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Sample records for inferior vena cava

  1. Inferior Vena Cava Filter from Left-Sided Superior Vena Cava

    SciTech Connect

    Nair, Sujit Ettles, Duncan; Robinson, Graham; Scott, Paul

    2008-07-15

    We describe the unusual case of a 71-year-old male with a history of deep vein thrombosis and recurrent multiple pulmonary embolism (PE) despite adequate anticoagulation. Computed tomography (CT) and brachiocephalic venography revealed a left-sided superior vena cava. We describe successful placement of an inferior vena cava filter via a left-sided superior vena cava.

  2. Total laparoscopic retrieval of inferior vena cava filter

    PubMed Central

    Benrashid, Ehsan; Adkar, Shaunak Sanjay; Bennett, Kyla Megan; Zani, Sabino

    2015-01-01

    While there is some local variability in the use of inferior vena cava filters and there has been some evolution in the indications for filter placement over time, inferior vena cava filters remain a standard option for pulmonary embolism prophylaxis. Indications are clear in certain subpopulations of patients, particularly those with deep venous thrombosis and absolute contraindications to anticoagulation. There are, however, a variety of reported inferior vena cava filter complications in the short and long term, making retrieval of the filter desirable in most cases. Here, we present the case of a morbidly obese patient complaining of chronic abdominal pain after inferior vena cava filter placement and malposition of the filter with extensive protrusion outside the inferior vena cava. She underwent successful laparoscopic retrieval of her malpositioned inferior vena cava filters after failure of a conventional endovascular approach. PMID:27489697

  3. Anatomic Variant of Liver, Gall Bladder and Inferior Vena Cava.

    PubMed

    Sontakke, Yogesh Ashok; Gladwin, V; Chand, Parkash

    2016-07-01

    The morphology and relations of liver, gall bladder and inferior vena cava are cardinal. Their anatomical variations may be a reason for the adverse surgical outcome. During routine anatomy dissection of an abdomen, we noticed a variant liver, gall bladder and inferior vena cava in a 63-year-old male cadaver. In the specimen, a retrohepatic segment of inferior vena cava was found to be intrahepatic. On dissection, it was observed that inferior vena cava was covered entirely by a liver tissue on its dorsal aspect. In the same specimen, the gall bladder had undulated inferior surface. On dissection of the gall bladder, numerous mucosal folds were present in the interior. A band of fibrous tissue was found, which was extending from the right side of the gall bladder to the falciform ligament. Hence, preoperative scanning of congenital variations of the liver, gall bladder and inferior vena cava may be compassionate in planning safe surgeries and interventional abdominal procedures. PMID:27630832

  4. Anatomic Variant of Liver, Gall Bladder and Inferior Vena Cava

    PubMed Central

    Gladwin, V.; Chand, Parkash

    2016-01-01

    The morphology and relations of liver, gall bladder and inferior vena cava are cardinal. Their anatomical variations may be a reason for the adverse surgical outcome. During routine anatomy dissection of an abdomen, we noticed a variant liver, gall bladder and inferior vena cava in a 63-year-old male cadaver. In the specimen, a retrohepatic segment of inferior vena cava was found to be intrahepatic. On dissection, it was observed that inferior vena cava was covered entirely by a liver tissue on its dorsal aspect. In the same specimen, the gall bladder had undulated inferior surface. On dissection of the gall bladder, numerous mucosal folds were present in the interior. A band of fibrous tissue was found, which was extending from the right side of the gall bladder to the falciform ligament. Hence, preoperative scanning of congenital variations of the liver, gall bladder and inferior vena cava may be compassionate in planning safe surgeries and interventional abdominal procedures. PMID:27630832

  5. Suprarenal symplastic leiomyoma of the inferior vena cava.

    PubMed

    Kepenekci, Ilknur; Demirkan, Arda; Sözener, Ulas; Cakmak, Atil; Demirer, Seher; Alaçayir, Iskender; Ekinci, Cemil

    2009-01-01

    We report on a case of a leiomyoma in the inferior vena cava that appeared in the image to be located in the adrenal gland. En bloc excision of the tumor with the right adrenal gland and the involved segment of the vena cava was carried out. Histopathological work-up of the tumor revealed smooth muscle fibers and marked nuclear pleomorphism consistent with symplastic leiomyoma. This case report presents a distinct histological variant of the rarely seen primary smooth muscle tumor of the inferior vena cava.

