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Sung E, Ramirez JL, Zarkowsky D. Endovascular release of an Adams-DeWeese clip and iliocaval reconstruction for debilitating lower extremity swelling. J Vasc Surg Cases Innov Tech 2024; 10:101445. [PMID: 38510098 PMCID: PMC10951536 DOI: 10.1016/j.jvscit.2024.101445] [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: 12/11/2023] [Accepted: 01/19/2024] [Indexed: 03/22/2024] Open
Abstract
More than 10 million cases of venous thromboembolisms are reported on an annual basis and are major contributors to morbidity and mortality. Studies have found that ≤90% of pulmonary embolisms originate from the abdominal and lower extremity veins. The mainstay of venous thromboembolism treatment has been, and still continues to be, anticoagulation. However, for patients for whom anticoagulation is contraindicated or has failed, physicians have turned to surgical innovations such as inferior vena cava (IVC) filters to create partial interruption of the IVC. Before the invention of IVC filters, the Adams-DeWeese clip was developed to create caval interruption, which allowed for venous return while preventing pulmonary emboli from distal veins. We report a case of endovascular release of a long-term Adams-DeWeese clip, which had caused IVC occlusion and debilitating bilateral lower extremity swelling.
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Affiliation(s)
- Eric Sung
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, Boston, MA
| | - Joel L. Ramirez
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, San Francisco, San Francisco, CA
- Chan Zuckerberg Biohub, San Francisco, CA
| | - Devin Zarkowsky
- Division of Vascular Surgery, Department of Surgery, Scripps Clinic, La Jolla, CA
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Xiong QG, Li Y, Chen F, Bi MM, Zhou W. Multiple venous thrombosis caused by F9 gene duplication and treated with catheter-directed thrombolysis, AngioJet-assisted pharmaco-mechanical thromboectomy and manual aspiration thromboectomy. Blood Coagul Fibrinolysis 2024; 35:133-135. [PMID: 38358900 DOI: 10.1097/mbc.0000000000001285] [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: 02/17/2024]
Abstract
Inferior vena cava thrombosis (IVCT) is rare. Thrombophilia is one of the important risk factors. It is also uncommon for gene mutations in F9 gene to cause thrombosis but not hemorrhage. A 35-year-old male patient was admitted to our department with left lower limb swelling without an obvious cause for 1 day. Through contrast-enhanced computed tomography and color Doppler ultrasound, he was found to have lower extremity deep vein thrombosis, IVCT and pulmonary embolism. Through whole-exome sequencing analysis, he was found to carry a 925.7 kb duplication (chrX:137939698-138865419, hg19) encompassing ATP11C , SRD5A1P1 , MCF2 , FGF13 and F9 genes. This duplication of F9 gene was not detected in his parents. Other thrombophilic genes defects were not found. The factor IX activities of this patient, his father and mother were 194, 70 and 148, respectively. He was treated with catheter-directed thrombolysis, AngioJet-assisted pharmaco-mechanical thromboectomy and manual aspiration thromboectomy. Complete recanalization of left femoral, iliac veins and inferior vena cava was achieved. F9 gene duplication is a rare mutation, which can induce multiple venous thrombosis through increasing the activity level of factor IX in plasma. IVCT is a serious type of venous thrombosis. Personalized intervention treatment plans should be developed based on the different clinical characteristics of each case to achieve a higher benefit-risk ratio.
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Affiliation(s)
- Qing Gen Xiong
- Department of Vascular and Interventional Radiology, the second affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, China
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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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Anweri AV, Kaniyoor Nagri S, Karanth S. Inferior vena cava and renal vein thrombosis: a rare cause of acute kidney injury in tuberculosis. BMJ Case Rep 2023; 16:e254084. [PMID: 36810333 PMCID: PMC9945012 DOI: 10.1136/bcr-2022-254084] [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] [Indexed: 02/24/2023] Open
Abstract
Recent studies show active tuberculosis induces a prothrombotic state and increases the risk of venous thromboembolism. We report a recently diagnosed case of tuberculosis who presented to our hospital with painful bilateral lower limb swelling and several episodes of vomiting with abdominal pain for 2 weeks. Investigations by a hospital elsewhere 2 weeks ago showed abnormal renal function, misdiagnosed as antitubercular therapy-induced acute kidney injury. D-dimer levels were increased on admission with us, with still deranged renal function. Imaging revealed thrombus at the origin of left renal vein, inferior vena cava and bilateral lower limbs. We started treatment with anticoagulants, which gradually improved kidney function. This case highlights that early diagnosis of renal vein thrombosis and prompt treatment are associated with good clinical outcomes. It also highlights the importance of further studies for risk assessment, prevention strategies and reduction of the burden of venous thromboembolism in patients with tuberculosis.
