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Nguyen D, Berman SS, Sabat JE. Symptomatic occlusion of the inferior vena cava and bilateral iliac veins due to malignant seminoma: Percutaneous recanalization, thrombectomy, and stenting to restore patency. J Vasc Surg Cases Innov Tech 2024; 10:101516. [PMID: 39040133 PMCID: PMC11261033 DOI: 10.1016/j.jvscit.2024.101516] [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] [Received: 12/04/2023] [Accepted: 04/11/2024] [Indexed: 07/24/2024] Open
Abstract
Testicular seminoma is rarely associated with occlusive venous thrombosis. Several investigators describe percutaneous guidewire recanalization for iliofemoral vein thrombosis; however, this technique is ill-documented for occlusion of the inferior vena cava, and even less information is available on managing pervasive iliocaval obstruction. Furthermore, there is limited data on percutaneous mechanical thrombectomy for malignancy-induced venous thrombosis. We present a case of symptomatic chronic occlusion of the inferior vena cava and iliac veins following remission for metastatic seminoma, with percutaneous intervention necessitating a unique combination of sharp wire recanalization, mechanical thrombectomy, and stenting to restore iliocaval patency.
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Affiliation(s)
- Daniel Nguyen
- Pima Heart and Vascular, Tucson, AZ
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Arizona College of Medicine, Tucson, AZ
| | - Scott S. Berman
- Pima Heart and Vascular, Tucson, AZ
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Arizona College of Medicine, Tucson, AZ
| | - Joseph E. Sabat
- Pima Heart and Vascular, Tucson, AZ
- Division of Vascular and Endovascular Surgery, Department of Surgery, The University of Arizona College of Medicine, Tucson, AZ
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Lofroth J, Pourghadiri A, Hadjivassiliou A, Heran M, Legiehn G, Ho S, Dhatt R. Total Iliocaval Reconstruction in a Complex Palliative Patient with Malignant Inferior Vena Cava Syndrome. Curr Oncol 2024; 31:3978-3984. [PMID: 39057166 PMCID: PMC11275574 DOI: 10.3390/curroncol31070294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
Inferior vena cava (IVC) compression secondary to mass effect is accompanied by edema, ascites, back and abdominal pain, and central nervous system symptoms. Most IVC syndrome cases described in the literature focus on the focal treatment of IVC lesions, and reports of complete iliocaval reconstructions secondary to malignant IVC syndrome in the palliative context are limited. In this case report, we describe the clinical presentation, technical approach, and symptomatic outcomes of a patient with extensive malignant compression and invasion of the iliofemoral venous system. An 82-year-old male with metastatic lung cancer invading the right upper quadrant of the abdomen presented with scrotal and bilateral lower extremity edema, as well as anasarca. Computed tomography (CT) demonstrated an 11 cm right adrenal metastasis and extensive retroperitoneal lymphadenopathy resulting in the compression of the IVC and iliac veins. Femoral venography demonstrated extensive collateral venous pathway formation with the opacification of the para-lumbar and vertebral veins, in addition to the vertebral/sacral venous plexus. Iliocaval reconstruction was performed using venous-dedicated stents. This case report highlights a technically successful total iliocaval reconstruction in a complex palliative patient with diffuse metastatic disease resulting in IVC compression and syndrome.
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Affiliation(s)
- Jack Lofroth
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Amir Pourghadiri
- Faculty of Medicine, University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | | | - Manraj Heran
- Department of Radiology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Gerald Legiehn
- Department of Radiology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Stephen Ho
- Department of Radiology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Ravjot Dhatt
- Department of Radiology, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
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3
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Xuan T, Jianlong L, Jinyong L, Xiao L, Mi Z, Ruifeng B, Zhong C. Antegrade and retrograde approaches with a mechanical thrombectomy device for the treatment of acute lower limb deep vein thrombosis. Ann Vasc Surg 2024:S0890-5096(24)00282-6. [PMID: 38942376 DOI: 10.1016/j.avsg.2024.04.014] [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: 12/16/2023] [Revised: 03/07/2024] [Accepted: 04/06/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To examine the efficacy of antegrade and retrograde approaches with the AngioJet thrombectomy device for the treatment of acute lower limb deep vein thrombosis (DVT) and to evaluate the necessity of filter placement. METHODS The clinical data of patients with acute lower limb DVT treated with the AngioJet device from January 2021 to June 2023 were retrospectively analyzed. The patients were divided into the antegrade and retrograde treatment groups according to the surgical approach and the direction of valve opening. The thrombosis interception rate of the filter, incidence of pulmonary embolism (PE), thrombectomy effectiveness, venous obstruction rate, and thrombosis recurrence rate of each treatment group were evaluated. In addition, factors affecting patency were analyzed. RESULTS AngioJet was employed for 84 patients with acute lower limb DVT, treating a total of 88 limbs. The thrombosis interception rate of the filter was 35.7% (30 patients). The incidence of new PE or PE exacerbation was 6.0% (5 patients), and a filter retrieval rate of 97.6% (82 patients) was detected. Thrombus removal of grade III occurred in 35 (64.8%) of the 54 limbs (61.4%) in the antegrade treatment group, versus 13 (38.2%) of the 34 limbs (38.6%) in the retrograde treatment group (P<0.05). At 3 months, venous patency and bleeding events involved 52 (96.3%) and 4 (7.4%) limbs in the antegrade treatment group, respectively, versus 29 (85.3%) and 2 (5.9%) in the retrograde treatment group, respectively (P>0.05). Regression analysis was performed to determine factors that may affect 3-month patency in both groups. Statistically significant linear relationships were found between 3-month patency and thrombus removal rate [OR=0.546 (0.326, 0.916)], thrombus formation time [OR=1.018 (1.002, 1.036)], and preoperative thrombosis score [OR=1.012 (1.002, 1.022)] in the antegrade treatment group, as well as thrombus removal rate [0.473 (0.229, 0.977)] in the retrograde treatment group. In regression analysis of factors affecting patency in both groups and VCSS/Villalta score, a statistically significant linear relationship was found between thrombus formation time and VCSS score in the antegrade treatment group [0.576 (0.467, 0.710)]. CONCLUSION Both antegrade and retrograde approaches are safe and effective for the treatment of acute lower limb DVT. There are no differences in 3-month deep vein patency and post-thrombotic syndrome (PTS) incidence rates. Individuals with acute lower limb DVT are at high risk of thrombus shedding after treatment with AngioJet thrombectomy, and placement of a vena cava filter (VCF) is recommended for effective interception.
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Affiliation(s)
- Tian Xuan
- Vascular Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029; Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Liu Jianlong
- Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Li Jinyong
- Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Liu Xiao
- Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Zhou Mi
- Vascular Surgery Department, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100035
| | - Bai Ruifeng
- Department of Clinical Laboratory; Department of Laboratory Medicine, Beijing Jishuitan Hospital, Capital Medical University, Beijing, 100029
| | - Chen Zhong
- Vascular Surgery Department, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029.
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Hsu A, Segal MS, Addis M. Inferior vena cava reconstruction to alleviate back pain. J Vasc Surg Cases Innov Tech 2024; 10:101439. [PMID: 38510097 PMCID: PMC10951514 DOI: 10.1016/j.jvscit.2024.101439] [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] [Received: 09/17/2023] [Accepted: 01/11/2024] [Indexed: 03/22/2024] Open
Abstract
We present the case of a 38-year-old man with end-stage renal disease receiving hemodialysis via a left femoral loop graft who developed debilitating back pain. During a maintenance fistulogram, we found a completely occluded inferior vena cava and engorged lumbar veins. The patient underwent inferior vena cava reconstruction with stenting, which resulted in complete resolution of the engorged lumbar veins on venography and a significant reduction in his back pain. Engorgement of the lumbar veins can cause significant pain, and treatment of the underlying pathology can alleviate these symptoms.
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Affiliation(s)
- Angel Hsu
- Department of General Surgery, Rutgers New Jersey Medical School, Newark, NJ
| | - Michael S. Segal
- Department of Vascular Surgery, Cooperman Barnabas Medical Center, Livingston, NJ
| | - Michael Addis
- Department of Vascular Surgery, Cooperman Barnabas Medical Center, Livingston, NJ
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5
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Desai SP, Yu CZ, Evangelista F, Gill JR. Perforation of the Heart During Elective Removal of an Inferior Vena Cava Filter. Am J Forensic Med Pathol 2024:00000433-990000000-00183. [PMID: 38833346 DOI: 10.1097/paf.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
ABSTRACT A common treatment for venous thromboembolic disease in patients with contraindications to anticoagulation includes placement of an inferior vena cava (IVC) filter. Temporary filters are available to avoid the risk of long-term permanent placement. A woman in her 60s with a history of uterine serous carcinoma presented to the emergency department with cardiac arrest following elective attempted IVC filter removal. Three months prior, a temporary filter was placed because anticoagulation medication was stopped in preparation for a hysterectomy. During the IVC retrieval procedure, which was performed using an intravascular approach from the right jugular vein, the filter was tilted, requiring the use of a different retrieval sheath. During catheter reentry, the patient complained of discomfort in the chest and neck, after which she became hypotensive, lost consciousness, and died. Autopsy revealed 2 cardiac perforations, one in each ventricle. Approximately 600 mL of liquid and clotted blood was within the tense pericardial sac. An IVC filter was found in place, with no adjacent hemorrhage.To our knowledge, this is the first reported fatality due to cardiac perforation by an access sheath during intravascular removal of an IVC filter. This instance also documents the time course of the cardiac perforations to the resultant loss of consciousness.