  6. Troubleshooting OptEase inferior vena cava filter retrieval.

    PubMed

    Nakashima, Masaya; Kobayashi, Hideaki; Kobayashi, Masayoshi

    2016-01-01

    For treatment of deep vein thrombosis and prevention of pulmonary thromboembolism, a retrievable inferior vena cava filter is commonly utilized as an effective bridge to anticoagulation. However, we have experienced difficulties in retrieving inferior vena cava filters. Endovascular retrieval assisted by disposable biopsy forceps is an appropriate approach because it provides a less-invasive low-cost way to remove a migrated filter. We suggest this troubleshooting technique to deal with filter hook migration into the caval wall.

  7. Leiomyosarcoma of the inferior vena cava: a case report.

    PubMed

    Nascif, Rafael Lemos; Antón, Ana Graziela Santana; Fernandes, Gabriel Lacerda; Dantas, George Caldas; Gomes, Vinícius de Araújo; Natal, Marcelo Ricardo Canuto

    2014-01-01

    The authors report a case of a 48 year-old female patient with moderate abdominal pain and bulging in the abdomen. Physical examination demonstrated the presence of a palpable abdominal mass. Computed tomography showed a heterogeneously enhancing retroperitoneal mass in close contact with the inferior vena cava. En bloc resection of the mass and of the attached vena cava segment was performed. Histological analysis revealed leiomyosarcoma.

  8. Anatomy of the ostia venae hepaticae and the retrohepatic segment of the inferior vena cava.

    PubMed Central

    Camargo, A M; Teixeira, G G; Ortale, J R

    1996-01-01

    In 30 normal adult livers the retrohepatic segment of inferior vena cava had a length of 6.7 cm and was totally encircled by liver substance in 30% of cases. Altogether 442 ostia venae hepaticae were found, averaging 14.7 per liver and classified as large, medium, small and minimum. The localisation of the openings was studied according to the division of the wall of the retrohepatic segment of the inferior vena cava into 16 areas. PMID:8655416

  9. Asymptomatic Lumbar Vertebral Erosion from Inferior Vena Cava Filter Perforation

    SciTech Connect

    Fang, Wayne Hieb, Robert A.; Olson, Eric; Carrera, Guillermo F.

    2007-06-15

    In 2002, a 24-year-old female trauma patient underwent prophylactic inferior vena cava filter placement. Recurrent bouts of renal stones prompted serial CT imaging in 2004. In this brief report, we describe erosion and ossification of the L3 vertebral body by a Greenfield filter strut.

  10. Deep Vein Thrombosis Provoked by Inferior Vena Cava Agenesis.

    PubMed

    Haddad, Raad A; Saadaldin, Mazin; Kumar, Binay; Bachuwa, Ghassan

    2015-01-01

    Inferior vena cava agenesis (IVCA) is a rare congenital anomaly that can be asymptomatic or present with vague, nonspecific symptoms, such as abdominal or lower back pain, or deep vein thrombosis (DVT). Here, we present a 55-year-old male who came with painless swelling and redness of his left lower limb. On examination, swelling and redness were noted extending from the left foot to the upper thigh; it was also warm compared to his right lower limb. Venous Doppler ultrasound was done which showed DVT extending up to the common femoral vein. Subsequently, computed-tomography (CT) of the chest and abdomen was done to exclude malignancy or venous flow obstruction; it revealed congenital absence (agenesis) of the infrarenal inferior vena cava (IVC). PMID:26788400

  11. Penetrating injuries of the abdominal inferior vena cava.

    PubMed Central

    Degiannis, E.; Velmahos, G. C.; Levy, R. D.; Souter, I.; Benn, C. A.; Saadia, R.