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Affiliation(s)
- Aishwarya Veeresh Anweri
- Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shivashankara Kaniyoor Nagri
- Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Shubhada Karanth
- Department of General Medicine, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Bistervels IM, Buchmüller A, Tardy B. Inferior vena cava filters in pregnancy: Safe or sorry? Front Cardiovasc Med 2022; 9:1026002. [DOI: 10.3389/fcvm.2022.1026002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
BackgroundPotential hazards of vena cava filters include migration, tilt, perforation, fracture, and in-filter thrombosis. Due to physiological changes during pregnancy, the incidence of these complications might be different in pregnant women.AimTo evaluate the use and safety of inferior vena cava filters in both women who had an inferior vena cava filter inserted during pregnancy, and in women who became pregnant with an inferior vena cava filter in situ.MethodsWe performed two searches in the literature using the keywords “vena cava filter”, “pregnancy” and “obstetrics”.ResultsThe literature search on women who had a filter inserted during pregnancy yielded 11 articles compiling data on 199 women. At least one filter complication was reported in 33/177 (19%) women and included in-filter thrombosis (n = 14), tilt (n = 6), migration (n = 5), perforation (n = 2), fracture (n = 3), misplacement (n = 1), air embolism (n = 1) and allergic reaction (n = 1). Two (1%) filter complications led to maternal deaths, of which at least one was directly associated with a filter insertion. Filter retrieval failed in 9/149 (6%) women. The search on women who became pregnant with a filter in situ resulted in data on 21 pregnancies in 14 women, of which one (6%) was complicated by uterine trauma, intraperitoneal hemorrhage and fetal death caused by perforation of the inferior vena cava filter.ConclusionThe risks of filter complications in pregnancy are comparable to the nonpregnant population, but could lead to fetal or maternal death. Therefore, only in limited situations such as extensive thrombosis with a contraindication for anticoagulants, inferior vena filters should be considered in pregnant women.
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Rahman A, Alqaisi S, Downing CW, Kenny DJ, LiPera W. Inferior Vena Cava Thrombosis in a Young Patient With COVID-19 Infection. Cureus 2022; 14:e24145. [PMID: 35582562 PMCID: PMC9107317 DOI: 10.7759/cureus.24145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2022] [Indexed: 11/05/2022] Open
Abstract
Inferior vena cava thrombosis (IVCT) is a potentially fatal condition that may rarely occur in young patients with COVID-19 infection. This report describes a young adult female with a recent COVID 19 infection who presented with fever, bilateral flank pain, elevated inflammatory markers, and evidence of thrombosis in the inferior vena cava (IVC) on computed tomography (CT). The patient required treatment with anticoagulation therapy and catheter-directed thrombolysis, IVC filter placement, and mechanical suction-assist thrombectomy.
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Yu A, Ding W, Lin W, Cai J, Huang W. Application of pulmonary rehabilitation in patients with pulmonary embolism (Review). Exp Ther Med 2022; 23:96. [PMID: 34976138 DOI: 10.3892/etm.2021.11019] [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: 08/03/2021] [Accepted: 11/09/2021] [Indexed: 11/06/2022] Open
Abstract
As a common clinical emergency, pulmonary embolism (PE) is the third most fatal cardiovascular disease worldwide. Although current sophisticated medical technology has considerably improved the prognosis of patients with PE, they remain at risk of developing long-term complications such as post-PE syndrome. Pulmonary rehabilitation is of great value for patients with chronic lung diseases since it can improve their quality of life while also relieving clinical symptoms. Rehabilitation therapy has been demonstrated to improve recovery and prognosis of patients with PE. Due to short implementation time and the small number of studies, its effectiveness and safety in PE warrant further investigation. The present review focused on elucidating PE pathogenesis, post-PE syndrome and the clinical application of pulmonary rehabilitation in patients with PE.
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Affiliation(s)
- Aiping Yu
- Department of Nursing, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Weiping Ding
- Department of Nursing, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Wanmi Lin
- Department of Nursing, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Juan Cai
- Department of Nursing, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
| | - Weina Huang
- Department of Respiratory and Critical Care Medicine, Ningbo First Hospital, Ningbo, Zhejiang 315000, P.R. China
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