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Swersky A, Desai KR. Inferior Vena Cava Filter Retrieval: Simple to Complex. Cardiovasc Intervent Radiol 2024:10.1007/s00270-024-03673-5. [PMID: 38396083 DOI: 10.1007/s00270-024-03673-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
Retrievable inferior vena cava filters were designed to provide mechanical prophylaxis from pulmonary embolism with the intent for retrieval once no longer indicated, and have been utilized at a high rate since their introduction. Unfortunately, retrieval rates have historically lagged behind, in part due to significant rates of failed standard retrieval techniques for filters with prolonged dwell time. Refinement in advanced retrieval techniques has now allowed (in experienced centers) for safe removal of filters previously considered irretrievable. An individualized approach is necessary for each potential advanced filter retrieval to determine appropriate course of action. This review will emphasize complex filter retrieval techniques amidst a larger discussion of inferior vena cava filters and their management.
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Affiliation(s)
- Adam Swersky
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 800, Chicago, IL, 60611, US
| | - Kush R Desai
- Division of Vascular and Interventional Radiology, Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street, Suite 800, Chicago, IL, 60611, US.
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Saleem T, Powell T, Walker W, Raju S. Assessment of flow mechanics in the lower extremity venous system. J Vasc Surg Venous Lymphat Disord 2023; 11:365-372.e3. [PMID: 36332888 DOI: 10.1016/j.jvsv.2022.10.009] [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: 07/20/2022] [Revised: 09/20/2022] [Accepted: 10/14/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Reynolds number (Re) is a dimensionless parameter that describes fluid flow mechanics. Veins are compliant and collapsible vascular conduits that can accommodate large volume changes in response to small pressure changes. However, only sparse information is available about flow parameters such as the Re in the venous system. METHODS Bilateral duplex ultrasound examination of 15 healthy volunteers (30 limbs) was performed before and after exercise (four flights of stairs) of the veins of the lower extremity (left and right sides) and inferior vena cava. These volunteers had been confirmed to not have any signs or symptoms of lower extremity venous disease via focused history and physical examination findings. RESULTS Most of the volunteers were women (73%). Their mean age was 37 ± 12.8 years. The Re was highest in the inferior vena cava among all the veins examined (470 ± 144 before exercise and 589 ± 205 after exercise; P = .04). The association between the change in Re before and after exercise and the specific vein examined was also significant for the right and left external iliac veins, right and left common femoral veins, right and left profunda femoris veins, right and left femoral veins, and right common iliac vein. Resistance and velocity maps for the lower extremity venous system were also created. The velocity increased and the resistance decreased as one moved up the venous tree toward the right atrium. CONCLUSIONS The Re increased for most of the lower extremity veins after exercise in our healthy volunteers. However, the critical value for turbulent flow was not reached despite the exercise.
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Affiliation(s)
- Taimur Saleem
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS.
| | - Thomas Powell
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - William Walker
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS
| | - Seshadri Raju
- The RANE Center for Venous and Lymphatic Diseases, Jackson, MS
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La Via L, Astuto M, Dezio V, Muscarà L, Palella S, Zawadka M, Vignon P, Sanfilippo F. Agreement between subcostal and transhepatic longitudinal imaging of the inferior vena cava for the evaluation of fluid responsiveness: A systematic review. J Crit Care 2022; 71:154108. [DOI: 10.1016/j.jcrc.2022.154108] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/07/2022] [Accepted: 06/25/2022] [Indexed: 12/18/2022]
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Odeh H, Al-Hyasat TG, Habash A, Assaf FJN, Sallam RA, Abdellatif AJ, Bani Hani A, Badran DH, Mahafza WS, Salameh MA, Shatarat AT. Morphometric analysis of the inferior vena cava and its clinical correlations using abdomino-pelvic computed tomography: Series from a Jordanian population. Int J Surg Case Rep 2022; 98:107514. [PMID: 35985110 PMCID: PMC9411680 DOI: 10.1016/j.ijscr.2022.107514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/09/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction and importance This study aimed to determine the impact of DM, HTN and age on IVC dimensions as measured by CT scan relevant to guide interventions in a Jordanian population. Presentation of cases Two hundred patients were selected from those referred to the Radiology Department, Jordan University Hospital, Amman, Jordan for clinical evaluation. Patients were divided into three age subgroups. Age, sex, and comorbidities such as DM and HTN were identified and saved for later use. All dimensions of the IVC were measured using an abdomino-pelvic CT scanner. Clinical discussion A full morphometric analysis of the IVC would provide a better understanding of the dynamicity of the IVC in relation to its blood flow. Our results revealed that the length of the IVC was significantly shorter with age (P = 0.003). DM significantly affected the length of the IVC (P = 0.044). Hypertension also significantly affected the length of the IVC (P = 0.031), but it did not significantly affect the anterio-posterior or the transverse diameters of the IVC. Conclusion The length of the IVC was significantly shorter with age, DM and hypertension. Morphometric measures of the IVC are of great clinical importance as they may assist in medical or surgical intervention and follow-up. Determining the main dimensions of IVC is clinically important. This study revealed significant variability in IVC dimensions in relation to age. Diabetes and hypertension are important in changing the dimensions of IVC.
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Affiliation(s)
- Hadeel Odeh
- Department of Basic Medical Sciences, Faculty of Medicine, Al-Balqa Applied University, Al-Salt 19117, Jordan.