    1996-01-01

    This is a retrospective study of 74 patients with penetrating injuries of the abdominal inferior vena cava; the cause of injury was gunshot in 91% and stabbing in 9%. Of the patients, 77% underwent lateral venorrhaphy, 5% underwent infrarenal ligation of the inferior vena cava (IVC), and 18% died perioperatively before any caval repair could be carried out. There was an overall perioperative mortality of 39%. Persistent shock, the site of the venous injury, particularly in the retrohepatic position, and the number of associated vascular injuries were directly related to mortality. Irrespective of the improvements in resuscitation and the various operative methods available, penetrating trauma of the abdominal IVC remains a life-threatening injury. PMID:8943628

  12. Atrioventricular nodal reentrant tachycardia ablation and inferior vena cava agenesis.

    PubMed

    Galand, Vincent; Pavin, Dominique; Behar, Nathalie; Mabo, Philippe; Martins, Raphaël P

    2016-10-01

    Congenital anomalies of the inferior vena cava (IVC) are rare and very often diagnosed in asymptomatic patients during computed tomography performed for other purposes. These anomalies can have significant clinical implications, for example if electrophysiology procedures are needed. Diagnostic and ablation procedures are difficult since catheter manipulation and positioning are more complex. We present here a case of successful atrioventricular nodal reentrant tachycardia ablation in a patient with unexpected IVC agenesis, using an azygos route. PMID:27633734

  13. Inferior Vena Cava Duplication: Incidental Case in a Young Woman.

    PubMed

    Coco, Danilo; Cecchini, Sara; Leanza, Silvana; Viola, Massimo; Ricci, Stefano; Campagnacci, Roberto

    2016-01-01

    A case of a double inferior vena cava (IVC) with retroaortic left renal vein, azygos continuation of the IVC, and presence of the hepatic portion of the IVC drained into the right renal vein is reported and the embryologic, clinical, and radiological significance is discussed. The diagnosis is suggested by multidetector computed tomography (MDCT), which reveals the aberrant vascular structures. Awareness of different congenital anomalies of IVC is necessary for radiologists to avoid diagnostic pitfalls and they should be remembered because they can influence several surgical interventions and endovascular procedures. PMID:27217964

  14. Leiomyosarcoma of the Inferior Vena Cava With Kidney Invasion.

    PubMed

    Brewer, Katherine; Attalla, Kyrollis; Husain, Fatima; Tsao, Che-Kai; Badani, Ketan K; Sfakianos, John P

    2016-11-01

    Primary leiomyosarcomas of the inferior vena cava (IVC) are rare tumors associated with poor prognosis, and surgical resection with the goal of obtaining negative margins is the gold standard for initial treatment. Tumor characteristics of both extraluminal extension into renal parenchyma and intraluminal extension of the subdiaphragmatic IVC are even less common. The prognosis of vascular leiomyosarcomas is determined by the location and the size of the tumor, as these factors determine the risk of local recurrence and metastasis. We present a case of a 30-year old female incidentally found to have a 14 cm right renal mass and IVC thrombus. PMID:27679758

  15. Left Inferior Vena Cava and Right Retroaortic Renal Vein

    PubMed Central

    Nania, Alberto; Capilli, Fabio; Longo, Eugenia

    2016-01-01

    Nowadays, incidental anatomical variants are frequent findings, due to the widespread diffusion of cross-sectional imaging. This case report illustrates a fairly uncommon anatomical variant, that is, the copresence of left inferior vena cava and retroaortic right renal vein reported in a 46-year-old lady, undergoing a staging CT for breast cancer. Although the patient was asymptomatic, the authors highlight potential risks related to the above-mentioned condition and the importance of correct identification and diagnosis of the findings. PMID:26955497