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Affiliation(s)
- Sapna P Desai
- From the Office of the Chief Medical Examiner, Farmington, CT
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Ju Z, Chen W, Min X, Dai K, Zheng H, Qiu J. Acute right extremity deep vein thrombosis and left-sided inferior vena cava thrombosis treated by percutaneous mechanical thrombectomy (PMT) combined with catheter directed thrombolysis (CDT): A case report. Medicine (Baltimore) 2024; 103:e37849. [PMID: 38640270 PMCID: PMC11029992 DOI: 10.1097/md.0000000000037849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Left-sided inferior vena cava (IVC) is an uncommon condition with a prevalence rate of 0.2% to 0.5%. Most of them remain asymptomatic and are discovered incidentally. The patient condition in this case is critical, and conventional procedures are not applicable. The surgical approach being considered is innovative, but it carries significant risks and uncertain therapeutic efficacy. PATIENT CONCERNS A 42-year-old male presented with acute right lower extremity pain with swelling for 2 days. DIAGNOSIS The patient was subsequently diagnosed with acute right lower extremity deep vein thrombosis, inferior vena cava thrombosis, and a left-sided IVC. INTERVENTIONS Based on the treatment guidelines for lower extremity deep venous thrombosis. OUTCOMES We successfully cured him with percutaneous mechanic thrombectomy (PMT) combined with catheter directed thrombolysis (CDT). CONCLUSION AND SIGNIFICANCE The relatively low incidence of left-sided IVC does not diminish the significance of its identification. PMT combined with CDT is a safe way to treat acute thrombosis. It provides a new approach for similar patients in the future.
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Affiliation(s)
- Zhinan Ju
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Wei Chen
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Xixi Min
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Kanghui Dai
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Henan Zheng
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Jiehua Qiu
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
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Soma G, DeGuardi J, Iqbal AU, Leviter J, Riera A. Is it Smoke and Mirrors? Detection of Inferior Vena Cava Thrombus by Focused Cardiac Ultrasound. Pediatr Emerg Care 2024; 40:323-325. [PMID: 38227793 DOI: 10.1097/pec.0000000000003107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
ABSTRACT Inferior vena cava assessment is a standard component of focused cardiac ultrasound, traditionally used to qualify intravascular volume status. In this case series, we demonstrate that pediatric focused cardiac ultrasound can also diagnose inferior vena cava thrombi and masses, while distinguishing them from a potentially benign smoke-like artifact.
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Affiliation(s)
- Gauthami Soma
- From the Yale School of Medicine, Department of Pediatrics, Section of Emergency Medicine, New Haven, CT
| | | | - Ammarah U Iqbal
- Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Julie Leviter
- From the Yale School of Medicine, Department of Pediatrics, Section of Emergency Medicine, New Haven, CT
| | - Antonio Riera
- From the Yale School of Medicine, Department of Pediatrics, Section of Emergency Medicine, New Haven, CT
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Benzakine J, Rial C, Mohamedi N, Messas E, Mauge L, Sapoval M, Gendron N, Khider L. Perioperative management of venous recanalization in a patient with inherited antithrombin deficiency: case report. Res Pract Thromb Haemost 2024; 8:102384. [PMID: 38617049 PMCID: PMC11015152 DOI: 10.1016/j.rpth.2024.102384] [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] [Received: 02/15/2024] [Accepted: 02/20/2024] [Indexed: 04/16/2024] Open
Abstract
Background Inherited antithrombin (AT) deficiency (ATD) is a severe thrombophilia causing venous thromboembolism, which can be complicated by postthrombotic syndrome (PTS). Venous recanalization, used to treat PTS, often requires a temporary withdrawal of anticoagulant therapy. In ATD patients, there is a risk of insufficient perioperative anticoagulation due to altered heparin response. Key Clinical Question There is no consensus on how to manage perioperative anticoagulation in ATD patients. Clinical Approach Warfarin-unfractionated heparin transition could be a more reliable strategy than low-molecular-weight heparin transition because unfractionated heparin anti-Xa activity not only reflects heparin-bound AT but also AT's activity, which correlates strongly with therapeutic anticoagulation. Biological monitoring could thus decrease the number of plasma-derived AT supplementation. Conclusion This study describes a successful perioperative management of anticoagulation for venous recanalization that could be suggested to type 1 ATD patients with PTS.
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Affiliation(s)
- Julie Benzakine
- Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Carla Rial
- Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Nassim Mohamedi
- Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, Centre-University Paris Cité, Paris, France
| | - Emmanuel Messas
- Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, Centre-University Paris Cité, Paris, France
| | - Laetitia Mauge
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
- Paris Cardiovascular Research Centre, INSERM, Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
| | - Marc Sapoval
- Paris Cardiovascular Research Centre, INSERM, Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris (APHP-CUP), Paris, France
- Paris Cardiovascular Research Centre, INSERM, Interventional Radiology, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Nicolas Gendron
- Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France
- Hematology Department, Assistance Publique Hôpitaux de Paris, Centre-Université de Paris, Paris, France
| | - Lina Khider
- Innovative Therapies in Haemostasis, INSERM, University Paris Cité, Paris, France
- Vascular Medicine Department, Assistance Publique Hôpitaux de Paris, Centre-University Paris Cité, Paris, France
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9
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Gong M, Zhao Q, Jiang R, Liu Z, Zhao B, Kong J, He X, Gu J. AngioJet rheolytic thrombectomy coupled with dose-reduced rt-PA for massive inferior vena cava filter-related thrombosis: A single-center retrospective study. Asian J Surg 2024; 47:263-268. [PMID: 37798188 DOI: 10.1016/j.asjsur.2023.08.098] [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: 03/14/2023] [Revised: 07/12/2023] [Accepted: 08/21/2023] [Indexed: 10/07/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of AngioJet rheolytic thrombectomy (ART) coupled with dose-reduced rt-PA, compared to catheter-directed thrombolysis (CDT) alone, for the treatment of massive inferior vena cava filter (IVCF)-related thrombosis. METHODS We conducted a retrospective analysis of 40 patients who received either ART or CDT alone as the first-line endovascular therapy (ET) between January, 2016 and September, 2022. The data on demographics, clinical characteristics, technical success, clinical success, complications, and early follow-up were reviewed. RESULTS Of the 40 included patients, 24 received ART and 16 received CDT alone. The demographics, presentation, lesion characteristics, comorbidities and risk factors were comparable (all p > .05). Technical success rates were 100% in both groups. The total CDT time and infusion agent dosage were lower in the ART group than those in the CDT group (both p < .05). At the end of CDT, clinical success was 81.8% in the ART group, which was slightly higher than that of 70.8% in the CDT group (p > .05). At the 6-month follow-up, the incidences of recurrent thrombosis in the two groups were 6.9% and 15.8%, respectively, and the incidence of post-thrombotic syndrome was 10.3% and 21.1%, respectively. However, these differences were not statistically significant (p > .05). No major complications were noted in either group, ART seemed to have slightly higher risk of transient macroscopic hemoglobinuria and recoverable acute kidney injury, but with a lower minor bleeding incidence when compared with CDT alone (4.2 vs. 31.3%, p < .05). CONCLUSIONS ART or CDT alone as the first-line ET for IVCF-related thrombosis has comparable outcomes but with different adverse event profiles. Both modalities are safe and effective in patients with massive IVCF-related thrombosis.
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Affiliation(s)
- Maofeng Gong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Qing Zhao
- Department of Gastroenterology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, 211100, PR China
| | - Rui Jiang
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Zhengli Liu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Boxiang Zhao
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Jie Kong
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Xu He
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China
| | - Jianping Gu
- Department of Interventional and Vascular Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, 210006, PR China.
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10
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Juarez JJ, Khalid MU, Ulloa BA, Romero CM, Maruthi R, Shah D, Chang E, Shafi I, Lakhter V, Zhao H, Rodriquez EJ, Pérez-Stable EJ, Bashir R. Racial and ethnic disparities in inferior vena cava filter placement for deep vein thrombosis in the United States. J Vasc Surg Venous Lymphat Disord 2024; 12:101683. [PMID: 37708935 DOI: 10.1016/j.jvsv.2023.08.022] [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: 04/04/2023] [Revised: 07/30/2023] [Accepted: 08/28/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVE We sought to determine whether racial and ethnic disparities existed in inferior vena cava (IVC) filter (IVCF) placement rates among Black and Latino patients for the treatment of acute proximal lower extremity (LE) deep vein thrombosis (DVT) in the United States from 2016 to 2019. METHODS We performed a retrospective review of National Inpatient Sample data to identify adult patients with a primary discharge diagnosis of acute proximal LE DVT from January 2016 to December 2019, including self-reported patient race and ethnicity. IVCF placement rates were identified using International Classification of Diseases, 10th revision, codes. Weighted multivariable logistic regression was used to compare IVCF use by race and ethnicity. The regression model was adjusted for patient demographics (ie, sex, primary payer, quartile classification of household income), hospital information (ie, region, location, teaching status, bed size), weekend admission, and clinical characteristics (ie, modified Charlson comorbidity index, hypertension, atrial fibrillation, diabetes mellitus type 2, congestive heart failure, dyslipidemia, coronary artery disease, smoking, obesity, alcohol abuse, chronic kidney disease, pulmonary embolism, malignancy, contraindications to anticoagulation, including other major bleeding). RESULTS Of 134,499 acute proximal LE DVT patients, 18,909 (14.1%) received an IVCF. Of the patients who received an IVCF, 12,733 were White (67.3%), 3563 were Black (18.8%), and 1679 were Latino (8.9%). IVCF placement decreased for all patient groups between 2016 and 2019. After adjusting for the U.S. population distribution, the IVCF placement rates were 11 to 12/100,000 persons for Black patients, 7 to 8/100,000 persons for White patients, and 4 to 5/100,000 persons for Latino patients. The difference in IVCF placement rates was statistically significant between patient groups (Black patients vs White patients, P < .05; Black patients vs Latino patients, P < .05; Latino patients vs White patients, P < .05). CONCLUSIONS This nationwide study showed that Black patients have higher IVCF placement rates compared with White and Latino patients. Given the known long-term complications and uncertain benefits of IVCFs, coupled with the 2010 U.S. Food and Drug Administration safety warning regarding adverse patient events for these devices, proactive measures should be taken to address this disparity among the Black patient population to promote health equity. Future work should assess whether clinician bias might be perpetuating this disparity.