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Albani S, Mesin L, Roatta S, De Luca A, Giannoni A, Stolfo D, Biava L, Bonino C, Contu L, Pelloni E, Attena E, Russo V, Antonini-Canterin F, Pugliese NR, Gallone G, De Ferrari GM, Sinagra G, Scacciatella P. Inferior Vena Cava Edge Tracking Echocardiography: A Promising Tool with Applications in Multiple Clinical Settings. Diagnostics (Basel) 2022; 12:diagnostics12020427. [PMID: 35204518 PMCID: PMC8871248 DOI: 10.3390/diagnostics12020427] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 01/29/2022] [Indexed: 01/25/2023] Open
Abstract
Ultrasound (US)-based measurements of the inferior vena cava (IVC) diameter are widely used to estimate right atrial pressure (RAP) in a variety of clinical settings. However, the correlation with invasively measured RAP along with the reproducibility of US-based IVC measurements is modest at best. In the present manuscript, we discuss the limitations of the current technique to estimate RAP through IVC US assessment and present a new promising tool developed by our research group, the automated IVC edge-to-edge tracking system, which has the potential to improve RAP assessment by transforming the current categorical classification (low, normal, high RAP) in a continuous and precise RAP estimation technique. Finally, we critically evaluate all the clinical settings in which this new tool could improve current practice.
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Affiliation(s)
- Stefano Albani
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
- Correspondence: ; Tel.: +39-3285999910
| | - Luca Mesin
- Mathematical Biology & Physiology, Department of Electronics and Telecommunications, Politecnico di Torino, 10129 Torino, Italy;
| | - Silvestro Roatta
- Integrative Physiology Lab, Department of Neuroscience, University of Turin, 10125 Turin, Italy;
| | - Antonio De Luca
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Alberto Giannoni
- Scuola Superiore Sant’Anna, 56127 Pisa, Italy;
- Fondazione Toscana G. Monasterio, 56124 Pisa, Italy
| | - Davide Stolfo
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Lorenza Biava
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Caterina Bonino
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Laura Contu
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Elisa Pelloni
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
| | - Emilio Attena
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli-Monaldi Hospital—A.O.R.N. Dei Colli, 80131 Naples, Italy; (E.A.); (V.R.)
| | - Vincenzo Russo
- Department of Translational Medical Sciences, University of Campania Luigi Vanvitelli-Monaldi Hospital—A.O.R.N. Dei Colli, 80131 Naples, Italy; (E.A.); (V.R.)
| | | | | | - Guglielmo Gallone
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy; (G.G.); (G.M.D.F.)
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Città della Salute e della Scienza, University of Turin, 10124 Turin, Italy; (G.G.); (G.M.D.F.)
| | - Gianfranco Sinagra
- Cardio-Thoraco-Vascular Department, Division of Cardiology and Postgraduate School in Cardiovascular Sciences, University of Trieste, 34127 Trieste, Italy; (A.D.L.); (D.S.); (G.S.)
| | - Paolo Scacciatella
- Division of Cardiology, Umberto Parini Regional Hospital, 11100 Aosta, Italy; (L.B.); (C.B.); (L.C.); (E.P.); (P.S.)
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Valette X, Ribstein P, Ramakers M, du Cheyron D. Subcostal versus transhepatic view to assess the inferior vena cava in critically ill patients. Echocardiography 2020; 37:1171-1176. [PMID: 32757463 DOI: 10.1111/echo.14802] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/29/2020] [Accepted: 07/11/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Evaluation of the inferior vena cava (IVC) is not always possible through the subcostal (SC) window. METHODS Inferior vena cava diameters measured by transhepatic (TH) and SC views were compared by Bland and Altman analysis. RESULTS 131 patients were enrolled, including 88 (67%) under mechanical ventilation. The echogenicity was statistically poorer through the TH view in comparison with the SC view (P = .002). The correlation between the SC and TH views was good and better for respiratory variation than for end-expiratory or end-inspiratory diameter measurements (r = 0.86). Despite low bias, the limits of agreement were wide (-7.5 and 7.7 mm for end-expiratory diameter, -8.7 and 8.5 mm for end-inspiratory diameter, and -5.3 and 5.8 mm for respiratory variation). Complementary analysis showed that the concordance between the SC and the TH views was better when the IVC was distended. However, the limits of agreement remained broad. CONCLUSIONS Although feasible in almost all patients, the TH view does not provide better echogenicity in comparison with the SC view. Despite a good correlation with the SC view and a low bias, the limits of agreement were wide, especially when the IVC has an ellipsoidal shape, suggesting caution in the interpretation of data obtained by the TH view.
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Affiliation(s)
- Xavier Valette
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
| | - Pierre Ribstein
- Department of Intensive Care, Center Hospitalier General Mémorial France Etats-Unis, Saint Lô, France
| | - Michel Ramakers
- Department of Intensive Care, Center Hospitalier General Mémorial France Etats-Unis, Saint Lô, France
| | - Damien du Cheyron
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
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Arendt VA, Mabud TS, Jeon GS, An X, Cohn DM, Fu JX, Hofmann LV. Analysis of patent, unstented lower extremity vein segment diameters in 266 patients with venous disease. J Vasc Surg Venous Lymphat Disord 2020; 8:841-850. [PMID: 32107163 DOI: 10.1016/j.jvsv.2019.12.078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 12/20/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The objective of this study was to characterize the average maximum diameters of widely patent lower extremity vein segments in patients with underlying venous disease and the demographic factors that affect these diameters. METHODS Maximum axial diameters of each deep vein segment from the diaphragm to the knee were measured from computed tomography venography studies for all patients who underwent venous stent placement during a 20-year period at a single quaternary venous referral institution. Limbs containing only widely patent, unstented vein segments without variant anatomy were identified for inclusion. The final analysis involved diameter measurements from 870 imaging studies of 266 patients. Multivariate linear regression was used to identify factors associated with vein segment diameters. RESULTS Average vein segment diameters ranged from 7.8 mm for the left and right femoral veins to 27.9 mm for the long axis of the suprarenal inferior vena cava. Multivariate linear regression demonstrated that women had larger IVC, common iliac vein, and external iliac vein diameters, whereas men had larger common femoral veins. Laterality, height, weight, and sex also had statistically significant associations with the diameters of select vein segments. CONCLUSIONS This study provides an estimate of the average diameters of widely patent deep vein segments in the lower extremities from the diaphragm to the knees in patients with underlying venous disease and characterizes covariates that significantly affect vein diameter. These findings may help interventionalists better select devices for endovascular intervention.