  16. Deep venous thrombosis in a young woman with hypoplastic inferior vena cava.

    PubMed

    Lavens, Matthias; Moors, Boudewijn; Thomis, Sarah

    2014-05-01

    We present a 33-year-old woman with deep venous thrombosis of the left iliac vein and the left lower limb. A computed tomography scan of her abdomen revealed a hypoplastic inferior vena cava and agenesis of the right kidney. Congenital anomalies of the inferior vena cava are uncommon and are sometimes an unrecognized cause of deep venous thrombosis.

  17. Pheochromocytoma with inferior vena cava thrombosis: An unusual association

    PubMed Central

    Kota, Sunil K.; Kota, Siva K.; Jammula, Sruti; Meher, Lalit K.; Modi, Kirtikumar D.

    2012-01-01

    Pheochromocytomas have been described in association with vascular abnormalities like renal artery stenosis. A 48-year-old man was admitted to our hospital with the complaints of headache, sweating, anxiety, dizziness, nausea, vomiting and hypertension. For last several days, he was having a dull aching abdominal pain. Abdominal computed tomography (CT) revealed the presence of a left adrenal pheochromocytoma. An inferior vena cava (IVC) venogram via the right jugular vein demonstrated occlusion of the IVC inferior to the right atrium. Surgical removal of pheochromocytoma was done, followed by anticoagulant treatment for IVC thrombosis, initially with subcutaneous low molecular weight heparin, and then with oral warfarin, resulting in restoration of patency. To the best of our knowledge, the occurrence of pheochromocytoma in IVC thrombosis has not been reported so far from India. Possible mechanisms of such an involvement are discussed. PMID:22629039

  18. Infrahepatic inferior vena cava agenesis with bilateral renal vein thrombosis.

    PubMed

    Skeik, Nedaa; Wickstrom, Kelly K; Schumacher, Clark W; Sullivan, Timothy M

    2013-10-01

    Congenital anomalies of the inferior vena cava (IVC) are rare and are estimated to be present in 0.07-8.7% of the general population. IVC agenesis (IVCA) is found in approximately 5% of cases of unprovoked lower extremity deep vein thrombosis in patients <30 years of age. Renal vein thrombosis (RVT) is an extremely rare and unusual presentation of IVCA. We report a unique case of a 23-year-old previously healthy man presenting with infrahepatic IVCA-induced bilateral RVT with azygos and hemiazygos continuation. To our knowledge, this is the third reported case in the literature of IVCA-induced RVT and the first to affect the bilateral renal veins in the absence of any other thrombogenic risk factors or any lower extremity venous complications. We also present a literature review of IVCA-induced vein thrombosis and highlight the lack of literature to manage this condition.

  19. Indications, Management, and Complications of Temporary Inferior Vena Cava Filters

    SciTech Connect

    Linsenmaier, Ulrich; Rieger, Johannes; Schenk, Franz; Rock, Clemens; Mangel, Eugen; Pfeifer, Klaus Juergen

    1998-11-15

    Purpose: We describe the results of a preliminary prospective study using different recently developed temporary and retrievable inferior vena cava (IVC) filters. Methods: Fifty temporary IVC filters (Guenther, Guenther Tulip, Antheor) were inserted in 47 patients when the required period of protection against pulmonary embolism (PE) was estimated to be less than 2 weeks. The indications were documented deep vein thrombosis (DVT) and temporary contraindications for anticoagulation, a high risk for PE, and PE despite DVT prophylaxis. Results: Filters were removed 1-12 days after placement and nine (18%) had captured thrombi. Complications were one PE during and after removal of a filter, two minor filter migrations, and one IVC thrombosis. Conclusion: Temporary filters are effective in trapping clots and protecting against PE, and the complication rate does not exceed that of permanent filters. They are an alternative when protection from PE is required temporarily, and should be considered in patients with a normal life expectancy.

