association (ASARUC), Buenos Aires, Argentina
| |
Collapse
|
9
|
Liu XR, Zhou W, Chen F. Severe compression of left iliac vein is a protective factor for the risk of inferior vena cava thrombosis. J Vasc Surg Venous Lymphat Disord 2022; 10:1107-1112. [PMID: 35716997 DOI: 10.1016/j.jvsv.2022.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2022] [Revised: 04/12/2022] [Accepted: 04/26/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The purpose of this study is to evaluate the association between left iliac vein (LIV) compression and inferior vena cava thrombosis (IVCT) in patients with LIV involvement of deep vein thrombosis (DVT). METHODS A total of 263 consecutive DVT patients were retrospectively reviewed and divided into group IVCT and non-IVCT. The influences of LIV smallest diameter and percentage compression on the risk of IVCT were investigated using logistic regression analysis. RESULTS The mean age of IVCT patients was significantly younger than that of non-IVCT patients (55.5±1.8 vs. 62.7±1.1, p=0.001). The percentage of provoked DVT in IVCT patients was higher than that in non-IVCT patients (67.1% vs 48.2%, p=0.01). The smallest diameter of LIV in ICVT patients was larger than that in non-IVCT patients (4.1±0.3 vs. 2.5±0.2, p<0.001). Mean percentage compression of LIV in IVCT patients was significantly lower than that in non-IVCT patients (63.5±2.2 vs. 74.3±1.3; P<0.001). Age was associated with decreased odds of ICVT (OR: 0.965, 95% CI: 0.965-0.985, P=0.001). Provoked DVT was associated with increased odds of ICVT (OR:2.011, 95% CI: 1.070-3.782, P=0.03). LIV compression was associated with decreased odds of ICVT for each 1mm decrease in smallest diameter of the LIV (OR, 0.717; 95% CI, 0.627-0.820; P <0.001), and for each 10% increase in percentage compression of the LIV (OR, 0.715; 95% CI, 0.612-0.835; P <0.001). CONCLUSION Among LIV involvement of DVT patients, non-IVCT patients had more severe LIV compression than IVCT patients. Severe LIV compression may be a protective factor for the risk of IVCT.
Collapse
Affiliation(s)
- Xin Ran Liu
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Nanchang University, Nanchang 330006, China;; Queen Mary School, Nanchang University, Nanchang 330006, China
| | - Wei Zhou
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Nanchang University, Nanchang 330006, China
| | - Feng Chen
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Nanchang University, Nanchang 330006, China;.
| |
Collapse
|
10
|
Association between age and incidence of deep vein thrombosis in patients with spinal cord injury: an observational cross-sectional study. Spinal Cord 2022; 60:1006-1013. [PMID: 35610481 DOI: 10.1038/s41393-022-00814-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 05/12/2022] [Accepted: 05/16/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To elucidate the association between age and incidence of deep vein thrombosis (DVT) in patients with spinal cord injury (SCI). SETTING Rehabilitation Medicine Department of the First Affiliated Hospital of China University of Science and Technology. METHODS Patients from August 2018 to December 2020 with SCI (N = 260) were tertiles divided the age into three groups to analyze the association between age and incidence of DVT. RESULTS American Spinal Cord Injury Association impairment scale (AIS), urinary tract infection (UTI), pulmonary infection (PI), and anticoagulation therapy (AT) were confounders for the association between age and incidence of DVT. The incidence of DVT increased by 1.07-fold (Non-adjusted model, OR = 1.07, P < 0.001), 1.05-fold (Minimally-adjusted model: adjusted for confounders, OR = 1.05, P = 0.010) and 1.06-fold [Fully-adjusted model: adjusted for confounders and unbalanced probable variables: AIS, UTI, PI, AT, Sex, D-dimer(new), Fibrinogen (new), Modes of injury and Level of injury, OR = 1.06, P = 0.012] when age increased by 1 year. The incidence of DVT had an increasing trend with age in different age tertile in the three models (P for trend <0.05). Age had a linearly association with incidence of DVT (OR = 1.07, P = 0.065) and stable in different subgroups, for lower age, the association was also linearly (OR = 4.40, P = 1.000), for middle (fold point = 46.46, P < 0.001) and higher age (fold point = 66, P = 0.017), the association was curvilinear. CONCLUSION Age had a linearly association with incidence of DVT. Quitting smoking, preventing/treating UTI and AT should be adopted in advance for patients with SCI for all age, especially for older.