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Affiliation(s)
- Victoria A Arendt
- Department of Interventional Radiology, Stanford Hospital and Clinics, Stanford, Calif.
| | - Tarub S Mabud
- Department of Interventional Radiology, Stanford Hospital and Clinics, Stanford, Calif
| | - Gyeong S Jeon
- Department of Radiology, CHA University Bundang Medical Center, Seongnam, South Korea
| | - Xiao An
- Department of Radiology, Shanghai General Hospital, Shanghai, China
| | - David M Cohn
- Department of Interventional Radiology, Stanford Hospital and Clinics, Stanford, Calif
| | - Jin Xin Fu
- Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Lawrence V Hofmann
- Department of Interventional Radiology, Stanford Hospital and Clinics, Stanford, Calif
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Dzieciuchowicz Ł, Krzyżański R, Kruszyna Ł, Krasinski Z, Gabriel M, Oszkinis G. The intravascular ultrasound morphometry of iliac veins in subjects without severe chronic venous insufficiency and its implications for treatment indications and stent size selection. Phlebology 2019; 35:354-360. [DOI: 10.1177/0268355519880032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives The purpose of this study is to report the intravascular ultrasound morphometry of iliac veins and its relation to demographic and anthropometric factors in subjects without chronic venous insufficiency. Methods Thirty-three patients, without chronic venous insufficiency – qualified to great saphenous vein stripping due to unilateral, primary varicose veins – participated in the study. During the surgery, left and right external iliac veins, common iliac veins and inferior vena cava were interrogated with intravascular ultrasound. The morphometric analysis included measurement of a cross-sectional area at normal, non-stenosed vein segments (ref-CSA) and at the point of the most prominent narrowing (minimal lumen area (MLA)). Based on these measurements, a percentage of stenosis (S%) and calculated lumen diameter of interrogated veins were determined according to the following formulas, S% = (ref-CSA–MLA)/ref-CSA × 100 and CLD = 2 × √(ref-CSA/π), respectively. Results Median ref-CSA, S% and calculated lumen diameter were 265.3 mm2, 45.8% and 18.4 mm for inferior vena cava; 193.9 mm2, 62.4% and 15.7 mm for left common iliac veins; 166.9 mm2, 35.7% and 14.2 mm for right common iliac veins; 136.5 mm2, 48.0% and 12.8 mm for left external iliac veins and 140.9 mm2, 46.3% and 13.5 mm for right external iliac veins. There were statistically significant differences between left and right common iliac veins ref-CSA, common iliac veins S% and common iliac veins calculated lumen diameter (p = 0.03, p < 0 and p = 0.03, respectively). The S% of left external iliac veins was greater in women 52.2 versus 37.2% in men (p = 0.04). Neither age nor anthropometric factors had any influence on the calculated lumen diameter of the analysed veins. A negative correlation between the left common iliac veins S% and the age was observed (p = 0.03). Conclusions In adult subjects, the calculated lumen diameter of the common iliac veins is greater on the left side and is not influenced by age and body size. Common iliac vein stenosis occurs more frequently on the left side, decreases with age and tends to be more frequent in women.
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Affiliation(s)
- Łukasz Dzieciuchowicz
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Radosław Krzyżański
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Łukasz Kruszyna
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Zbigniew Krasinski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcin Gabriel
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Grzegorz Oszkinis
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Poznan, Poland
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Xiao YD, Zhang ZS, Ma C. Cavographic vs. cross-sectional measurement of the inferior vena cava diameter before filter placement: are we routinely oversizing? Eur Radiol 2018; 29:3281-3286. [PMID: 30413963 DOI: 10.1007/s00330-018-5820-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/14/2018] [Accepted: 10/02/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE A megacava (vena cava with a diameter of 28 mm or greater) requires a particular filter to avoid migration. However, caval morphologies are variable. As the inferior vena cava (IVC) usually adopts a circular geometry after a filter is inserted, this study aims (a) to classify caval geometry and orientation; (b) to compare discrepancy between anterioposterior projective diameter (PD) and circumference-based calculated diameter (CD) measurements on cross-sectional computed tomography (CT) images; (c) if a discrepancy exists, determine how often it can affect IVC filter selection. METHODS A total of 1503 patients were retrospectively reviewed. Caval morphology was classified. PD and CD were measured at infrarenal IVC. Differences between the PD and CD were assessed by the Wilcoxon signed-rank test or paired t test (if appropriate). The scatterplot of PD vs. CD was used to show whether one is consistently larger than the other. RESULTS The PD was significantly larger than the CD (22.3 ± 3.5 vs. 20.4 ± 2.8, p < 0.001). The caval morphologies were divided into five types. Type 1 was oval IVC oriented left-anterior-oblique to the horizontal line with an angle (n = 999, 66.5%), type 2 was round IVC (n = 49, 3.3%), type 3 was oval IVC with a vertical long axis (n = 8, 0.5%), type 4 was oval IVC with a horizontal long axis (n = 75, 5.0%), and type 5 was irregularly shaped IVC (n = 372, 24.7%). CONCLUSION Patients with round IVC are rare. Measurement of CD may be better to assess maximum IVC diameter compared with PD for the purpose of IVC filter placement. KEY POINTS • Five types of IVC orientation are described in this paper: type 1 (n = 999, 66.5%), type 2 (n = 49, 3.3%), type 3 (n = 8, 0.5%), type 4 (n = 75, 5.0%), and type 5 (n = 372, 24.7%). • The incidence of megacava (vena cava with a diameter of 28 mm or greater) measured on anterioposterior projective imaging may be overestimated. • As an IVC will adopt a circular geometry following filter placement, circumference-based calculated diameter may be an appropriate approach for caval size determination.