  20. Inferior vena cava leiomyosarcoma confirmed by catheter suction biopsy during digital subtraction angiography.

    PubMed

    Wei, Ning; Xu, Xiang-Dong; Xu, Hao; Zu, Mao-Heng

    2014-01-01

    Leiomyosarcoma of vascular origin is a rare disease and most cases arise in the inferior vena cava. Inferior vena cava leiomyosarcoma (IVCLMS) usually presents in females in their sixth decade of life. The clinical symptoms are often non-specific and the diagnosis is often delayed. Current imaging techniques can accurately differentiate inferior vena cava neoplasms from other non-neoplastic lesions. However, definitive diagnosis of IVCLMS needs histologic evidence. We report a case of IVCLMS in a 61-year old Chinese woman. This is the first IVCLMS case confirmed by catheter suction biopsy during digital subtraction angiography. PMID:25232438

  1. Advanced Techniques for Removal of Retrievable Inferior Vena Cava Filters

    SciTech Connect

    Iliescu, Bogdan; Haskal, Ziv J.

    2012-08-15

    Inferior vena cava (IVC) filters have proven valuable for the prevention of primary or recurrent pulmonary embolism in selected patients with or at high risk for venous thromboembolic disease. Their use has become commonplace, and the numbers implanted increase annually. During the last 3 years, in the United States, the percentage of annually placed optional filters, i.e., filters than can remain as permanent filters or potentially be retrieved, has consistently exceeded that of permanent filters. In parallel, the complications of long- or short-term filtration have become increasingly evident to physicians, regulatory agencies, and the public. Most filter removals are uneventful, with a high degree of success. When routine filter-retrieval techniques prove unsuccessful, progressively more advanced tools and skill sets must be used to enhance filter-retrieval success. These techniques should be used with caution to avoid damage to the filter or cava during IVC retrieval. This review describes the complex techniques for filter retrieval, including use of additional snares, guidewires, angioplasty balloons, and mechanical and thermal approaches as well as illustrates their specific application.

  2. Venous Thromboembolism After Removal of Retrievable Inferior Vena Cava Filters

    SciTech Connect

    Yamagami, Takuji Tanaka, Osamu; Yoshimatsu, Rika; Miura, Hiroshi; Nishimura, Tsunehiko

    2010-02-15

    The purpose of this study was to examine the incidence of new or recurrent venous thromboembolism (VTE) after retrieval of inferior vena cava (IVC) filters and risk factors associated with such recurrence. Between March 2001 and September 2008, at our institution, implanted retrievable vena cava filters were retrieved in 76 patients. The incidence of new or recurrent VTE after retrieval was reviewed and numerous variables were analyzed to assess risk factors for redevelopment of VTE after filter retrieval. In 5 (6.6%) of the 76 patients, redevelopment or worsening of VTE was seen after retrieval of the filter. Three patients (4.0%) had recurrent deep venous thrombosis (DVT) in the lower extremities and 2 (2.6%) had development of pulmonary embolism, resulting in death. Although there was no significant difference in the incidence of new or recurrent VTE related to any risk factor investigated, a tendency for development of VTE after filter retrieval was higher in patients in whom DVT in the lower extremities had been so severe during filter implantation that interventional radiological therapies in addition to traditional anticoagulation therapies were required (40% in patients with recurrent VTE vs. 23% in those without VTE; p = 0.5866 according to Fisher's exact probability test) and in patients in whom DVT remained at the time of filter retrieval (60% in patients with recurrent VTE vs. 37% in those without VTE; p = 0.3637). In conclusion, new or recurrent VTE was rare after retrieval of IVC filters but was most likely to occur in patients who had severe DVT during filter implantation and/or in patients with a DVT that remained at the time of filter retrieval. We must point out that the fatality rate from PE after filter removal was high (2.6%).

  3. [Calcified bullet thrombus of the inferior vena cava and left renal vein in an adult].