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Affiliation(s)
- Jordan J Juarez
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA; Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Muhammad U Khalid
- Department of Vascular Medicine, Miller Family Heart, Vascular & Thoracic Institute, Cleveland Clinic, Cleveland, OH
| | - Bianca A Ulloa
- Medical Scientist Training Program, Albert Einstein College of Medicine, Bronx, NY
| | - Carlos M Romero
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Rohit Maruthi
- Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Devrat Shah
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Eric Chang
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Irfan Shafi
- Division of Cardiovascular Medicine, Wayne State University, Detroit Medical Center, Detroit, MI
| | - Vladimir Lakhter
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Huaqing Zhao
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, PA
| | - Erik J Rodriquez
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Eliseo J Pérez-Stable
- Division of Intramural Research, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD; Office of the Director, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD
| | - Riyaz Bashir
- Division of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
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11
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Raidah A, Jaramillo N, Pradas KF, Ramanathan A. Extensive Iliocaval Deep Vein Thrombosis Provoked by Coronavirus Disease 2019 (COVID-19) in the Setting of an Inferior Vena Cava Filter. Cureus 2024; 16:e51873. [PMID: 38327914 PMCID: PMC10848074 DOI: 10.7759/cureus.51873] [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: 09/17/2023] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
Thrombotic events are well-known complications of coronavirus disease 2019 (COVID-19). Inferior vena cava filters (IVCF) are devices used to prevent pulmonary embolism (PE) and also increase the risk of thrombotic complications. Here, we describe the case of a 38-year-old female with extensive bilateral lower extremity deep vein thrombosis (DVT) and thrombosis of the infrarenal inferior vena cava (IVC) in the setting of an IVCF and symptomatic COVID-19. The IVCF had been placed a few months prior for a left femoral DVT and PE after spinal surgery. This patient was treated with pharmacomechanical thrombectomy and ultrasound-assisted thrombolysis followed by angioplasty and anticoagulation. The IVCF was retrieved after confirming there was no residual DVT when the patient recovered from COVID-19 infection. This case of a rare combination of IVCF-related thrombosis secondary to COVID-19 highlights the potential pitfalls of IVCF in this situation.
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Affiliation(s)
- Anisa Raidah
- Surgery, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
- Surgery, Nassau University Medical Center, East Meadow, USA
| | - Nolberto Jaramillo
- Surgery, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, USA
- Surgery, Nassau University Medical Center, East Meadow, USA
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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.
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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
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Zhang L, Hu WP, Zhang H, Xia SB, Wang HF, Song C, Lu QS. Retrievable Inferior Vena Cava Filter Trapped Embolus: A Risk Factor of Detachment of Thrombus Analysis Based on a Multicenter Prospective Observational Study. J Endovasc Ther 2023:15266028231205718. [PMID: 37882181 DOI: 10.1177/15266028231205718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
PURPOSE Up to now, the indications of inferior vena cava filter placement still remain controversial in the academic field. The aim of this study was to determine the risk factors of detachment of thrombus and to evaluate the necessity of inferior vena cava filter placement to prevent fatal pulmonary embolism. MATERIALS AND METHODS A total of 2892 patients participated in the multicenter prospective observational study from January 1, 2018, to December 31, 2018, and underwent retrievable inferior vena cava filter (RIVCF) placement in 103 centers in China. The primary endpoint of the study was RIVCF trapped embolus detected by inferior vena cava venography/ultrasound/computed tomography scanning or visible macroscopic thrombus before or during RIVCF retrieval. The relative factors of RIVCF trapped embolus were analyzed accordingly. RESULTS The average age of the patients was 61.0 (50.0-71.0) years. Retrievable inferior vena cava filter trapped embolus occurred in 308 patients (10.65%). The fracture location, surgery location, and endovascular intervention differed between RIVCF trapped embolus and non-RIVCF trapped embolus groups (p<0.001, respectively). By multivariate analysis, RIVCF trapped embolus were less common in older patients (odds ratio [OR]=0.998; p<0.001) and more common in patients with below-the-knee fracture (OR=1.093, p=0.038), thigh fracture (OR=1.118, p=0.007), and pelvis surgery (OR=1.067, p=0.016). In addition, compared with patients without endovascular intervention, patients with percutaneous mechanical thrombectomy (PMT) + catheter-directed thrombolysis (CDT) were more prone to develop RIVCF trapped embolus (OR=1.060, p=0.010). However, RIVCF trapped embolus was less common in patients with CDT (OR=0.961, p=0.004). CONCLUSIONS Lower limb fracture, pelvis surgery, and PMT + CDT are prone to cause trapped embolus. As a trapped embolus often represents the possibility of severe pulmonary embolism, lower limb fracture, pelvis surgery, and PMT + CDT could be risk factors of fatal pulmonary embolism. Due to the low incidence of trapped embolus, it is not necessary to place filters in elderly patients and CDT-only patients. CLINICAL IMPACT The purpose of this paper is to standardize the use of inferior vena cava filter and avoid unnecessary filter implantation through the summary and analysis of a large number of clinical data. At the same time, more attention should be paid to and active treatment should be given to high-risk groups of pulmonary embolism.
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Affiliation(s)
- Lei Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Wen-Ping Hu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
- Department of Vascular Surgery, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hao Zhang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Shi-Bo Xia
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Hong-Fei Wang
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Chao Song
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
| | - Qing-Sheng Lu
- Department of Vascular Surgery, Changhai Hospital, Navy (Second) Military Medical University, Shanghai, China
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14
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Cao P, Luo X, Li Y, Liu X, Li L, Dou Y, Zhang Y. Removing infrarenal inferior vena cava filters (IVCFs) with thrombus under protection of suprarenal IVCFs: A retrospective study in a single-center institution. Medicine (Baltimore) 2023; 102:e35574. [PMID: 37861528 PMCID: PMC10589510 DOI: 10.1097/md.0000000000035574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
To determine feasibility of removing inferior vena cava filters (IVCFs) with massive thrombus (>1*1cm) under protection of suprarenal IVCFs, and evaluate the filter thrombus detachment due to removal. The patients who had massive infrarenal IVCFs thrombus and received retrieval under protection of suprarenal IVCFs were retrospectively reviewed from July 2018 to December 2021. Medical data of them including demographics, filter types, dwell time, management, thrombus detachment was collected, and analyzed. There were 33 patients having massive infrarenal IVCFs thrombus and receiving retrieval under protection of suprarenal IVCFs including 23 males and 10 females with a mean age of 55.30 ± 11.97 (range, 30-85 years). All Infrarenal IVCFs were removed successfully and 29 cases (87.88%) were confirmed detachment of thrombus by cavography including 7 small-size thrombus (<1*1cm) and 22 large-size thrombus (>1*1cm). Twenty-two suprarenal IVCFs trapped large-size thrombus were treated with additional anticoagulation and 21 of them had successful retrievals with additional anticoagulation period of 66.18 ± 43.38 days (range, 9-154 days). The large-size IVCFs thrombus may be break off during retrieval, and IVCFs with large-size thrombus could be removed safely with suprarenal IVCFs protection. The thrombus trapped in filters could be reduced with an additional period of anticoagulation.
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Affiliation(s)
- Pengkai Cao
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xintong Luo
- Neurology Department of Hebei General Hospital, Shijiazhuang, China
| | - Yunsong Li
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiangdong Liu
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Liang Li
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yaodong Dou
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanrong Zhang
- Vascular Surgery Department of Third Hospital of Hebei Medical University, Shijiazhuang, China
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Torizawa N, Nagasawa H, Takeuchi I, Ohsaka H, Yanagawa Y. A Case of Bilateral Psoas Muscle Abscesses Complicated by Inferior Vena Cava Thrombosis. J Emerg Trauma Shock 2023; 16:199-200. [PMID: 38292281 PMCID: PMC10824220 DOI: 10.4103/jets.jets_88_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 02/01/2024] Open
Affiliation(s)
- Noriko Torizawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiroki Nagasawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Ikuto Takeuchi
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Hiromichi Ohsaka
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
| | - Youichi Yanagawa
- Department of Acute Critical Care Medicine, Shizuoka Hospital, Juntendo University, Shizuoka, Japan
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16
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Elhag H, Al-Tairy F, Dahdaha MS, Shaeshaa A, Yigit Y. Inferior Vena Cava Thrombosis in a Patient with Factor V Leiden Syndrome Presenting with Scrotal Pain. Case Rep Med 2023; 2023:6234371. [PMID: 37790840 PMCID: PMC10545471 DOI: 10.1155/2023/6234371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/05/2023] Open
Abstract
Thrombosis in the inferior vena cava (IVC) is a rare but serious condition that can lead to significant morbidity and mortality. We present a case report of a 39-year-old male who presented to the emergency department with right flank pain that had progressed to severe back pain, bilateral flank pain, scrotal pain, and leg pain over the course of two days. The pain was severe enough to affect his daily activities. Laboratory investigations revealed a D-dimer level of 17 ng/mL, creatinine level of 110 µmol/L, and a white blood cell count of 10 × 109/L with a CRP level of 5 mg/L. Urine analysis was positive for blood. Doppler ultrasound of both legs showed deep vein thrombosis extending from the external iliac veins to the distal veins of both legs. Further investigation with computed tomography of the abdomen revealed a large thrombus in the distal vena cava extending to the renal artery and both external and internal iliac veins. The patient was diagnosed with Factor V Leiden syndrome based on genetic testing, which revealed a heterozygous mutation in the F5 gene. He was successfully treated with low molecular weight heparin and warfarin, and after five days of hospitalization, he was discharged with warfarin for long-term anticoagulation. This case report emphasizes the importance of considering IVC thrombosis in patients with a constellation of symptoms, including scrotal pain, and the role of genetic testing in identifying underlying hypercoagulable states.