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Affiliation(s)
- Yu-Dong Xiao
- Department of Radiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Changsha, 410011, China
| | - Zi-Shu Zhang
- Department of Radiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Changsha, 410011, China.
| | - Cong Ma
- Department of Radiology, The Second Xiangya Hospital of Central South University, No. 139 Middle Renmin Road, Changsha, 410011, China
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Sentry Bioconvertible Inferior Vena Cava Filter: Study of Stages of Incorporation in an Experimental Ovine Model. Int J Vasc Med 2018; 2018:6981505. [PMID: 30112213 PMCID: PMC6077616 DOI: 10.1155/2018/6981505] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Accepted: 05/09/2018] [Indexed: 11/29/2022] Open
Abstract
The Sentry inferior vena cava (IVC) filter is designed to provide temporary protection from pulmonary embolism (PE) and then bioconvert to become incorporated in the vessel wall, leaving a patent IVC lumen. Objective. To evaluate the performance and stages of incorporation of the Sentry IVC filter in an ovine model. Methods. Twenty-four bioconvertible devices and 1 control retrievable filter were implanted in the infrarenal IVC of 25 sheep, with extensive daily monitoring and intensive imaging. Vessels and devices were analyzed at early (≤98 days, n = 10) and late (180 ± 30 days, n = 14 study devices, 1 control) termination and necropsy time-points. Results. Deployment success was 100% with all devices confirmed in filtering configuration, there were no filter-related complications, and bioconversion was 100% at termination with vessels widely patent. By 98 days for all early-incorporation analysis animals, the stabilizing cylindrical part of the Sentry frame was incorporated in the vessel wall, and the filter arms were retracted. By 180 days for all late-incorporation analysis animals, the filter arms as well as frames were stably incorporated. Conclusions. Through 180 days, there were no filter-related complications, and the study devices were all bioconverted and stably incorporated, leaving all IVCs patent.
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Desai KR, Pandhi MB, Seedial SM, Errea MF, Salem R, Ryu RK, Lewandowski RJ. Retrievable IVC Filters: Comprehensive Review of Device-related Complications and Advanced Retrieval Techniques. Radiographics 2017; 37:1236-1245. [PMID: 28696849 DOI: 10.1148/rg.2017160167] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Use of retrievable inferior vena cava filters (RIVCFs) has grown exponentially since their introduction into clinical practice, but many of these devices are not retrieved. Some are not retrieved due to poor clinical follow-up, but other devices remain in situ for extended periods because they present significant technical challenges during retrieval. Because of these and other factors, many of these devices were thus left in place permanently. However, recent data have placed a renewed emphasis on device retrieval due to increased risk of RIVCF-related complications, which are positively correlated with filter dwell time. Development of advanced filter retrieval techniques has had a significant impact on the removal of embedded RIVCFs, permitting retrieval of the majority of devices. The purpose of this article is to present an imaging and data review of the dominant device-related factors that complicate RIVCF retrieval and to describe the relevant advanced retrieval techniques to manage these factors. RIVCF imaging is frequently encountered in daily clinical practice via various imaging modalities. Therefore, diagnostic radiologists can play a vital role in identifying filter-related issues. Familiarity with the context for managing these issues in the interventional suite is essential for improving triage and care of patients with RIVCFs. © RSNA, 2017.
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Affiliation(s)
- Kush R Desai
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Mithil B Pandhi
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Stephen M Seedial
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Martin F Errea
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Riad Salem
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Robert K Ryu
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
| | - Robert J Lewandowski
- From the Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 800, Chicago, IL 60611 (K.R.D., M.B.P., S.M.S., M.F.E., R.S., R.J.L.); and Department of Radiology, U of C School of Medicine, Aurora, Colo (R.K.R.)