    PubMed

    Leclerc, A; Lapébie, F-X; Thuillier, F; Lacroix, P

    2016-07-01

    Calcifications are rarely located within the inferior vena cava and the renal veins. The etiology is poorly understood and the prognosis is uncertain. We report a case in a 55-year-old man. PMID:27344300

  4. Amebic Liver abscess Complicated by Inferior Vena Cava Thrombosis: A Case Report.

    PubMed

    Ray, S; Khanra, D; Saha, M; Talukdar, A

    2012-10-01

    Amebic liver abscess is the most common extraintestinal manifestation of infection with Entamoeba histolytica. It is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. The authors describe a case of amebic liver abscess in a patient who developed a rare vascular complication of inferior vena cava thrombosis. The case responded to conservative treatment and radiological intervention.

  5. [Retroperitoneal hematoma revealing a tumor of the inferior vena cava: about a case].

    PubMed

    Lakhdar, Karim; Malki, Sidi Mohamed; Er-Raji, Ihssane; Derkaoui, Ali; Shimi, Abdelkrim; Khatouf, Mohamed

    2016-01-01

    Tumors of the inferior vena cava are rare, their most common histology is represented by leiomyosarcoma. They have few specific clinical features, however, the literature does not report hemorrhagic manifestations. Preoperative diagnosis is based on tomodensitometry and magnetic resonance imaging (MRI); it is confirmed by histology. We report a case with retroperitoneal hematoma revealing a tumor of the inferior vena cava. The diagnosis was made on the basis of clinical and radiological findings. PMID:27642432

  6. Bedside insertion of inferior vena cava filters by a medical intensivist: preliminary results.

    PubMed

    Haley, Michael; Christmas, Britton; Sing, Ronald F

    2009-01-01

    The development of percutaneous techniques has allowed vena cava filters to be safely placed at the bedside. Such procedures appear uniquely suited for critically ill patients as they avoid the inherent risks associated with transportation. We report a "medical intensivist's" experience with the placement of 13 percutaneous vena cava filters. Vena cava filters were successfully placed in 12 of 13 patients as confirmed by postplacement venacavograms; 1 placement attempt was aborted because of a completely occluded inferior vena cava. These results suggest that with appropriate training and supervision, medical intensivists can safely insert vena cava filters in the intensive care unit setting. Such a practice appears safe, reduces patient risk associated with intrahospital transport, and may promote cost containment.

  7. Compression of the Inferior Vena Cava in Bowel Obstruction

    PubMed Central

    Cina, Alessandro; Zamparelli, Roberto; Venturino, Sara

    2013-01-01

    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. PMID:24151603

  8. Inferior vena cava filter migration: updated review and case presentation.

    PubMed

    Janjua, Muhammad; Omran, Fatema M; Kastoon, Tony; Alshami, Mahmood; Abbas, Amr E

    2009-11-01

    We report a case of inferior vena cava filter migration to the right ventricle resulting in ventricular tachycardia and elevated troponin. The patient was taken to the cardiac catheterization laboratory and under fluoroscopy the filter was found to be in the right ventricle. Later in the day the filter was removed surgically with the aid of cardiopulmonary bypass. This case, as well as the other 27 reported cases of filter migration, were reviewed. It was noticed that newer retrievable filters made of nitinol, phynox and elgioly have a significantly higher percentage of filter migration into the right ventricle as compared to the old stainless steel and titanium-based Greenfield filters. Similarly, there were also higher percentages of complications and mortality associated with the newer retrievable filters migrating to the right ventricle. Filter migration to the right ventricle as opposed to the right atrium increased over the past 10 years, which has resulted in more serious symptoms, ventricular arrhythmias, deaths and higher rates of surgical removal.