Collapse
|
11
|
Rahman A, Alqaisi S, Downing CW, Kenny DJ, LiPera W. Inferior Vena Cava Thrombosis in a Young Patient With COVID-19 Infection. Cureus 2022; 14:e24145. [PMID: 35582562 PMCID: PMC9107317 DOI: 10.7759/cureus.24145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/05/2022] Open
Abstract
Inferior vena cava thrombosis (IVCT) is a potentially fatal condition that may rarely occur in young patients with COVID-19 infection. This report describes a young adult female with a recent COVID 19 infection who presented with fever, bilateral flank pain, elevated inflammatory markers, and evidence of thrombosis in the inferior vena cava (IVC) on computed tomography (CT). The patient required treatment with anticoagulation therapy and catheter-directed thrombolysis, IVC filter placement, and mechanical suction-assist thrombectomy.
Collapse
|
12
|
Zhao GD, Zhang XP, Hu MG, Huang QB, Xu S, Wang BJ, Ma X, Zhang X, Zou WB, Zhang X, Zhao ZM, Tan XL, Chou S, Wang G, Liu R. Step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus is the key to robot-assisted thrombectomy for Mayo III/IV tumor thrombus. BMC Cancer 2022; 22:151. [PMID: 35130848 PMCID: PMC8822687 DOI: 10.1186/s12885-022-09235-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 01/12/2022] [Indexed: 11/14/2022] Open
Abstract
Background The surgical management of Mayo III/IV tumor thrombi is difficult and risky, and robotic surgery is even more difficult. The purpose of this study was to introduce the step-by-step and orderly lowering of the height of inferior vena cava tumor thrombus, which was the core technique of robot operation for Mayo III/IV tumor thrombus. Method A total of 18 patients were included in this study. The average tumor thrombus height was 2.4 cm above the level of the second porta hepatis (SPH), and 9 patients were prepared for cardiopulmonary bypass (CPB) before surgery. During the operation, the height of the tumor thrombus was lowered orderly for 2-3 times, and the blood flow blocking method was changed sequentially. The CPB was required when tumor thrombus in the atrium; After the height of the thrombus was lowered to the atrium entrance, CPB was stopped and the blood flow was blocked in the upper- and retro-hepatic inferior vena cava (IVC); After the tumor thrombus continued to descend to the lower part of the SPH, liver blood flow could be restored, and then, the blood flow was simply blocked in the retro-hepatic IVC to complete the removal of the thrombus and the repair or resection of the IVC. Finally, the diseased kidney and renal vein were removed. Results All operations were successfully completed, and 2 cases were transferred to laparotomy. Seven cases received CPB, while the other 11 did not. 15 patients underwent two times of the lowering of the tumor thrombus, 2 patients underwent one time and 1 patient underwent three times. The mean liver/IVC dissociation and vascular suspension time was 22.0 min. All patients had less than Clavien-Dindo grade III complications, no serious complications occurred during operation, and no patient died within 90 days. Conclusions The step-by-step and orderly decline of tumor thrombus height is the key to the success of robot Mayo III / IV tumor thrombus surgery. This method can shorten FPH and CPB time and improve the success rate of surgery.
Collapse
Affiliation(s)
- Guo-Dong Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Xiu-Ping Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Ming-Gen Hu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Qing-Bao Huang
- Faculty of Urology Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Shuai Xu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China.,School of Medicine, Nankai University, Tianjin, China
| | - Bao-Jun Wang
- Faculty of Urology Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xin Ma
- Faculty of Urology Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xu Zhang
- Faculty of Urology Surgery, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Wen-Bo Zou
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Xuan Zhang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Zhi-Ming Zhao
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Xiang-Long Tan
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Sai Chou
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Gang Wang
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China
| | - Rong Liu
- Faculty of Hepato-Biliary-Pancreatic Surgery, Chinese People's Liberation Army (PLA) General Hospital, Institute of Hepatobiliary Surgery of Chinese PLA, 28 Fuxing Road, Beijing, 100853, China. .,School of Medicine, Nankai University, Tianjin, China.