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Raju S, Crim W, Buck W. Factors influencing peripheral venous pressure in an experimental model. J Vasc Surg Venous Lymphat Disord 2017; 5:864-874. [DOI: 10.1016/j.jvsv.2017.05.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 05/15/2017] [Indexed: 10/18/2022]
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Complications and Retrieval Data of Vena Cava Filters Based on Specific Infrarenal Location. Cardiovasc Intervent Radiol 2017; 41:239-244. [PMID: 29038876 DOI: 10.1007/s00270-017-1805-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 09/21/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Although recommended placement of IVC filters is with their tips positioned at the level of the renal vein inflow, in practice, adherence is limited due to clinical situation or IVC anatomy. We seek to evaluate the indwelling and retrieval complications of IVC filters based on their specific position within the infrarenal IVC. MATERIALS AND METHODS Retrospective, single institution study of 333 consecutive infrarenal vena cava filters placed by interventional radiologists in patients with an average age of 62.2 ± 15.7 years was performed between 2013 and 2015. Primary indication was venous thromboembolic disease (n = 320, 96.1%). Filters were classified based on location of the apex below the lowest renal vein inflow on the procedural venogram: less than 1 cm (n = 180, 54.1%), 1-2 cm (n = 96, 28.8%), and greater than 2 cm (n = 57, 17.1%). Denali (n = 171, 51.4%) and Celect (n = 162, 48.6%) filters were evaluated. CT follow-up, indwelling complications, and retrieval data were obtained. RESULTS Follow-up CT imaging performed for symptomatic indications occurred for 38.3% of filters placed < 1 cm below the lowest renal vein, 27.1% of filters placed 1-2 cm, and 36.8% placed > 2 cm (p = .16). There was no difference in caval strut penetration, penetration of adjacent viscera, time to penetration, filter migration, or tilt (p = .15, .27, .41, .57, .93). No filter fractures occurred. There was no difference in the incidence of breakthrough PE or complex filter retrieval (p = .83, .59). Only one retrieval failure occurred. CONCLUSIONS This study suggests filter apex location within the infrarenal IVC, including placement > 2 cm below the level of the renal vein inflow, is not associated with differences in indwelling or retrieval complications. LEVEL OF EVIDENCE Level 3 non-randomized controlled follow-up study.
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Folino A, Benzo M, Pasquero P, Laguzzi A, Mesin L, Messere A, Porta M, Roatta S. Vena Cava Responsiveness to Controlled Isovolumetric Respiratory Efforts. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2113-2123. [PMID: 28543857 DOI: 10.1002/jum.14235] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/23/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Respirophasic variation of inferior vena cava (IVC) size is affected by large variability with spontaneous breathing. This study aims at characterizing the dependence of IVC size on controlled changes in intrathoracic pressure. METHODS Ten healthy subjects, in supine position, performed controlled isovolumetric respiratory efforts at functional residual capacity, attaining positive (5, 10, and 15 mmHg) and negative (-5, -10, and -15 mmHg) alveolar pressure levels. The isovolumetric constraint implies that equivalent changes are exhibited by alveolar and intrathoracic pressures during respiratory tasks. RESULTS The IVC cross-sectional area equal to 2.88 ± 0.43 cm2 at baseline (alveolar pressure = 0 mmHg) was progressively decreased by both expiratory and inspiratory efforts of increasing strength, with diaphragmatic efforts producing larger effects than thoracic ones: -55 ± 15% decrease, at +15 mmHg of alveolar pressure (P < .01), -80 ± 33 ± 12% at -15 mmHg diaphragmatic (P < .01), -33 ± 12% at -15 mmHg thoracic. Significant IVC changes in size (P < .01) and pulsatility (P < .05), along with non significant reduction in the response to respiratory efforts, were also observed during the first 30 minutes of supine rest, detecting an increase in vascular filling, and taking place after switching from the standing to the supine position. CONCLUSIONS This study quantified the dependence of the IVC cross-sectional area on controlled intrathoracic pressure changes and evidenced the stronger influence of diaphragmatic over thoracic activity. Individual variability in thoracic/diaphragmatic respiratory pattern should be considered in the interpretation of the respirophasic modulations of IVC size.
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Affiliation(s)
- Anna Folino
- Integrative Physiology Laboratory, Department of Neuroscience, Torino, Italy
| | - Marco Benzo
- Department of Electronics and Telecommunications, Mathematical Biology and Physiology, Politecnico di Torino, Torino, Italy
| | - Paolo Pasquero
- Department of Medical Sciences, AOU San Giovanni Battista, University of Torino, Torino, Italy
| | - Andrea Laguzzi
- Department of Medical Sciences, AOU San Giovanni Battista, University of Torino, Torino, Italy
| | - Luca Mesin
- Department of Electronics and Telecommunications, Mathematical Biology and Physiology, Politecnico di Torino, Torino, Italy
| | - Alessandro Messere
- Integrative Physiology Laboratory, Department of Neuroscience, Torino, Italy
| | - Massimo Porta
- Department of Medical Sciences, AOU San Giovanni Battista, University of Torino, Torino, Italy
| | - Silvestro Roatta
- Integrative Physiology Laboratory, Department of Neuroscience, Torino, Italy
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Taghizadieh A, Nia KS, Moharramzadeh P, Pouraghaei M, Ghavidel A, Parsian Z, Mahmoodpoor A. The PCQP Score for Volume Status of Acutely Ill Patients: Integrating Vascular Pedicle Width, Caval Index, Respiratory Variability of the QRS Complex and R Wave Amplitude. Indian J Crit Care Med 2017; 21:726-732. [PMID: 29279632 PMCID: PMC5698999 DOI: 10.4103/ijccm.ijccm_275_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction Techniques for measuring volume status of critically ill patients include invasive, less invasive, or noninvasive ones. The present study aims to assess the accuracy of noninvasive techniques for measuring volume status of critically ill patients. Patients and Methods A total of 111 critically ill patients admitted to the emergency department and undergoing central venous catheterization were included in the study. Five parameters were measured including vascular pedicle width (VPW), diameter of inferior vena cava, caval index, respiratory changes in QRS, and P wave amplitude. Patients with risk factors which could decrease the accuracy of central venous pressure (CVP) value were excluded from study. We compared these parameters with static CVP parameter. Finally, based on the afore-mentioned parameters, PCQP role in criteria was designed. Results In detecting loss of circulating blood volume, area under the curve of VPW was 0.92 (90%, confidence interval [CI]: 0.85-0.99), diameter of inferior vena cava was 0.82 (90%, CI: 0.72-0.91), caval index was 0.9 (90%, CI: 0.82-0.98), and changes in QRS and P waves were 0.88 (95%, CI: 0.81-0.95) and 0.73 (95%, CI: 0.63-0.82), respectively. PCQP role in criteria was designed according to these parameters, and at its best cutoff point (score 6), VPW had a sensitivity of 97.4% (95%, CI: 84.57-99.99) and specificity of 83.6% (95%, CI: 72.65-90.86) for the detection of loss of circulating blood volume (<8 cmH2O). Conclusion PCQP score could be a reliable and noninvasive technique for the assessment of volume status in critically ill patients.