  9. Mesoaortic entrapment of a left inferior vena cava.

    PubMed

    Gupta, Ashish; Naik, Nitish; Gulati, Gurpreet Singh

    2010-02-01

    A persistent left inferior vena cava (IVC) is a rare anomaly, with a reported incidence of only 0.2-0.5%. When present, it courses between the superior mesenteric artery and the aorta to continue as the right IVC, similar to the course of a left renal vein (LRV). This anomaly is usually asymptomatic, but there may be vague abdominal complaints if the IVC is compressed in the mesoaortic angle. Although symptomatic compression of the LRV (anterior nutcracker syndrome) is well recognized, there has been only one report in the literature of a similar compression of a persistent left IVC. Because of its rarity, this anomaly may be missed or mistaken for other conditions on imaging. An accurate diagnosis is crucial as the presence of this anomaly may have implications for surgical treatment of aortic lesions or placement of an IVC filter. Magnetic resonance angiography and, more recently, multidetector computed tomography scan, can provide an exquisite three-dimensional demonstration of vascular abnormalities.

  10. [Symptomatology and treatment of malformations of the inferior vena cava (author's transl)].

    PubMed

    Sachweh, D; Horsch, S; Janssen, W

    1979-05-01

    A review of the embryology, pathophysiology semiotics and surgical treatment of malformations of the inferior vena cava is given based on 3 clinical histories. The cases consisted of a typical membrane occlusion, an atresia of the infrarenal segment and of a hitherto not described combination of several malformations of the inferior vena cava: membrane occlusion, aplasia of the infrarenal segment of the vena cava inferior and multiple aneurysms of the iliac vein. The symptomatology of malformations of the vena cava inferior depends on the compensation by the collateral or the persisting embryonic veins, respectively, and on the localization and the degree of the obliteration. The varying hemodynamic reactions are described. The following surgical methods for the treatment of inferior vena cava occlusions in the hepatic segment are available: The so called conservative interventions for the creation of collaterals, the direct or indirect recanalization and the bypass operation. Congenital infrarenal atresias of the vena cava are corrected by homologous or prosthetic interposition. The venous replacement with a bovine heterograft presented here, has not yet been described in the literature.

  11. The curious case of the disappearing IVC: A case report and review of the aetiology of Inferior Vena Cava Agenesis

    PubMed Central

    Paddock, Michael; Robson, Nicola

    2014-01-01

    We report the case of a previously well 18-year-old male who presented to the Emergency Department with lower limb pain. An ultrasound demonstrated extensive left sided deep vein thrombosis and computed tomography demonstrated inferior vena cava agenesis, leading to the diagnosis of inferior vena cava agenesis associated deep vein thrombosis. The aetiology of inferior vena cava agenesis is explored in depth. PMID:24967034

  12. Inferior vena cava aneurysm in an infant presenting with a renal mass.

    PubMed

    Unzueta-Roch, José L; García-Abós, Miriam; Sirvent-Cerdá, Sara; de Prada, Inmaculada; Martínez de Azagra, Amelia; Ollero, Jose M; Madero-López, Luis

    2014-10-01

    Aneurysm of the inferior vena cava is a rare finding in the pediatric population. We report the case of a 5-month-old infant presenting with anemia, hypertension, and dehydration in the emergency room. A renal mass was found with ultrasound and MRI and a renal tumor was first considered. Histopathologic review of the surgical specimen led to the diagnosis of aneurysmal dilatation of the vena cava.

  13. Haematogenous tumour growth in the inferior vena cava in a patient with a nonseminomatous testicular tumour.

    PubMed

    Ham, S J; Schraffordt Koops, H; Sleijfer, D T; Freling, N M; Molenaar, W M

    1991-08-01

    The case history is reported of a patient with an invasion of the inferior vena cava by metastases of a non-seminomatous testicular tumour. He was treated with combination chemotherapy, followed by laparotomy and resection of residual tumour tissue. Fourteen months after this operation he is in good health. For every retroperitoneal lymph node dissection it is necessary to be on the look-out for invasion of the vena cava, because of the risk of a sudden pulmonary embolism.