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Affiliation(s)
- Helmy Elhag
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fadl Al-Tairy
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Shaeshaa
- Department of Emergency Medicine, Lincoln County Hospital, Lincolnshire, UK
| | - Yavuz Yigit
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Blizard Institute, Queen Mary University, London, UK
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17
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Cochran RL, Ghoshhajra BB, Hedgire SS. Body and Extremity MR Venography: Technique, Clinical Applications, and Advances. Magn Reson Imaging Clin N Am 2023; 31:413-431. [PMID: 37414469 DOI: 10.1016/j.mric.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Magnetic resonance venography (MRV) represents a distinct imaging approach that may be used to evaluate a wide spectrum of venous pathology. Despite duplex ultrasound and computed tomography venography representing the dominant imaging modalities in investigating suspected venous disease, MRV is increasingly used due to its lack of ionizing radiation, unique ability to be performed without administration of intravenous contrast, and recent technical improvements resulting in improved sensitivity, image quality, and faster acquisition times. In this review, the authors discuss commonly used body and extremity MRV techniques, different clinical applications, and future directions.
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Affiliation(s)
- Rory L Cochran
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Brian B Ghoshhajra
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Sandeep S Hedgire
- Division of Cardiovascular Imaging, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
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18
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Ho YJ, Hsu HC, Wu BH, Lin YC, Liao LD, Yeh CK. Preventing ischemia-reperfusion injury by acousto-mechanical local oxygen delivery. J Control Release 2023; 356:481-492. [PMID: 36921723 DOI: 10.1016/j.jconrel.2023.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 02/28/2023] [Accepted: 03/11/2023] [Indexed: 03/17/2023]
Abstract
Ischemia-reperfusion (I/R) injury is a pathological process that causes vascular damage and dysfunction which increases recurrence and/or mortality in myocardial infarction, ischemic stroke, and organ transplantation. We hypothesized that ultrasound-stimulated oxygen-loaded microbubble (O2-MB) cavitation would enhance mechanical force on endothelium and simultaneously release oxygen locally at the targeted vessels. This cooperation between biomechanical and biochemical stimuli might modulate endothelial metabolism, providing a potential clinical approach to the prevention of I/R injury. Murine hindlimb and cardiac I/R models were used to demonstrate the feasibility of injury prevention by O2-MB cavitation. Increased mechanical force on endothelium induced eNOS-activated vasodilation and angiogenesis to prevent re-occlusion at the I/R vessels. Local oxygen therapy increased endothelial oxygenation that inhibited HIF-1α expression, increased ATP generation, and activated cyclin D1 for cell repair. Moreover, a decrease in interstitial H2O2 level reduced the expression of caspase3, NFκB, TNFα, and IL6, thus ameliorating inflammatory responses. O2-MB cavitation showed efficacy in maintaining cardiac function and preventing myocardial fibrosis after I/R. Finally, we present a potential pathway for the modulation of endothelial metabolism by O2-MB cavitation in relation to I/R injury, wound healing, and vascular bioeffects.
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Affiliation(s)
- Yi-Ju Ho
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
| | - Hui-Ching Hsu
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan
| | - Bing-Huan Wu
- Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Yu-Chun Lin
- Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan; Institute of Molecular Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Lun-De Liao
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - Chih-Kuang Yeh
- Department of Biomedical Engineering and Environmental Sciences, National Tsing Hua University, Hsinchu, Taiwan.
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19
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Layios N, Mathieu D, Dumont R, Gillard R. Fulminant hepatic failure: An unusual suspect. J Am Coll Emerg Physicians Open 2023; 4:e12912. [PMID: 36817077 PMCID: PMC9936055 DOI: 10.1002/emp2.12912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/30/2023] [Indexed: 02/19/2023] Open
Affiliation(s)
- Nathalie Layios
- Department of Intensive CareUniversity Hospital of LiegeLiegeBelgium,Laboratory of Cardiovascular Sciences, GIGA InstituteUniversity Hospital of LiegeLiegeBelgium
| | - Dimitri Mathieu
- Department of Intensive CareUniversity Hospital of LiegeLiegeBelgium
| | - Romain Dumont
- Department of Intensive CareUniversity Hospital of LiegeLiegeBelgium
| | - Romain Gillard
- Department of RadiologyUniversity Hospital of LiegeLiegeBelgium
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20
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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.
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21
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Muacevic A, Adler JR, Soto B, Falb V, Page C. Duplicated Inferior Vena Cava Thrombosis Mimicking Acute Pancreatitis in a COVID-19 Patient. Cureus 2023; 15:e33220. [PMID: 36733566 PMCID: PMC9888417 DOI: 10.7759/cureus.33220] [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] [Accepted: 01/01/2023] [Indexed: 01/02/2023] Open
Abstract
An 86-year-old woman with a recent hospitalization for severe coronavirus disease 2019 (COVID-19) infection presented to the emergency department with abdominal discomfort and bilateral leg swelling. She was mildly tachycardic on physical exam, with superficial abdominal vessel dilation and bilateral lower extremity edema. Her laboratory results were significant for a mildly elevated lipase of 260 U/L (normal range: 0-160 U/L) and a positive COVID-19 PCR test. CT of the abdomen and pelvis did not show any pancreatic abnormality but revealed a duplicated inferior vena cava (IVC) with a thrombus located in the right IVC. The patient was subsequently placed on full-dose anticoagulation with the eventual achievement of clot lysis. It appears that the incidence of thrombosis, including IVC thrombosis, has been on the rise due to COVID-19-associated coagulopathy; therefore, a high index of clinical suspicion in these cases may prove to be lifesaving.
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22
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Tian X, Liu J, Li J, Jia W, Jiang P, Cheng Z, Zhang Y, Liu X, Zhou MI, Tian C. Removal of inferior vena cava filter by open surgery after failure of endovenous retrieval. Front Cardiovasc Med 2023; 10:1127886. [PMID: 37139130 PMCID: PMC10150111 DOI: 10.3389/fcvm.2023.1127886] [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: 12/20/2022] [Accepted: 03/28/2023] [Indexed: 05/05/2023] Open
Abstract
Background The permanent placement of inferior vena cava (IVC) filters may lead to numerous complications and their removal is recommended once the risk of pulmonary embolism is reduced. Removal of IVC filters by endovenous means is preferred. But failure of endovenous removal happens when recycling hooks penetrate the vein wall and filters are left in place for too long time. In these scenarios, open surgery may be effective for removal of IVC filters. We aimed to describe the surgical approach, outcomes, and 6-month follow-up of the removal of IVC filter by open surgery, after the failure of removal via the endovenous method. Methods A total of 1,285 patients with retrievable IVC filters were admitted from July 2019 to June 2021, including 1,176 (91.5%) endovenous filter removals, and 24 (1.9%) open surgical IVC filter removals after the failure by endovenous method, of whom 21 (1.6%) were followed-up and eligible for analysis of the study. Patient characteristics, filter type, filter removal rate, IVC patency rate, and complications were retrospectively analyzed. Results Twenty-one patients were left with IVC filters for 26 (10, 37) months, of which 17 (81.0%) patients had non-conical filters and 4 (19.0%) had conical filters; all 21 filters were successfully removed, with a 100% removal rate, no deaths, no serious complications, and no symptomatic pulmonary embolism. At the 3rd month follow-up after surgery and 3rd month follow-up after discontinuation of anticoagulation therapy, only 1 case (4.8%) had IVC occlusion, but without any occurrence of new lower limb deep venous thrombosis and silent pulmonary embolism. Conclusion Open surgery can be used for the removal of IVC filters after failure of removal by endovenous method or when accompanied by complications without symptoms of pulmonary embolism. Open surgical approach can be used as an adjunctive clinical intervention for the removal of such filters.
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23
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Watson LR, Lee J, Palmer S, Sim S, Sanders L. Inferior vena cava thrombosis as a potential source of embolic stroke in a patient with a patent foramen ovale. Intern Med J 2022; 52:2197-2198. [PMID: 37133373 DOI: 10.1111/imj.15969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 10/17/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Leisa R. Watson
- Department of Medicine St Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Jean Lee
- Department of Medical Imaging St Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Sonny Palmer
- Department of Medicine St Vincent's Hospital Melbourne Melbourne Victoria Australia
- Department of Cardiology St Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Shirlene Sim
- Department of Clinical Haematology St Vincent's Hospital Melbourne Melbourne Victoria Australia
| | - Lauren Sanders
- Department of Medicine St Vincent's Hospital Melbourne Melbourne Victoria Australia
- Department of Neurosciences St Vincent's Hospital, The University of Melbourne Melbourne Victoria Australia
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Revascularization of acute inferior vena cava thrombosis and atresia in an adolescent. J Vasc Surg Cases Innov Tech 2022; 8:331-334. [PMID: 35812128 PMCID: PMC9263748 DOI: 10.1016/j.jvscit.2022.04.006] [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: 12/21/2021] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Inferior vena cava (IVC) anomalies will remain silent until collateralized venous drainage has been lost. The initial signs can be subtle, including back pain, and are often missed initially until progressive changes toward motor weakness, phlegmasia cerulea dolens, and/or renal impairment have occurred. We have presented a case of acute occlusion of an atretic IVC and infrarenal collateral drainage in an adolescent patient, who had been treated with successful thrombolysis, thrombectomy, and endovascular revascularization for IVC stenting and reconstruction.
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25
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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).