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Affiliation(s)
- Ali Taghizadieh
- Tuberculosis and Lung Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Kavous Shahsavari Nia
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Payman Moharramzadeh
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahboob Pouraghaei
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Atefeh Ghavidel
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Parsian
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ata Mahmoodpoor
- Department of Anesthesiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Laborda A, Sierre S, Malvè M, Blas ID, Ioakeim I, Kuo WT, Gregorio MAD. Influence of breathing movements and Valsalva maneuver on vena caval dynamics. World J Radiol 2014; 6:833-839. [PMID: 25349666 PMCID: PMC4209428 DOI: 10.4329/wjr.v6.i10.833] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 08/19/2014] [Accepted: 09/17/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study changes produced within the inferior vena cava (IVC) during respiratory movements and identify their possible clinical implications.
METHODS: This study included 100 patients (46 women; 54 men) over 18 years of age who required an abdominal computed tomography (CT) and central venous access. IVC cross-sectional areas were measured on CT scans at three levels, suprarenal (SR), juxtarenal (JR) and infrarenal (IR), during neutral breathing and again during the Valsalva maneuver. All patients were instructed on how to perform a correct Valsalva maneuver. In order to reduce the total radiation dose in our patients, low-dose CT protocols were used in all patients. The venous blood pressure (systolic, diastolic and mean) was invasively measured at the same three levels with neutral breathing and the Valsalva maneuver during venous port implantation. From CT scans, three-dimensional models of the IVC were constructed and a collapsibility index was calculated for each patient. These data were then correlated with venous pressures and cross-sectional areas.
RESULTS: The mean patient age was 51.64 ± 12.01 years. The areas of the ellipse in neutral breathing were 394.49 ± 85.83 (SR), 380.10 ± 74.55 (JR), and 342.72 ± 49.77 mm2 (IR), and 87.46 ± 18.35 (SR), 92.64 ± 15.36 (JR) and 70.05 ± 9.64 mm2 (IR) during the Valsalva (Ps < 0.001). There was a correlation between areas in neutral breathing and in the Valsalva maneuver (P < 0.05 in all areas). Large areas decreased more than smaller areas. The collapsibility indices were 0.49 ± 0.06 (SR), 0.50 ± 0.04 (JR) and 0.50 ± 0.04 (IR), with no significant differences in any region. Reconstructed three-dimensional models showed a flattening of the IVC during Valsalva, adopting an ellipsoid cross-sectional shape. The mean pressures with neutral breathing were 9.44 ± 1.78 (SR), 9.40 ± 1.44 (JR) and 8.84 ± 1.03 mmHg (IR), and 81.08 ± 21.82 (SR), 79.88 ± 19.01 (JR) and 74.04 ± 16.56 mmHg (IR) during Valsalva (Ps < 0.001). There was a negative correlation between cross-sectional caval area and venous blood pressure, but this was not statistically significant in any of the cases. There was a significant correlation between diastolic and mean pressures measured during neutral breathing and in Valsalva.
CONCLUSION: Respiratory movements have a major influence on IVC dynamics. The increase in intracaval pressure during Valsalva results in a significant decrease in the IVC cross-sectional area.