| |
Collapse
|
13
|
Rheolytic mechanical thrombectomy in an oncological emergency. ANGIOLOGIA 2022. [DOI: 10.20960/angiologia.00381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
|
14
|
Kaylor RM, Gehrz JA, Gutweiler AA, Cortes JS. Inferior Vena Cava Thrombosis, Appendicitis Mimic. Mil Med 2021; 188:usab487. [PMID: 34865133 DOI: 10.1093/milmed/usab487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 10/31/2021] [Accepted: 11/13/2021] [Indexed: 11/14/2022] Open
Abstract
Right lower quadrant abdominal pain is a common presentation to the Emergency Department. While appendicitis is a frequently diagnosed pathology associated with this complaint, there are multiple, well-documented alternatives that must be considered. The authors present a unique case of a 20 year old active duty male who presented with 3 days of acutely worsening right lower quadrant abdominal pain, right flank pain, and anorexia. Following a detailed work-up, computed tomography and magnetic resonance imaging (MRI) demonstrated a bland thrombus within the inferior vena cava (IVC) secondary to a vascular web. This case highlights the difficulty in astutely diagnosing appendicitis utilizing clinical examination and scoring metrics. While IVC thrombosis is a rare phenomenon, it should be considered in the emergency physician's differential for right lower quadrant abdominal pain, particularly when additional nonspecific symptoms are present.
Collapse
Affiliation(s)
- Ryan M Kaylor
- Department of Emergency Medicine, Naval Medical Center, San Diego, CA 92134, USA
| | - Joseph A Gehrz
- Department of Emergency Medicine, Naval Medical Center, San Diego, CA 92134, USA
| | - Alex A Gutweiler
- Department of Radiology, Naval Medical Center, San Diego, CA 92134, USA
| | - James S Cortes
- Department of Emergency Medicine, Naval Medical Center, San Diego, CA 92134, USA
| |
Collapse
|
15
|
Contemporary Rates of Inferior Vena Cava Filter Thrombosis and Risk Factors. J Vasc Surg Venous Lymphat Disord 2021; 10:313-324. [PMID: 34425266 DOI: 10.1016/j.jvsv.2021.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/27/2021] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Inferior vena cava thrombosis is an uncommon complication associated with inferior vena cava filters (IVCF), with literature citing rates ranging from 1% to 31%. Few observational studies describe risk factors associated with IVCF thrombosis, despite the significant clinical sequelae such as post-thrombotic syndrome, venous claudication, and venous ulceration. To better describe IVCF thrombosis and risk factors, data were queried from VQI-participating centers. METHODS IVCF data were obtained through the international VQI database from 2013 - 2019. Patients included in this analysis had two-year follow-up. Baseline demographics, medical comorbidities, medication, procedural, anatomical, and post-operative variables were assessed using Kaplan-Meier survival curves with log-rank tests, Student's t-tests, or Mann-Whitney U tests for IVCF thrombosis at two years. Cox regression analyses identified independent predictors of IVCF thrombosis. A subgroup analysis of those who presented with a venous thromboembolism (VTE) was also performed. RESULTS There were 62 US and Canadian VQI-participating centers, including 12,874 cases of IVCF placement. There 78 cases (1.3%) of IVCF thrombosis identified out of a total of 5,780 cases with two-year follow up. Those who experienced IVCF thrombosis had significantly lower rates of diabetes, coronary artery disease, pre-operative antiplatelet medications, pre-operative statins, as well as lower rates of discharge and follow up antiplatelet medications. On univariable analysis, cases of IVCF thrombosis also had higher rates of pulmonary emboli (PE) and VTE on admission, internal jugular venous access (versus femoral vein access), temporary IVCF use, follow up anticoagulation, follow up IVCF complication, follow up access site thrombosis, and rates of new or propagated DVT at follow up, and longer post-operative hospital stays. Multivariable analysis demonstrated independent predictors of IVCF thrombosis included new or propagated DVT at follow up (hazard ratio [HR]=16.3, 95% confident interval (CI) = 9.8 - 27.3, P<.001), no antiplatelet at follow up (HR=4.8, 95% CI= 1.9 - 12.5, P=.001), internal jugular venous access (HR=2.2, 95% CI=1.4 - 3.5, P=.001), VTE on admission (HR=2.7, 95% CI=1.4 - 5.1, P=.002), and temporary IVCF placement (HR=2.5, 95% CI = 1.1 - 5.6, P=.031). In an analysis of the subgroup of patients with VTE on admission, similar predictive factors were identified in a multivariable model, in addition, massive PE was also predictive of IVCF thrombosis in this subgroup. CONCLUSION The rate of IVCF thrombosis remained low in a contemporary international database. This study of over 5,000 patients with IVCFs suggests that antiplatelet therapy should be administered after IVCF placement to decreased risk of IVCF thrombosis.