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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
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26
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Alexiou VG, Ntanika A, Pappas G, Vassiliou A, Palialexis K, Geroulakos G. Conservative treatment vs thrombus removal for Iliofemoral vein thrombosis in patients with congenital abnormalities of the inferior vena cava: a case report and systematic review of the literature. J Thromb Thrombolysis 2022; 54:230-254. [PMID: 35829838 DOI: 10.1007/s11239-022-02674-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
Congenital abnormalities of the Inferior Vena Cava (IVC) should be suspected in cases of Deep Venous Thrombosis (DVT), especially in young patients, with no other risk factors and apparent causes. Currently, there is no guidance regarding the management of such patients. We report a case of Iliofemoral vein thrombosis in a young patient with congenital absence of the IVC that was successfully treated with catheter-directed thrombolysis (CDT) and perform a systematic review of the literature to identify evidence about the epidemiology, clinical presentation, management, and prognosis of this rare cause of DVT. A total of 42 studies reporting on 56 cases were included in the review. The mean age of the patients at the presentation of their first DVT episode is 23.6 years, 83.9% of patients were males, conservative management with anticoagulation was used in 68% of the reported cases, and thrombolysis was used in 32% of the cases. Only 10.7% of patients presented with PE potentially justified by the abnormal anatomy of the deep veins which makes the propagation of thrombi into the pulmonary arteries less possible. Comparing the long-term outcomes of the two treatment groups; 42.3% of the patients treated conservatively vs 15.4% of the patients treated with thrombolysis developed chronic symptoms (residual heaviness, pain, swelling, and cramping). 11.5% of patients who received conservative treatment developed post-thrombotic syndrome. None of the patients treated with thrombolysis developed post-thrombotic syndrome. There were no procedure-related complications and thrombolysis was well tolerated by the entirety of the thrombolysis treatment group. Recurrence of DVT occurred in 13% of the patients treated conservatively and in 7.7% of patients treated with thrombolysis. Thrombus removal by means of thrombolysis is the recommended treatment and can offer excellent short and long-term results. Anticoagulation with NOACs may be prescribed for life to prevent recurrence or for at least 6 months and then reconsidered following further evaluation of patients' bleeding risk. It may be of value to organise an international registry for such patients. Guidelines issued by the relevant scientific societies will then be able to make a clear recommendation about the management of such patients.
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Affiliation(s)
- Vangelis G Alexiou
- Department of Surgery - Vascular Surgery Unit, Faculty of Medicine, University of Ioannina, Niarxou Avenue, 45500, Ioannina, Greece. .,Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
| | - Anna Ntanika
- Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios Pappas
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Areti Vassiliou
- Department of Surgery - Vascular Surgery Unit, Faculty of Medicine, University of Ioannina, Niarxou Avenue, 45500, Ioannina, Greece
| | - Konstantinos Palialexis
- Department of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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27
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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.
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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;.
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28
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Pavlenko EV, Blagova OV, Sedov AV, Zaitsev AY, Kukleva AD, Kogan EA. [Thromboembolic mask of severe lymphocytic myopericarditis: possibilities of clinical and morphological diagnostics and complex treatment]. KARDIOLOGIIA 2022; 62:75-80. [PMID: 35692178 DOI: 10.18087/cardio.2022.5.n1430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/18/2020] [Indexed: 06/15/2023]
Abstract
This report presents a clinical case of a 57-year-old female patient who was admitted for dyspnea, productive cough, reduced left ventricular (LV) systolic function, and who had previously undergone thoracocentesis for significant pleural effusion. This case is a unique combination of lymphocytic myocarditis and massive intracardiac and ileo-caval thrombosis. Morphological verification of the diagnosis, that was necessary prior to the administration of immunosuppressive therapy due to the prothrombogenic effect of glucocorticoids, provided a justification for a basis therapy for myocarditis, which significantly improved the patient's condition.
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Affiliation(s)
- E V Pavlenko
- Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - O V Blagova
- Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - A V Sedov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - A Y Zaitsev
- Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - A D Kukleva
- Sechenov First Moscow State Medical University (Sechenov University), Moscow
| | - E A Kogan
- Sechenov First Moscow State Medical University (Sechenov University), Moscow
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29
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Ali AA, Malak OA, Salem K, Alkhoury G, Sridharan N, Chaer RA, Avgerinos E. Acute Deep Vein Thrombosis Involving the Inferior Vena Cava: Interventional Perspectives. VASCULAR AND ENDOVASCULAR REVIEW 2022. [DOI: 10.15420/ver.2021.08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Extension of an iliofemoral thrombosis into the inferior vena cava (IVC), or from the IVC descending into the iliofemoral segments, can confer significant morbidity and mortality. Interventional management of acute deep vein thrombosis (DVT) has been controversial, but there is little doubt that certain subpopulations benefit, such as those with symptomatic IVC thrombosis. When considering an intervention, caval involvement introduces technical difficulties due to its larger diameter, high thrombus burden, bilateral limb clot extension and need for dual access. The frequent coexistence of an IVC filter increases the complexity even more. This review summarises the current indications and treatment modalities available for the management of acute DVT involving the vena cava.
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Affiliation(s)
- Adham Abou Ali
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Othman A Malak
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Karim Salem
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - George Alkhoury
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Natalie Sridharan
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Rabih A Chaer
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, US
| | - Efthymios Avgerinos
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, US; Clinic for Vascular and Endovascular Surgery, Athens Medical Center, Athens, Greece
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30
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Li WR, Feng H, Jin L, Chen XM, Zhang ZW. Duplication of the inferior vena cava: a case series. J Int Med Res 2022; 50:3000605221100771. [PMID: 35607249 PMCID: PMC9134440 DOI: 10.1177/03000605221100771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
The inferior vena cava (IVC) may develop abnormally because of its complex embryogenesis. An understanding of congenital variants such as duplication of the IVC is essential for clinical interventions, particularly those performed by surgeons and radiologists. We herein describe five patients who were diagnosed with duplication of the IVC by computed tomography or angiography and summarize their imaging and clinical features. All five patients were men aged 46 to 78 years. Two of the patients had pulmonary embolism and deep vein thrombosis and were treated by placement of an IVC filter and catheter-directed thrombolysis. The IVC in all patients ascended on either side of the abdominal aorta. All left IVCs terminated in the left renal vein, which crossed the aorta and joined the right IVC. The average follow-up time was 29 months (range, 14-46 months), and no patients developed venous thromboembolism or recurrence of thrombosis. Duplication of the IVC can be diagnosed by computed tomography and angiography. Its course and relationship with the renal vein must be identified for accurate planning of IVC filter placement in the setting of deep vein thrombosis and pulmonary embolism.
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Affiliation(s)
- Wen-rui Li
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
| | - Hai Feng
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
| | - Lei Jin
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
| | - Xue-ming Chen
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
| | - Zhi-wen Zhang
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
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31
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Parker LP, Svensson Marcial A, Brismar TB, Broman LM, Prahl Wittberg L. Impact of Altered Vena Cava Flow Rates on Right Atrium Flow Characteristics. J Appl Physiol (1985) 2022; 132:1167-1178. [PMID: 35271411 PMCID: PMC9054263 DOI: 10.1152/japplphysiol.00649.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The right atrium (RA) combines the superior (SVC) and inferior vena cava (IVC) flows. Treatments like extracorporeal membrane oxygenation (ECMO) and hemodialysis by catheter alter IVC/SVC flows. Here we assess how altered IVC/SVC flow contributions impact RA flow. Four healthy volunteers were imaged with CT, reconstructed and combined into a patient-averaged model. Large Eddy Simulations (LES) were performed for a range of IVC/SVC flow contributions (30-70% each, increments of 5%) and common flow metrics were recorded. Model sensitivity to reconstruction domain extent, constant/pulsatile inlets and hematocrit was also assessed. Consistent with literature, a single vortex occupied the central RA across all flowrates with a smaller counter-rotating vortex, not previously reported, in the auricle. Vena cava flow was highly helical. RA turbulent kinetic energy (TKE) (P=0.027) and time-averaged wall shear stress (WSS) (P<0.001) increased with SVC flow. WSS was lower in the auricle (2 Pa, P<0.001). WSS in the vena cava were equal at IVC/SVC =65/35%. The model was highly sensitive to the reconstruction domain with cropped geometries lacking helicity in the vena cavae, altering RA flow. RA flow was not significantly affected by constant inlets or hematocrit. The rotational flow conventionally described in the RA is confirmed however a new, smaller vortex was also recorded in the auricle. When IVC flow dominates, as is normal, TKE in the RA is reduced and WSS in the vena cavae equalize. Significant helicity exists in the vena cava, a result of distal geometry and this geometry appears crucial to accurately simulating RA flow.
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Affiliation(s)
- Louis P Parker
- FLOW and BioMEx, Department of Engineering Mechanics, Royal Institute of Technology, KTH, Stockholm, Sweden
| | - Anders Svensson Marcial
- Department of Clinical Science, Intervention and Technology at Karolinska Institute, Division of Medical Imaging and Technology, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology at Karolinska Institute, Division of Medical Imaging and Technology, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Lars Mikael Broman
- ECMO Centre Karolinska, Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Lisa Prahl Wittberg
- FLOW and BioMEx, Department of Engineering Mechanics, Royal Institute of Technology, KTH, Stockholm, Sweden
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32
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Xiao N, Karp J, Lewandowski R, Cuttica M, Schimmel D, Martin K, Desai KR. Inferior Vena Cava Thrombosis Risk in 1582 Patients with Inferior Vena Cava Filters. Radiology 2022; 303:300-302. [PMID: 35133197 DOI: 10.1148/radiol.211169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Nicholas Xiao
- From the Departments of Radiology, Division of Interventional Radiology (N.X., J.K., R.L., K.R.D.), and Medicine, Divisions of Pulmonary and Critical Care (M.C.), Cardiology (D.S.), and Hematology/Oncology (K.M.), Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611
| | - Jennifer Karp
- From the Departments of Radiology, Division of Interventional Radiology (N.X., J.K., R.L., K.R.D.), and Medicine, Divisions of Pulmonary and Critical Care (M.C.), Cardiology (D.S.), and Hematology/Oncology (K.M.), Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611
| | - Robert Lewandowski
- From the Departments of Radiology, Division of Interventional Radiology (N.X., J.K., R.L., K.R.D.), and Medicine, Divisions of Pulmonary and Critical Care (M.C.), Cardiology (D.S.), and Hematology/Oncology (K.M.), Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611
| | - Michael Cuttica
- From the Departments of Radiology, Division of Interventional Radiology (N.X., J.K., R.L., K.R.D.), and Medicine, Divisions of Pulmonary and Critical Care (M.C.), Cardiology (D.S.), and Hematology/Oncology (K.M.), Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611
| | - Daniel Schimmel
- From the Departments of Radiology, Division of Interventional Radiology (N.X., J.K., R.L., K.R.D.), and Medicine, Divisions of Pulmonary and Critical Care (M.C.), Cardiology (D.S.), and Hematology/Oncology (K.M.), Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611
| | - Karlyn Martin
- From the Departments of Radiology, Division of Interventional Radiology (N.X., J.K., R.L., K.R.D.), and Medicine, Divisions of Pulmonary and Critical Care (M.C.), Cardiology (D.S.), and Hematology/Oncology (K.M.), Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611
| | - Kush R Desai
- From the Departments of Radiology, Division of Interventional Radiology (N.X., J.K., R.L., K.R.D.), and Medicine, Divisions of Pulmonary and Critical Care (M.C.), Cardiology (D.S.), and Hematology/Oncology (K.M.), Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611
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33
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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.