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Chen SL, Krishnam MS, Bosemani T, Dissayanake S, Sgroi MD, Lane JS, Fujitani RM. Geometric changes of the inferior vena cava in trauma patients subjected to volume resuscitation. Vascular 2014; 23:459-67. [PMID: 25298135 DOI: 10.1177/1708538114552665] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Dynamic changes in anatomic geometry of the inferior vena cava from changes in intravascular volume may cause passive stresses on inferior vena cava filters. In this study, we aim to quantify variability in inferior vena cava dimensions and anatomic orientation to determine how intravascular volume changes may impact complications of inferior vena cava filter placement, such as migration, tilting, perforation, and thrombosis. METHODS Retrospective computed tomography measurements of major axis, minor axis, and horizontal diameters of the inferior vena cava at 1 and 5 cm below the lowest renal vein in 58 adult trauma patients in pre-resuscitative (hypovolemic) and post-resuscitative (euvolemic) states were assessed in a blinded fashion by two independent readers. Inferior vena cava perimeter, area, and volume were calculated and correlated with caval orientation. RESULTS Mean volumes of the inferior vena cava segment on pre- and post-resuscitation scans were 9.0 cm(3) and 11.0 cm(3), respectively, with mean percentage increase of 48.6% (P < 0.001). At 1 cm and 5 cm below the lowest renal vein, the inferior vena cava expanded anisotropically, with the minor axis expanding by an average of 48.7% (P < 0.001) and 30.0% (P = 0.01), respectively, while the major axis changed by only 4.2% (P = 0.11) and 6.6% (P = 0.017), respectively. Cross-sectional area and perimeter at 1 cm below the lowest renal vein expanded by 61.6% (P < 0.001) and 10.7% (P < 0.01), respectively. At 5 cm below the lowest renal vein, the expansion of cross-sectional area and perimeter were 43.9% (P < 0.01) and 10.7% (P = 0.002), respectively. The major axis of the inferior vena cava was oriented in a left-anterior oblique position in all patients, averaging 20° from the horizontal plane. There was significant underestimation of inferior vena cava maximal diameter by horizontal measurement. In pre-resuscitation scans, at 1 cm and 5 cm below the lowest renal vein, the discrepancy between the horizontal and major axis diameter was 2.1 ± 1.2 mm (P < 0.001) and 1.7 ± 1.0 mm (P < 0.001), respectively, while post-resuscitation studies showed the same underestimation at 1 cm and 5 cm below the lowest renal vein to be 2.2 ± 1.2 mm (P < 0.01) and 1.9 ± 1.0 mm (P < 0.01), respectively. CONCLUSIONS There is significant anisotropic variability of infrarenal inferior vena cava geometry with significantly greater expansive and compressive forces in the minor axis. There can be significant volumetric changes in the inferior vena cava with associated perimeter changes but the major axis left-anterior oblique caval configuration is always maintained. These significant dynamic forces may impact inferior vena cava filter stability after implantation. The consistent major axis left-anterior oblique obliquity may lead to underestimation of the inferior vena cava diameter used in standard anteroposterior venography, which may influence initial filter selection.
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Affiliation(s)
- Samuel L Chen
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA
| | - Mayil S Krishnam
- Division of Cardiovascular and Thoracic Imaging, University of California, Irvine, CA
| | | | - Sumudu Dissayanake
- Division of Cardiovascular and Thoracic Imaging, University of California, Irvine, CA
| | - Michael D Sgroi
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA
| | - John S Lane
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA
| | - Roy M Fujitani
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA
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Cina A, Zamparelli R, Venturino S, Gargaruti R, Semeraro V, Cavaliere F. Compression of the inferior vena cava in bowel obstruction. BIOMED RESEARCH INTERNATIONAL 2013; 2013:469297. [PMID: 24151603 PMCID: PMC3787563 DOI: 10.1155/2013/469297] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 07/15/2013] [Accepted: 07/28/2013] [Indexed: 01/02/2023]
Abstract
INTRODUCTION We investigated whether (a) the inferior vena cava (IVC) is compressed in bowel obstruction and (b) some tracts are more compressed than others. METHODS Two groups of abdominal computed tomography (CT) examinations were collected retrospectively. Group O (N = 69) scans were positive for bowel obstruction, group C (N = 50) scans were negative for diseases. IVC anteroposterior and lateral diameters (APD, LAD) were assessed at seven levels. RESULTS In group C, IVC section had an elliptic shape (APD/LAD: .76 ± .14), the area of which increased gradually from 1.9 (confluence of the iliac veins) to 3.1 cm²/m² of BSA (confluence of the hepatic veins) with a significant narrowing in the hepatic section. In group O, bowel obstruction caused a compression of IVC (APD/LAD: .54 ± .17). Along its course, IVC section area increased from 1.3 to 2.5 cm²/m². At ROC curve analysis, an APD/LAD ratio lower than 0.63 above the confluence of the iliac veins discriminated between O and C groups with sensitivity of 74% and specificity of 96%. CONCLUSIONS Bowel obstruction caused a compression of IVC, which involved its entire course except for the terminal section. APD/LAD ratio may be useful to monitor the degree of compression.
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Affiliation(s)
- Alessandro Cina
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Roberto Zamparelli
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Sara Venturino
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Riccardo Gargaruti
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Vittorio Semeraro
- Department of Bioimaging and Radiological Sciences, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Franco Cavaliere
- Institute of Anaesthesia and Intensive Care, Catholic University of the Sacred Heart, 00168 Rome, Italy
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Arnoldussen CWKP, de Graaf R, Wittens CHA, de Haan MW. Value of magnetic resonance venography and computed tomographic venography in lower extremity chronic venous disease. Phlebology 2013; 28 Suppl 1:169-75. [PMID: 23482555 DOI: 10.1177/0268355513477785] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
For the treatment of chronic venous disease (CVD) of the lower extremity, identification of the underlying venous pathologies is essential. Traditionally, the pathologies to detect with imaging have been centred on insufficiency and reflux of the superficial, perforator and deep veins of the leg. More recently, stenosis and obstruction of the deep veins of the pelvis and abdomen (i.e. inferior vena cava, common and external iliac veins) have been identified as significant underlying pathologies in CVD. Accurate detection of stenotic and/or occlusive venous disease expands the treatment options for patients with CVD. In most cases, imaging of venous disease is performed with duplex ultrasound. In this article we discuss the existing evidence and potential value of computed tomographic venography and magnetic resonance venography to contribute in accurately identifying chronic venous disease, in particular chronic venous obstruction.