Collapse
|
16
|
Lin HY, Lin CY, Shen MC. Review article inferior vena cava thrombosis: a case series of patients observed in Taiwan and literature review. Thromb J 2021; 19:43. [PMID: 34158063 PMCID: PMC8218556 DOI: 10.1186/s12959-021-00296-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 06/07/2021] [Indexed: 12/19/2022] Open
Abstract
Inferior vena cava thrombosis (IVCT) is rare and can be under-recognized. However, the associated complications and mortality may be severe. We report the first case series of IVCT observed in Taiwan with a brief literature review. Eight Taiwanese patients with IVCT between May 2012 and December 2019 were enrolled in this study. Deep venous thrombosis (DVT, 8/8) and pulmonary embolism (5/8) were reported. Various risk factors were identified, including an unretrieved inferior vena cava (IVC) filter, pregnancy, surgery, presence of lupus of anticoagulants, essential thrombocythemia, antithrombin deficiency, and hemoglobin H disease. Of note, four of our patients experienced complete IVC thrombosis with bilateral lower extremity swelling (due to DVT) and abdominal wall superficial venous dilatation, while four other patients presented with partial IVCT and unilateral DVT. The etiology, clinical characteristics, presentations, diagnosis, and treatment of IVCT were reviewed.
Collapse
Affiliation(s)
- Hsuan-Yu Lin
- Division of Hematology/Oncology, Changhua Christian Hospital, Nanshiao St 135, Changhua City, Changhua County, Taiwan
| | - Ching-Yeh Lin
- Division of Hematology/Oncology, Changhua Christian Hospital, Nanshiao St 135, Changhua City, Changhua County, Taiwan
| | - Ming-Ching Shen
- Division of Hematology/Oncology, Changhua Christian Hospital, Nanshiao St 135, Changhua City, Changhua County, Taiwan. .,Department of Laboratory Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| |
Collapse
|
17
|
McGlinn E, Parviz J, Pazderka P. Postpartum fever and radicular low back pain. Am J Emerg Med 2021; 48:378.e3-378.e5. [PMID: 33892941 DOI: 10.1016/j.ajem.2021.04.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/11/2021] [Accepted: 04/14/2021] [Indexed: 11/17/2022] Open
Abstract
Fever and low back pain with radicular symptoms raise concern for epidural abscess or other neuraxial infection, especially in the context of recent epidural anesthesia. Here we present an unusual case with several confounding factors and an unexpected diagnosis.
Collapse
Affiliation(s)
- Evan McGlinn
- Department of Emergency Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8060, United States of America.
| | - Jason Parviz
- Department of Emergency Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8060, United States of America
| | - Philip Pazderka
- Department of Emergency Medicine, Western Michigan University, Homer Stryker MD School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-8060, United States of America
| |
Collapse
|
18
|
Shah NG, Wible BC, Paulisin JA, Zaki M, Lamparello P, Sista A, Sadek M, Jacobowitz GR, Maldonado TS. Management of inferior vena cava thrombosis with the FlowTriever and ClotTriever systems. J Vasc Surg Venous Lymphat Disord 2020; 9:615-620. [PMID: 33045392 DOI: 10.1016/j.jvsv.2020.09.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/24/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Although inferior vena cava (IVC) thrombosis is infrequently encountered, it carries a significant risk of post-thrombotic syndrome and pulmonary embolus. Recent studies show no difference in the incidence of post-thrombotic syndrome in patients with iliofemoral deep venous thrombosis (DVT) treated with pharmacothrombolysis vs anticoagulation alone; however, there is an associated increased risk of bleeding. The treatment of IVC thrombosis is less well-studied and the hemodynamic changes may be more significant with pharmacothrombolysis, although the bleeding risk remains. The ClotTriever and FlowTriever systems remove thrombus from veins without the use of thrombolytics. Our study evaluates outcomes of patients undergoing mechanical thrombectomy for the treatment of IVC thrombosis using the ClotTriever and FlowTriever devices. METHODS A retrospective chart review was performed to identify consecutive patients who underwent mechanical thrombectomy for the treatment of IVC thrombosis using the ClotTriever and/or FlowTriever systems from November 2018 to January 2020 at four data-sharing institutions. The decision of which device(s) to use was at the discretion of the surgeon. Patient demographics, symptomatology, and imaging characteristics were captured at presentation and follow-up. RESULTS A total of 15 patients met the inclusion criteria; 10 were male, and the average age was 59 years. The majority of patients were symptomatic at presentation (n = 14), had a prior history of DVT (n = 13), and had a preexisting IVC filter (n = 8). Eleven patients presented with acute onset (<1 week) of symptoms, whereas three patients had subacute (1-4 weeks) symptoms. Most patients had an associated iliofemoral DVT (n = 13) and were treated with both ClotTriever and FlowTriever (n = 8); others were treated with either ClotTriever or FlowTriever alone (n = 5 and n = 2, respectively). Technical success was achieved in all but two patients, one who had a nonocclusive thrombus densely adherent to a preexisting IVC filter and another who had a chronic rubbery clot in the IVC that could not be cleared. No patient required concomitant lytic therapy or a postoperative stay in the intensive care unit. Furthermore, there were no postoperative bleeding events, myocardial infarctions, pulmonary emboli, renal impairments, or deaths. The median length of stay was 3 days (range, 1-37 days). Patients underwent postoperative follow-up (n = 7) as well as extended follow-up (>6 months; n = 8). All patients who achieved technical success were asymptomatic without evidence of reocclusion of the IVC on follow-up imaging. CONCLUSIONS In our multicenter series of 15 patients, The ClotTriever and FlowTriever showed promise in the treatment of IVC thrombosis without the use of fibrinolytic drugs, with no bleeding events and no requirement for intensive care unit stay.