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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.
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Koren O, Patel V, Koseki K, Natanzon SS, Friedman J, Makkar RR. Abnormal wire’s trajectory during edge-to-edge mitral valve repair—a rare case report of inferior vena cava anomaly. Eur Heart J Case Rep 2022; 6:ytac060. [PMID: 35295723 PMCID: PMC8922697 DOI: 10.1093/ehjcr/ytac060] [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: 08/17/2021] [Revised: 09/06/2021] [Accepted: 01/21/2022] [Indexed: 11/21/2022]
Abstract
Background Inferior vena cava (IVC) anomalies are rare and diagnosed incidentally as most patients are asymptomatic. We present a case where an abnormal course of the wire during percutaneous mitral valve repair revealed abnormal IVC anatomy leading to procedure termination. We summarized all IVC anomalies relevant to cardiovascular physicians and designed a simplified tool to illustrate their course for differential diagnosis. Case summary A 78-year-old female presented with severe and symptomatic mitral regurgitation. The heart team decided to proceed with a percutaneous option, considering the patient's high surgical risk. While ascending from the femoral vein, the wire took an abnormal course to the left side of the vertebrae and continued beyond the cardiac silhouette downwards the right atrium (RA). We decided to abort the procedure due to the high risk for vascular complications assuming the need to cross it with the device's delivery system. Retrospective computed tomography analysis revealed an interrupted IVC at the level of the renal vasculature and azygos continuation toward the RA via a dilated superior vena cava. The patient was referred to surgery and had successful mitral and tricuspid valve repair and was discharged home in good health. Discussion The increased number of minimally invasive percutaneous procedures, especially for valvular heart disease, mandates a profound understanding of the arterial, and venous system anatomy. Inferior vena cava anomalies represent a group of anomalies with different paths and variations and have a tremendous impact on all aspects of the procedure.
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Affiliation(s)
- Ofir Koren
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Advanced Health Sciences Pavilion, Third Floor, Suite A3100, Los Angeles, CA 90048, USA
- Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Vivek Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Advanced Health Sciences Pavilion, Third Floor, Suite A3100, Los Angeles, CA 90048, USA
| | - Keita Koseki
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Advanced Health Sciences Pavilion, Third Floor, Suite A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, The University of Tokyo, Graduate School of Medicine, Tokyo, Japan
| | - Sharon Shalom Natanzon
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Advanced Health Sciences Pavilion, Third Floor, Suite A3100, Los Angeles, CA 90048, USA
| | - John Friedman
- Department of Imaging and Medicine and Biomedical Sciences, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S. San Vicente Boulevard, Advanced Health Sciences Pavilion, Third Floor, Suite A3100, Los Angeles, CA 90048, USA
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35
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Cohen O, Ageno W, Farjat AE, Turpie AGG, Weitz JI, Haas S, Goto S, Goldhaber SZ, Angchaisuksiri P, Gibbs H, MacCallum P, Kayani G, Schellong S, Bounameaux H, Mantovani LG, Prandoni P, Kakkar AK. Management strategies and clinical outcomes in patients with inferior vena cava thrombosis: Data from GARFIELD-VTE. J Thromb Haemost 2022; 20:366-374. [PMID: 34714962 PMCID: PMC9299483 DOI: 10.1111/jth.15574] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 10/08/2021] [Accepted: 10/25/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUND Inferior vena cava (IVC) thrombosis is a rare form of venous thromboembolism (VTE). The optimal treatment strategies and outcomes are unclear in patients with this presentation. OBJECTIVE We aimed to compare baseline characteristics, treatment patterns and 24-month outcomes in IVC thrombosis patients (n = 100) with lower extremity deep vein thrombosis (LEDVT) patients (n = 7629). METHODS GARFIELD-VTE is a prospective, observational registry of 10 868 patients with objectively diagnosed VTE from 415 sites in 28 countries. RESULTS IVC thrombosis patients were younger (51.9 vs. 59.8 years), more frequently had active cancer (26.0% vs. 8.9%) or history of cancer (21.0% vs. 12.2%), and less frequently had recent trauma or surgery than LEDVT patients. IVC thrombosis was more frequently treated with parenteral anticoagulants alone (35.1% vs. 15.9%), whereas patients with LEDVT more commonly received vitamin K antagonists (32.0% vs. 25.8%) or direct oral anticoagulants (49.0% vs. 35.1%). Thrombolysis (11.0% vs. 3.6%) and surgical/mechanical interventions (4.0% vs. 1.4%) were more frequent in IVC thrombosis. At 24-months, the rate per 100 person-years (95% confidence interval) of all-cause mortality was higher in patients with IVC thrombosis than LEDVT (13.28 [8.57-20.58] vs. 4.91 [4.55-5.3]); the incidence of cancer-associated mortality was comparable as was the incidence of VTE recurrence (4.11 [1.85-9.15] vs. 4.18 [3.84-4.55]). Major bleeding was slightly higher in IVC thrombosis (2.03 [0.66-6.31] vs. 1.66 [1.45-1.89]). CONCLUSION In summary, IVC thrombosis patients have higher all-cause mortality rates than those with LEDVT, a finding only partly attributable to malignancy.
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Affiliation(s)
- Omri Cohen
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
- National Hemophilia CenterInstitute of Thrombosis and HemostasisSheba Medical CenterTel‐HashomerIsrael
- Sackler School of MedicineTel Aviv UniversityTel AvivIsrael
| | - Walter Ageno
- Department of Medicine and SurgeryUniversity of InsubriaVareseItaly
| | | | | | - Jeffrey I. Weitz
- McMaster UniversityHamiltonOntarioCanada
- Thrombosis and Atherosclerosis Research InstituteHamiltonOntarioCanada
| | - Sylvia Haas
- Formerly Technical University of MunichMunichGermany
| | - Shinya Goto
- Department of Medicine (Cardiology)Tokai University School of MedicineIseharaJapan
| | | | | | - Harry Gibbs
- Vascular LaboratoryThe Alfred HospitalMelbourneVictoriaAustralia
| | - Peter MacCallum
- Thrombosis Research InstituteLondonUK
- Queen Mary University of LondonLondonUK
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Wang JL, Xu CY, Geng CJ, Liu L, Zhang MZ, Wang H, Xiao RT, Liu L, Zhang G, Ni C, Guo XY. Anesthesia and perioperative management for giant adrenal Ewing’s sarcoma with inferior vena cava and right atrium tumor thrombus: A case report. World J Clin Cases 2022; 10:643-655. [PMID: 35097090 PMCID: PMC8771399 DOI: 10.12998/wjcc.v10.i2.643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/01/2021] [Accepted: 12/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Ewing’s sarcoma of the adrenal gland with inferior vena cava (IVC) and right atrium thrombus is extremely rare. Here, we report a case of giant adrenal Ewing’s sarcoma with IVC and right atrium tumor thrombus and summarize the anesthesia and perioperative management.
CASE SUMMARY A young female was admitted to the Department of Urology with intermittent pain under the right costal arch for four months. Enhanced abdominal computed tomography revealed a large retroperitoneal mass (22 cm in diameter), which may have originated from the right adrenal gland and was closely related to the liver. Transthoracic echocardiography showed a strong echogenic filling measuring 70 mm extended from the IVC into the right atrium and ventricle. After preoperative preparation with cardiopulmonary bypass, sufficient blood products, transesophageal echocardiography and multiple monitoring, tumor and thrombus resection by IVC exploration and right atriotomy were successfully performed by a multidisciplinary team. Intraoperative hemodynamic stability was the major concern of anesthesiologists and the status of tumor thrombus and pulmonary embolism were monitored continuously. During transfer of the patient to the intensive care unit (ICU), cardiac arrest occurred without external stimulus. Cardiopulmonary resuscitation was performed immediately and cardiac function was restored after 1 min. In the ICU, extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) were provided to maintain cardiac, liver and kidney function. Histopathologic examination confirmed the diagnosis of Ewing’s sarcoma. After postoperative treatments and rehabilitation, the patient was discharged from the urology ward.
CONCLUSION An adrenal Ewing’s sarcoma with IVC and right atrium thrombus is extremely rare, and its anesthesia and perioperative management have not been reported. Thus, this report provides significant insights in the perioperative management of patients with adrenal Ewing’s sarcoma and IVC tumor thrombus. Intraoperative circulation fluctuations and sudden cardiovascular events are the major challenges during surgery. In addition, postoperative treatments including ECMO and CRRT provide essential support in critically ill patients. Moreover, this case report also highlights the importance of multidisciplinary cooperation during treatment of the disease.