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Affiliation(s)
- C W K P Arnoldussen
- Department of Radiology and Interventional Radiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
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Wang H, Shi R, Mahler S, Gaspard J, Gorchynski J, D'Etienne J, Arnold T. Vascular pedicle width on chest radiograph as a measure of volume overload: meta-analysis. West J Emerg Med 2012; 12:426-32. [PMID: 22224132 PMCID: PMC3236159 DOI: 10.5811/westjem.2011.3.2023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 01/19/2011] [Accepted: 03/28/2011] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Vascular pedicle width (VPW), a measurement obtained from a chest radiograph (CR), is thought to be an indicator of circulating blood volume. To date there are only a handful of studies that demonstrate a correlation between high VPW and volume overload, each utilizing different VPW values and CR techniques. Our objective was to determine a mean VPW measurement from erect and supine CRs and to determine whether VPW correlates with volume overload. METHODS MEDLINE database, Web of Science, and the Cochrane Central Register of Controlled Trials were searched electronically for relevant articles. References from the original and review publications selected electronically were manually searched for additional relevant articles. Two investigators independently reviewed relevant articles for inclusion criteria and data extraction. Mean VPW measurements from both supine and erect CRs and their correlation with volume overload were calculated. RESULTS Data from 8 studies with a total of 363 subjects were included, resulting in mean VPW measurements of 71 mm (95% confidence interval [CI] 64.9-77.3) and 62 mm (95% CI 49.3-75.1) for supine and erect CRs, respectively. The correlation coefficients for volume overload and VPW were 0.81 (95% CI 0.74-0.86) for both CR techniques and 0.81 (95% CI 0.72-0.87) for supine CR and 0.80 (95% CI 0.69-0.87) for erect CR, respectively. CONCLUSION There is a clinical and statistical correlation between VPW and volume overload. VPW may be used to evaluate the volume status of a patient regardless of the CR technique used.
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Affiliation(s)
- Hao Wang
- JPS Health Network, Department of Emergency Medicine, Fort Worth, Texas
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Blehar DJ, Resop D, Chin B, Dayno M, Gaspari R. Inferior vena cava displacement during respirophasic ultrasound imaging. Crit Ultrasound J 2012; 4:18. [PMID: 22866665 PMCID: PMC3463481 DOI: 10.1186/2036-7902-4-18] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 07/22/2012] [Indexed: 11/12/2022] Open
Abstract
Background Ultrasound measurement of dynamic changes in inferior vena cava (IVC) diameter can be used to assess intravascular volume status in critically ill patients, but published studies vary in accuracy as well as recommended diagnostic cutoffs. Part of this variability may be related to movements of the vessel relative to the transducer during the respiratory cycle which results in unintended comparison of different points of the IVC at end expiration and inspiration, possibly introducing error related to variations in normal anatomy. The objective of this study was to quantify both craniocaudal and mediolateral movements of the IVC as well as the vessel's axis of collapse during respirophasic ultrasound imaging. Methods Patients were enrolled from a single urban academic emergency department with ultrasound examinations performed by sonographers experienced in IVC ultrasound. The IVC was imaged from the level of the diaphragm along its entire course to its bifurcation with diameter measurements and respiratory collapse measured at a single point inferior to the confluence of the hepatic veins. While imaging the vessel in its long axis, movement in a craniocaudal direction during respiration was measured by tracking the movement of a fixed point across the field of view. Likewise, imaging the short axis of the IVC allowed for measurement of mediolateral displacement as well as the vessel's angle of collapse relative to vertical. Results Seventy patients were enrolled over a 6-month period. The average diameter of the IVC was 13.8 mm (95% CI 8.41 to 19.2 mm), with a mean respiratory collapse of 34.8% (95% CI 19.5% to 50.2%). Movement of the vessel relative to the transducer occurred in both mediolateral and craniocaudal directions. Movement was greater in the craniocaudal direction at 21.7 mm compared to the mediolateral movement at 3.9 mm (p < 0.001). Angle of collapse assessed in the transverse plane averaged 115° (95% CI 112° to 118°). Conclusions Movement of the IVC occurs in both mediolateral and craniocaudal directions during respirophasic ultrasound imaging. Further, collapse of the vessel occurs not at true vertical (90°) but 25° off this axis. Technical approach to IVC assessment needs to be tailored to account for these factors.
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Affiliation(s)
- David J Blehar
- Department of Emergency Medicine, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, USA.
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Caggiati A. The left common iliac artery also compresses the left common iliac vein. J Vasc Surg 2011; 54:56S-61S. [DOI: 10.1016/j.jvs.2011.06.031] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2011] [Revised: 06/03/2011] [Accepted: 06/16/2011] [Indexed: 01/28/2023]
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Kassavin DS, Constantinopoulos G, Ansari S. Cardiopulmonary Resuscitation and Associated Anatomic and Hemodynamic Changes in the Vena Cava: Risk Factors for Inferior Vena Cava Filter Migration? Cardiovasc Intervent Radiol 2010; 34 Suppl 2:S318-20. [DOI: 10.1007/s00270-010-0034-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rundback JH, Zybulewski A, Manno J. Permanent or temporary IVC filtration with a novel double-ring anchoring technology optional nitinol filter. Expert Rev Med Devices 2009; 7:11-9. [PMID: 20021237 DOI: 10.1586/erd.09.60] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Permanent or temporary implantation of inferior vena cava filters for protection against pulmonary embolism is well established. There have been numerous devices developed for this purpose, each of which has proprietary design considerations that affect performance and potentially impose limitations with regard to positioning, efficacy and risk profile. This article describes a recently developed, unique inferior vena cava filter design that employs a separated filtration component and a novel double-ring anchoring system that allows intraprocedural capture and repositioning for optimized placement. In addition, early experience suggests easy removal when desired, a high rate of filtration success and excellent caval patency.
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Affiliation(s)
- John H Rundback
- Interventional Institute at Holy Name Hospital, Teaneck, NJ 07666, USA.
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