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Bikdeli B, Sadeghipour P, Lou J, Bejjani A, Khairani CD, Rashedi S, Lookstein R, Lansky A, Vedantham S, Sobieszczyk P, Mena-Hurtado C, Aghayev A, Henke P, Mehdipoor G, Tufano A, Chatterjee S, Middeldorp S, Wasan S, Bashir R, Lang IM, Shishehbor MH, Gerhard-Herman M, Giri J, Menard MT, Parikh SA, Mazzolai L, Moores L, Monreal M, Jimenez D, Goldhaber SZ, Krumholz HM, Piazza G. Developmental or Procedural Vena Cava Interruption and Venous Thromboembolism: A Review. Semin Thromb Hemost 2024; 50:851-865. [PMID: 38176425 DOI: 10.1055/s-0043-1777991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Cardiovascular Research Foundation (CRF), New York, New York
| | - Parham Sadeghipour
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Junyang Lou
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antoine Bejjani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Candrika D Khairani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sina Rashedi
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Robert Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Piotr Sobieszczyk
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ghazaleh Mehdipoor
- Cardiovascular Research Foundation (CRF), New York, New York
- Center for Evidence-based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Saurav Chatterjee
- Division of Cardiology, Department of Medicine, Zucker School of Medicine, New York, New York
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suman Wasan
- University of North Carolina, Chapel Hill, North Carolina
| | - Riyaz Bashir
- Departement of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Irene M Lang
- Department of Internal Medicine II, Cardiology and Center of Cardiovascular Medicine, Medical University of Vienna, Vienna, Austria
| | - Mehdi H Shishehbor
- University Hospitals Heath System, Harrington Heart and Vascular Institute, Cleveland, Ohio
| | - Marie Gerhard-Herman
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahil A Parikh
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Lisa Moores
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | | | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harlan M Krumholz
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Saab K, Brahmandam AS, Brackett AL, Desai MM, Dardik A, Guzman RJ, Chaar CIO. Systematic review of inferior vena cava atresia. J Vasc Surg Venous Lymphat Disord 2023; 11:1253-1264. [PMID: 37453547 DOI: 10.1016/j.jvsv.2023.07.002] [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: 02/07/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Inferior vena cava (IVC) atresia is a rare venous anomaly characterized by absence of the IVC. It has been associated with deep vein thrombosis (DVT) and other congenital anomalies. The aim of the present study is to provide a comprehensive summary of the literature on IVC atresia and discuss the presentation and outcomes of patients with IVC atresia. METHODS A systematic review of the English literature up to April 2020 was performed. The presentations and treatments reported were noted and compared between the two sexes. The IVC atresia cases were further stratified into isolated IVC atresia and IVC atresia associated with other congenital anomalies. RESULTS A total of 412 abstracts were screened, with 178 reports included. A total of 376 patients were analyzed. Overall, males seem to be more affected than females, with a ratio of almost 2:1 (male, 227 [64.1%]; vs female, 127 [35.8%]). However, females were more likely to have congenital IVC atresia compared with males (46.1% vs 21.3%; P < .001). The mean age at presentation was 27.9 ± 18.0 years (range, 0-77 years), with no differences between the sexes. Most patients with IVC atresia presented with DVT (n = 242 of 376; 64.3%), with the iliac veins most often affected (n = 159 of 242; 65.7%). No difference was found in the reported proportion of patients presenting with DVT between the two sexes. The symptom presentation was similar, with leg pain and swelling the most common in both sexes. The patients were treated either medically with anticoagulation or surgically (open or endovascular). No mortality was reported with isolated IVC atresia in either treatment group. However, the mortality of patients with IVC atresia associated with other congenital anomalies was 11.7%. CONCLUSIONS IVC atresia is more common in males but seems to have a predilection for females in the setting of other congenital anomalies. Most patients present with leg pain and swelling related to the development of DVT. Open and endovascular surgical interventions to treat IVC atresia have been reported in 18.3% of patients reviewed, with acceptable mid-term results in terms of patency and symptomatic relief.
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Affiliation(s)
- Karim Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Anand S Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Alexandria L Brackett
- Clinical Research and Education, Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, CT
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT.