Collapse
Affiliation(s)
- Noor G Shah
- New York University Langone Medical Center, New York, NY
| | | | - Joseph A Paulisin
- Ascension Genesys Hospital, Grand Blanc, Mich Saint Luke's Hospital, Kansas, Mo
| | - Mina Zaki
- Beaumont Dearborn Hospital, Dearborn, Mich
| | | | - Akhilesh Sista
- New York University Langone Medical Center, New York, NY
| | - Mikel Sadek
- New York University Langone Medical Center, New York, NY
| | | | | |
Collapse
|
19
|
Zhang S, Chu W, Wang H, Liang Y, Fan Y, Liu H, Wei G. Evaluation of stability of deep venous thrombosis of the lower extremities using Doppler ultrasound. J Int Med Res 2020; 48:300060520942098. [PMID: 32841580 PMCID: PMC7526051 DOI: 10.1177/0300060520942098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective This study aimed to assess using Doppler ultrasound for analyzing stability of deep venous thrombosis (DVT) of the lower extremities. Methods Patients with DVT of the lower extremities who were treated from August 2017 to December 2019 were selected. The patients were divided into stable and unstable groups according to whether thrombus was collected in a filter. Related ultrasound and blood test results were analyzed and compared. Results A total of 126 patients with DVT of the lower extremities were included, of whom 74 were in the stable group and 52 were in the unstable group. There were significant differences in the prothrombin time (PT), and lipoprotein alpha, D-dimer, and triglyceride levels between the groups. D-dimer levels >2800 ug/L, smoking, history of venous thrombosis, PT >13.15 s, and body mass index >24.45 kg/m2 were independent risk factors for stability of DVT of the lower extremities. The area under the curve with combined detection of DVT was significantly higher than that for body mass index, PT, and D-dimer alone. Conclusion Doppler ultrasound may be reliable for analyzing the stability of DVT of the lower extremities. Related strategies targeting risk factors are required for reducing DVT of the lower extremities.
Collapse
Affiliation(s)
- Shefang Zhang
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang City, Henan Province, China
| | - Wen Chu
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang City, Henan Province, China
| | - Hua Wang
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang City, Henan Province, China
| | - Yajun Liang
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang City, Henan Province, China
| | - Yajuan Fan
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang City, Henan Province, China
| | - Hui Liu
- Department of Ultrasound, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang City, Henan Province, China
| | - Guoshi Wei
- Department of Clinical Pharmacy, Luoyang Central Hospital Affiliated to Zhengzhou University, Luoyang City, Henan Province, China
| |
Collapse
|
20
|
Ahmed M, Saeed R, Abdulsalam M, Johna S, Elias D. Inferior Vena Cava Calcified Thrombus Presenting With Abdominal Pain: A Case Report. Cureus 2019; 11:e5384. [PMID: 31616615 PMCID: PMC6786840 DOI: 10.7759/cureus.5384] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
De novo thrombosis of the inferior vena cava (IVC) can cause significant morbidity and mortality. Calcified thrombus of IVC is an extremely rare incidental finding and is associated with recurrent deep venous thrombosis (DVT) and pulmonary embolism (PE). We present a case of abdominal pain secondary to a calcified thrombus in the supra-hepatic region of the IVC.
Collapse
Affiliation(s)
| | - Rasha Saeed
- Surgery, Arrowhead Regional Medical Center, Fontana, USA
| | | | - Samir Johna
- Surgery, Loma Linda University School of Medicine, California, USA
| | - Dina Elias
- Trauma, Riverside Community Hospital, Riverside, USA
| |
Collapse
|