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Affiliation(s)
- Ji-Lian Wang
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Chuan-Ya Xu
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Chun-Jing Geng
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Ming-Zhu Zhang
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hua Wang
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Ruo-Tao Xiao
- Department of Urology, Peking University Third Hospital, Beijing 100191, China
| | - Lu Liu
- Intensive Care Unit, Peking University Third Hospital, Beijing 100191, China
| | - Geng Zhang
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
| | - Cheng Ni
- Department of Anesthesiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Xiang-Yang Guo
- Department of Anesthesiology, Peking University Third Hospital, Beijing 100191, China
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Leiderman DBD, Fiorelli M, Teivelis MP, Stabellini N, Amaro Júnior E, Wolosker N. Temporal trends in vena cava filter implantation in public health system inpatients: an 11-year analysis of the largest city in Brazil. J Vasc Bras 2022; 21:e20210186. [PMID: 35516910 PMCID: PMC9038042 DOI: 10.1590/1677-5449.20210186] [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: 11/08/2021] [Accepted: 01/26/2022] [Indexed: 11/22/2022] Open
Abstract
Background Vena cava filter implantation is considered a simple procedure, which can lead to overuse and over-indication. It is nevertheless associated with short and long-term complications. Objectives The goals of this study were to evaluate rates of vena cava filter implantation conducted by Brazil’s Unified Public Health System, analyzing in-hospital mortality and migration of patients from other cities seeking medical attention in São Paulo. Methods This study analyzed all vena cava filter procedures conducted from 2008 to 2018 in the city of São Paulo and registered on the public database using a big data system to conduct web scraping of publicly available databases. Results A total of 1324 vena cava filter implantations were analyzed. 60.5% of the patients were female; 61.7% were under 65 years old; 34.07% had registered addresses in other cities or states; and there was a 7.4% in-hospital mortality rate. Conclusions We observed an increase in the rates of use of vena cava filters up to 2010 and a decrease in rates from that year onwards, which coincides with the year that the Food and Drug Administration published a recommendation to better evaluate vena cava filter indications.
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Affiliation(s)
| | - Marcelo Fiorelli
- Hospital Israelita Albert Einstein, Brasil; Universidade de São Paulo, Brasil
| | | | | | - Edson Amaro Júnior
- Hospital Israelita Albert Einstein, Brasil; Universidade de São Paulo, Brasil; Universidade de São Paulo, Brasil
| | - Nelson Wolosker
- Universidade de São Paulo, Brasil; Universidade de São Paulo, Brasil
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Tian J, Zhang L, Hu M, Zeng X, Wang Y, Yang C, Hu Z. Heterotopic Ossification of the Inferior Vena Cava Wall: A Case Report and Literature Review. Front Surg 2021; 8:738934. [PMID: 34926564 PMCID: PMC8674723 DOI: 10.3389/fsurg.2021.738934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 11/04/2021] [Indexed: 12/17/2022] Open
Abstract
Masses of the inferior vena cava (IVC) are very diverse, most of which are thrombus and tumor thrombus, whereas heterotopic ossification of IVC has never been reported. Heterotopic ossification (HO) is the formation of mature lamellar bone outside normal bones and in soft tissues. Some researchers believe that HO is a manifestation of vascular calcification. Here we present a case of HO of the inferior vena cava (IVC) wall. A 68 year old female patient complaining hypertension and palpitation and diagnosed with a retroperitoneal mass was found to have a primary mass of the inferior vena cava wall during surgery. Histopathological examination after surgical resection revealed that the mass was mainly composed of mature bone tissues and hematopoietic tissues of bone marrow, there was no recurrence and the patient was symptom-free 15 months after the surgery. HO of the inferior vena cava wall is very rare, with large volume it can affect the circulation, and this case remind us that it can be cured by surgical resection.
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Affiliation(s)
- Jihua Tian
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Li Zhang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Min Hu
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xing Zeng
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yongjun Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunguang Yang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiquan Hu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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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.
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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
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Apostolova Y, Mehier P, Qanadli SD, Pruijm M. Inferior vena cava thrombosis as a possible cause of nephrotic-range proteinuria: two case reports. J Med Case Rep 2021; 15:569. [PMID: 34823573 PMCID: PMC8614051 DOI: 10.1186/s13256-021-03132-6] [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] [Received: 09/12/2020] [Accepted: 09/24/2021] [Indexed: 11/25/2022] Open
Abstract
Background Nephrotic-range proteinuria is a common reason for nephrological consultation in clinical practice. The differential diagnosis is wide, and generally focuses on different forms of glomerulonephritis, but other causes should not be overlooked, as illustrated in this article. Case presentations We report two female patients with nephrotic-range proteinuria. In the first case, a 46 year old Caucasian patient who suffered from extreme obesity (Body mass index (BMI) 77 kg/m2), acute kidney injury and nephrotic-range proteinuria were discovered during an emergency consultation for acute abdominal pain. The second patient (aged 52, also Caucasian) developed stage 4 chronic kidney disease and nephrotic proteinuria (protein/creatinine ratio 1821 g/mol) after accidental rupture of the inferior vena cava during a gastric bypass operation. On split-urine collection, both had a much higher degree of proteinuria during the day than during the night, compatible with orthostatic proteinuria. At further work-up, inferior vena cava thrombosis was diagnosed in both patients, whereas renal veins were patent. Discussion After simple anticoagulation in the first case, and anticoagulation plus endovascular recanalization in the second, there was almost complete resolution of the orthostatic proteinuria and a strong improvement of the estimated glomerular filtration rate in both patients. These cases highlight that nephrotic-range proteinuria can be linked to inferior vena cava thrombosis, and that a split-urine collection may also be very useful in the diagnostic work-up of proteinuria in adults.
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Affiliation(s)
- Yana Apostolova
- Department of Internal Medicine, University Hospital of Lausanne and University of Lausanne (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - Patricia Mehier
- Service of Nephrology, Riviera-Chablais Hospital, Rennaz, Switzerland
| | - Salah D Qanadli
- Department of Radiology, Interventional Radiology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
| | - Menno Pruijm
- Service of Nephrology, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland
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Tian X, Liu J, Jia W, Jiang P, Cheng Z, Zhang Y, Li J, Tian C. Placing a New Filter before Removing Embolized Nonconical Filter: A Report of 13 Cases. Ann Vasc Surg 2021; 81:249-257. [PMID: 34775026 DOI: 10.1016/j.avsg.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/31/2021] [Accepted: 09/03/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Permanent filter placement may result in numerous complications. Filter removal is recommended if there are no risks of pulmonary embolism. This study aimed to explore the feasibility of placing a new filter when the embolized nonconical filter is removed. METHODS This study included patients who had received a new filter between 2018 and 2019 before the nonconical filters were removed. Patient characteristics, new filter types, thrombus interception rate, filter removal rate, feasibility, and safety were analyzed retrospectively. Feasibility was defined as the successful placement of new filters and the removal of the nonconical filters. Safety was defined as the absence of symptomatic pulmonary embolism and inferior vena cava hemorrhage after removing the nonconical filters, as well as the successful removal of new filters without symptomatic pulmonary embolism. RESULTS The average indwelling period of the nonconical filters was 29 (range, 17-30) days among the 13 patients. The removal rate of the nonconical filters was 100%. Five patients (38.5%) received new Denali filters, one (7.7%) received a new Celect filter, and 7 (53.8%) received new temporary filters. Thrombi were intercepted in 10 of the patients (76.9%). The removal rate of the replaced new filters was 100%. No rupture or shifting of the new filters occurred. No symptomatic pulmonary embolism was found after the removal of both the nonconical filters and the new filters. The patients were followed up for 3 months after the surgeries, and the inferior vena cavae of 12 (92.3%) patients were patent, and no new embolic events were found. CONCLUSIONS Placing a new replacement filter before removal of the embolized nonconical filter may be a feasible approach to prevent pulmonary embolism. Both the nonconical filter and the new filter could be removed subsequently after the thrombi were treated.
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Affiliation(s)
- Xuan Tian
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Jianlong Liu
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China.
| | - Wei Jia
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Peng Jiang
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Zhiyuan Cheng
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Yunxin Zhang
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Jinyong Li
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
| | - Chenyang Tian
- Department of Vascular Surgery, Beijing Jishuitan Hospital, Beijing, China
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Du J, Nie M, Yan Z, Fu J, Sun J, Liu F. Safety and Efficacy of Rivaroxaban for Inferior Vena Cava Thrombosis after Successful Catheter-Directed Thrombolysis. Semin Thromb Hemost 2021; 48:459-464. [PMID: 34624911 DOI: 10.1055/s-0041-1733924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Rivaroxaban use for inferior vena cava (IVC) thrombosis after successful catheter-directed thrombolysis (CDT) is rarely reported. This study aimed at investigating the safety and efficacy of rivaroxaban for IVC thrombosis after CDT. The clinical data on 38 consecutive patients with IVC thrombosis (68% male; mean age, 51.5 ± 16.5), who received rivaroxaban after CDT between July 2017 and January 2020, were retrospectively analyzed in this study. Safety and efficacy of rivaroxaban (bleedings and recurrent venous thromboembolism), cumulative prevalence of post-thrombotic syndrome (PTS), primary patency, clinically driven target lesion revascularization rate, and other adverse events including all-cause mortality and vascular events (systemic embolism, acute coronary syndrome, ischemic stroke, and transient ischemic attack) were retrospectively analyzed. Of the 38 patients who received rivaroxaban for IVC thrombosis after CDT, 27 (71%) had an anticoagulant duration of 6 months and 11 patients (29%) of more than 6 months. Four patients (10%) suffered recurrent thrombosis. No patient suffered major bleeding, while clinically relevant nonmajor bleeding occurred in two (5%) patients. The cumulative prevalence of PTS was 18% (7/38) during the 12 months follow-up period. Primary patency at 1, 3, 6, and 12 months was 97, 92, 90, and 90%, respectively. According to follow-up data, the clinically driven target lesion revascularization of this study was 10%. Cardiovascular events and mortality did not occur in any patient during the study period. Rivaroxaban for IVC thrombosis after successful CDT can be safe and effective.