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Kinariwala D, Liles A, Williams DM, Khaja MS. Iliocaval Reconstruction: Review of Technique, Challenges, and Outcomes. Semin Intervent Radiol 2022; 39:464-474. [PMID: 36561935 PMCID: PMC9767777 DOI: 10.1055/s-0042-1757936] [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: 12/24/2022]
Abstract
Iliocaval thrombosis is a major source of morbidity for patients, with a range of clinical presentations, including recurrent lower extremity deep venous thrombosis and postthrombotic syndrome. Endovascular reconstruction of chronic iliocaval occlusion has been demonstrated to be a technically feasible procedure that provides long-lasting symptom relief in combination with antithrombotic therapy and close clinical monitoring. Herein, we describe the etiologies of iliocaval thrombosis, patient assessment, patient management prior to and after intervention, procedural techniques, and patient outcomes.
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Affiliation(s)
- Dhara Kinariwala
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia
| | - Amber Liles
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
| | - David M. Williams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
| | - Minhaj S. Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
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Zhao Y, Ping J, Yu X, Cui Y, Yin J, Sun C, Hua G, Wang C, Li X, Tang L. Computational fluid dynamics simulation of time-resolved blood flow in Budd-Chiari syndrome with inferior vena cava stenosis and its implication for postoperative efficacy assessment. Clin Biomech (Bristol, Avon) 2021; 82:105256. [PMID: 33508562 DOI: 10.1016/j.clinbiomech.2020.105256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 12/08/2020] [Accepted: 12/22/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to adopt computational fluid dynamics to simulate the blood flow dynamics in inferior vena cava stenosis based on time-dependent patient-specific models of Budd-Chiari syndrome as well as a normal model. It could offer valuable references for a retrospective insight into the underlying mechanisms of Budd-Chiari syndrome pathogenesis as well as more accurate evaluation of postoperative efficacy. METHODS Three-dimensional inferior vena cava models of Budd-Chiari syndrome patient-specific (preoperative and postoperative) and normal morphology model were reconstructed as per magnetic resonance images using Simpleware. Moreover, computational fluid dynamics of time-resolved inferior vena cava blood flow were simulated using actual patient-specific measurements to reflect time-dependent flow rates. FINDINGS The assessment of the preoperative model revealed the dramatic variations of hemodynamic parameters of the stenotic inferior vena cava. Moreover, the comparison of the preoperative and postoperative models with the normal model as benchmark showed that postoperative hemodynamic parameters were markedly ameliorated via stenting, with the attenuation of overall velocity and wall shear stress, and the increase of pressure. However, the comparative analysis of the patient-specific simulations revealed that some postoperative hemodynamic profiles still bore some resemblance to the preoperative ones, indicating potential risks of restenosis. INTERPRETATION Computational fluid dynamics simulation of time-resolved blood flow could reveal the tight correlation between the hemodynamic characteristics and the pathological mechanisms of inferior vena cava stenosis. Furthermore, such time-resolved hemodynamic profiles could provide a quantitative approach to diagnosis, operative regimen and postoperative evaluation of Budd-Chiari syndrome with inferior vena cava stenosis.
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Affiliation(s)
- Yinghong Zhao
- China University of Mining and Technology, No.1, Daxue Road, Xuzhou, Jiangsu, China; Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China
| | - Jie Ping
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Xianchao Yu
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Yanfeng Cui
- The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Jie Yin
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China; The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Cunjie Sun
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China; The Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China.
| | - Gang Hua
- China University of Mining and Technology, No.1, Daxue Road, Xuzhou, Jiangsu, China.
| | - Chongwei Wang
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China
| | - Xinxiu Li
- Xuzhou Medical University, 209 Tongshan Road, Xuzhou, Jiangsu, China
| | - Lu Tang
- China University of Mining and Technology, No.1, Daxue Road, Xuzhou, Jiangsu, China
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Schiffman MH, Cornman-Homonoff J, Sos TA. Percutaneous Orthotopic IVC Construction in a Pediatric Patient with Symptomatic IVC Agenesis. Cardiovasc Intervent Radiol 2018; 42:308-312. [PMID: 30420997 DOI: 10.1007/s00270-018-2098-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
Inferior vena cava agenesis is an uncommon condition usually attributed to embryologic dysgenesis. When symptomatic, unprovoked deep venous thrombosis and/or lower extremity venous congestion are the most frequent manifestations. Its rarity has precluded consensus regarding appropriate management. Symptomatic chronic venous congestion requires surgical construction of auxiliary venous pathways, which may involve substantial morbidity, prolonged recovery and extensive scarring. We report successful minimally invasive management via percutaneous endovascular orthotopic inferior vena cava construction in a pediatric patient, thereby obviating the need for surgery and its associated morbidity. LEVEL OF EVIDENCE: Level IV, case study.
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Affiliation(s)
- Marc H Schiffman
- Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA.
| | - Joshua Cornman-Homonoff
- Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Thomas A Sos
- Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
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