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Affiliation(s)
- Jun Du
- Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Menglin Nie
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhitong Yan
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jian Fu
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jianming Sun
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Fanyun Liu
- Department of Vascular Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Li SJ, Lee J, Hall J, Sutherland TR. The inferior vena cava: anatomical variants and acquired pathologies. Insights Imaging 2021; 12:123. [PMID: 34460015 PMCID: PMC8405820 DOI: 10.1186/s13244-021-01066-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/07/2021] [Indexed: 01/05/2023] Open
Abstract
The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.
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Affiliation(s)
- Simon J Li
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Jean Lee
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jonathan Hall
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Tom R Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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Successful IVC thrombus extraction with the AngioVac device following five vessel coronary artery bypass graft: a case report. J Cardiothorac Surg 2021; 16:226. [PMID: 34372883 PMCID: PMC8350305 DOI: 10.1186/s13019-021-01605-9] [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] [Received: 07/15/2021] [Accepted: 07/29/2021] [Indexed: 11/14/2022] Open
Abstract
Background Inferior vena cava thrombosis is cited to be a complication of inferior vena cava filter placement and post coronary artery bypass surgery. Often only mild symptoms arise from these thrombi; however, due to the chronic nature of some thrombi and the recanalization process, more serious complications can arise. Although anticoagulation remains the gold standard of treatment, some patients are unable to be anticoagulated. In this case, we present a 65-year-old male who underwent IVC filter placement and open-heart surgery who later developed extensive femoral and iliocaval thrombosis leading to right heart failure, which required thrombus extraction with an AngioVac suction device. Case presentation We present a 65-year-old male who presented with bilateral pulmonary emboli with extensive right lower extremity deep vein thrombosis. Upon investigation he had ischemic heart disease and underwent a five-vessel coronary artery bypass for which he had an IVC filter placed preoperatively. On post operative day 3 to 4, he was decompensated and was diagnosed with an IVC thrombus. He progressed to right heart failure and worsening cardiogenic shock despite therapeutic anticoagulation and was taken for a suction thrombectomy using the AngioVac (AngioDynamics, Latham, NY) aspiration thrombectomy device. The thrombectomy was successful and he was able to recover and was discharged from the hospital. Conclusion Despite being a rare complication, IVC thrombosis can have detrimental effects. This case is an example of how IVC thrombus in the post-operative setting can lead to mortality. The gold standard is therapeutic anticoagulation but despite that, this patient continued to have worsening cardiogenic shock. Other therapies have been described but because of its rarity, they are only described in case reports. This case shows that the AngioVac device is a successful treatment option for IVC thrombus and can have the possibility of future use.
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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.
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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.
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Singh M, Shafi I, Rali P, Panaro J, Lakhter V, Bashir R. Contemporary Catheter-Based Treatment Options for Management of Acute Pulmonary Embolism. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021; 23:44. [PMID: 33994774 PMCID: PMC8113788 DOI: 10.1007/s11936-021-00920-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 01/21/2023]
Abstract
Introduction Acute pulmonary embolism (PE) remains an important cause of cardiovascular mortality and morbidity in the USA and worldwide. Catheter-based therapies are emerging as a new armamentarium for improving outcomes in these patients. Purpose of review The purpose of this review is to familiarize the clinicians with (1) various types of catheter-based modalities available for patients with acute PE, (2) advantages, disadvantages, and appropriate patient selection for the use of these devices, and (3) evidence base and the relevance of such therapies in the COVID-19 pandemic. Recent findings There are four main types of catheter-based therapies in acute PE: (1) standard catheter-directed thrombolysis (CDT), (2) ultrasound-assisted CDT, (3) pharmacomechanical CDT, and (4) mechanical thrombectomy without thrombolysis. Ultrasound-assisted thrombolysis is the most widely studied modality in this group; however, evidence base for other catheter-based technologies is rapidly emerging. Summary Current use of catheter-based therapies is most suitable for patients with intermediate and high-risk acute PE. The adoption of a multidisciplinary approach like the pulmonary embolism response team (PERT) is desirable for appropriate patient selection and possibly/potentially improving patient outcomes. We discuss the current status of these therapies.
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Affiliation(s)
- Maninder Singh
- Department of Cardiovascular Disease, Temple University Hospital, Philadelphia, PA USA
| | - Irfan Shafi
- Department of Internal Medicine, Wayne State University/DMC, Detroit, MI USA
| | - Parth Rali
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA USA
| | - Joseph Panaro
- Department of Radiology, Temple University Hospital, Philadelphia, PA USA
| | - Vladimir Lakhter
- Department of Cardiovascular Disease, Temple University Hospital, Philadelphia, PA USA
| | - Riyaz Bashir
- Department of Cardiovascular Disease, Temple University Hospital, Philadelphia, PA USA.,Division of Cardiovascular Diseases, Temple University Hospital, 3401 N. Broad Street (9PP), Philadelphia, PA 19140 USA
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47
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A case of inferior vena cava atresia complicated by bilateral deep vein thrombosis. Radiol Case Rep 2021; 16:1548-1551. [PMID: 33948132 PMCID: PMC8081874 DOI: 10.1016/j.radcr.2021.03.031] [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] [Received: 01/30/2021] [Revised: 03/16/2021] [Accepted: 03/17/2021] [Indexed: 11/20/2022] Open
Abstract
In this report, we describe a case of deep vein thrombosis with suspected congenital inferior vena cava atresia treated with thrombolysis, angioplasty, and bilateral “kissing” iliac stent placement. An 18-year-old male presented with left common iliac vein thrombus and suspected congenital inferior vena cava atresia. He was treated over 4 days and discharged on anticoagulation which was continued long-term. These treatments were shown to be clinically successful in treating and preventing re-thrombosis in the context of inferior vena cava atresia initially presenting with symptomatic bilateral lower extremity deep vein thrombosis.
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48
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Prater S, Awan MA, Antuna K, Colon JZ. Prevention of Pulmonary Cement Embolism by Inferior Vena Cava Filter following Vertebroplasty-related Cement Intravasation. J Radiol Case Rep 2021; 15:17-27. [PMID: 34276872 DOI: 10.3941/jrcr.v15i4.4139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
A 77 year old woman with recent history of vertebroplasty for treatment of multiple osteoporotic lumbar vertebral body compression fractures presented for post-procedure care. A series of radiographs and cross-sectional imaging of the lumbar spine revealed an unexpected finding of cured bone cement within a small lumbar vertebral vein, the inferior vena cava and within the spokes of an inferior vena cava filter which had originally been placed two years earlier. Inferior vena cava filters have become the standard of care to prevent pulmonary embolism in the setting of deep venous thrombosis. However, cases of foreign materials becoming entrapped in filters are uncommon despite the documented frequency of intravasation of bone cement into the circulatory system following vertebroplasty procedures. This case is significant because it illustrates the rare occurrence of an inferior vena cava filter capturing intravasated bone cement and preventing its migration to the pulmonary circulation.
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Affiliation(s)
- Stephanie Prater
- Department of Radiology, Aventura Hospital & Medical Center, Miami, FL, USA
| | - Muhammad Ali Awan
- Kiran C. Patel School of Allopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Kristina Antuna
- Kiran C. Patel School of Allopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Julio Zayas Colon
- Department of Radiology, Aventura Hospital & Medical Center, Miami, FL, USA
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49
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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.
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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
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50
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Sebastian T, Barco S, Kreuzpointner R, Konstantinides S, Kucher N. Reversal of cardiopulmonary exercise intolerance in patients with post-thrombotic obstruction of the inferior vena cava. Thromb Res 2021; 208:219-225. [PMID: 33840477 DOI: 10.1016/j.thromres.2021.03.025] [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: 01/21/2021] [Revised: 03/05/2021] [Accepted: 03/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND It is unclear whether cardiopulmonary exercise intolerance in patients with chronic obstruction of the inferior vena cava (IVC) is reversible following endovascular IVC reconstruction. METHODS In 17 patients (mean age 45 ± 15 years, 71% men) with post-thrombotic syndrome due to IVC obstruction and preserved left ventricular ejection fraction (mean 58 ± 3%), we performed cardiopulmonary exercise testing before and 3 months after IVC reconstruction (mean 4.1 ± 1.5 implanted stents). The median time from latest episode of deep vein thrombosis to intervention was 150 (interquartile range 102-820) days. RESULTS At baseline, 12 (71%) patients reported New York Heart Association (NYHA) class II or III symptoms, 76% did not achieve >85% of predicted oxygen uptake at peak exercise (mean 61.8 ± 13.7%). After IVC reconstruction, the following changes were observed at anaerobic threshold: work rate increased by 14.6 W, 95%CI (-0.7; 30.0), oxygen uptake increased by 1.8 ml/kg, 95%CI (0.3; 3.3). Oxygen pulse increased by 1.95 ml per beat, 95%CI (1.12; 2.78), corresponding to a mean relative increase of 22.5%, 95%CI (12.4; 32.7) (p < 0.001). The following changes were observed at peak exercise: work rate increased by 48.1 W, 95%CI (27.8; 68.4), oxygen uptake increased by 6.4 ml/kg, 95%CI (3.8; 9.1). Oxygen pulse increased by 2.68 ml per beat, 95%CI (1.60; 3.76), corresponding to a mean relative increase of 29.4%, 95%CI (17.7; 41.2) (p < 0.001). At follow-up, 5 (29%) patients remained in NYHA class II. CONCLUSIONS In patients with chronic IVC obstruction, cardiopulmonary exercise intolerance as a result of impaired cardiac filling is at least partially reversible following endovascular IVC reconstruction. STUDY REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT02433054.
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Affiliation(s)
- Tim Sebastian
- Clinic for Angiology, University Hospital Zurich, Switzerland
| | - Stefano Barco
- Clinic for Angiology, University Hospital Zurich, Switzerland; Center for Thrombosis and Hemostasis (CTH), University Mainz, Germany.
| | | | | | - Nils Kucher
- Clinic for Angiology, University Hospital Zurich, Switzerland.
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