  14. Adjunctive Inferior Vena Cava Filter Placement for Acute Pulmonary Embolism

    SciTech Connect

    Jha, V. M.; Lee-Llacer, J.; Williams, J.; Ubaissi, H.; Gutierrez, G.

    2010-08-15

    Inferior vena cava (IVC) filters are sometimes placed as an adjunct to full anticoagulation in patients with significant pulmonary embolism (PE). We aimed to determine the prevalence of adjunctive IVC filter placement in individuals diagnosed with PE, as well as the effect of adjunctive filter placement on mortality in patients with right heart strain associated with PE. This was a retrospective study of patients with acute PE treated with full anticoagulation admitted to a single academic medical center. Information abstracted from patient charts included presence or absence of right heart strain and of deep-vein thrombosis, and whether or not an IVC filter was placed. The endpoint was in-hospital mortality. Over 2.75 years, we found that 248 patients were diagnosed with acute PE, with an in-hospital mortality rate of 4.4%. The prevalence of adjunctive IVC filter placement was 13.3% (33 of 248), and the prevalence of documented right heart strain was 27.0% (67 of 248). In-hospital mortality was 10.2% in the non-filter-treated group (5 of 49), whereas there were no deaths in the filter-treated group (0 of 18); however, the difference was not statistically significant (P = 0.37). Both the presence of deep-vein thrombosis and of right heart strain increased the likelihood that an adjunctive IVC filter was placed (P < 0.0001 and P < 0.001, respectively). At our institution, patients were treated with IVC filters in addition to anticoagulation in 13.3% of cases of acute PE. Prospective studies or large clinical registries should be conducted to clarify whether this practice improves outcomes.

  15. A Critical Review of Available Retrievable Inferior Vena Cava Filters and Future Directions.

    PubMed

    Montgomery, Jennifer P; Kaufman, John A

    2016-06-01

    Inferior vena cava filters have been placed in patients for decades for protection against pulmonary embolism. The widespread use of filters has dramatically increased owing at least in part to the approval of retrievable vena cava filters. Retrievable filters have the potential to protect against pulmonary embolism and then be retrieved once no longer needed to avoid potential long-term complications. There are several retrievable vena cava filters available for use. This article discusses the different filter designs as well as the published data on these available filters. When selecting a filter for use, it is important to consider the potential short-term complications and the filters' window for retrieval. Understanding potential long-term complications is also critical, as these devices are approved for permanent placement and many filters are not retrieved. Finally, this article will address research into new designs that may be the future of vena cava filtration.

  16. Successful Percutaneous Retrieval of an Inferior Vena Cava Filter Migrating to the Right Ventricle in a Bariatric Patient

    SciTech Connect

    Veerapong, Jula; Wahlgren, Carl Magnus; Jolly, Neeraj; Bassiouny, Hisham

    2008-07-15

    The use of an inferior vena cava filter has an important role in the management of patients who are at high risk for development of pulmonary embolism. Migration is a rare but known complication of inferior vena cava filter placement. We herein describe a case of a prophylactic retrievable vena cava filter migrating to the right ventricle in a bariatric patient. The filter was retrieved percutaneously by transjugular approach and the patient did well postoperatively. A review of the current literature is given.

  17. Clinical Sequelae of Thrombus in an Inferior Vena Cava Filter

    SciTech Connect

    Ahmad, Iftikhar; Yeddula, Kalpana; Wicky, Stephan; Kalva, Sanjeeva P.

    2010-04-15

    The purpose of this study was to assess the long-term clinical sequelae of inferior vena cava (IVC) filter thrombus and the effect of anticoagulation on filter thrombus. Of 1,718 patients who had IVC filters placed during 2001-2008, 598 (34.8%) had follow-up abdominal CT. Filter thrombus was seen in 111 of the 598 (18.6%). There were 44 men (39.6%). The mean age at filter placement was 64 years. The medical diseases included cancer in 64, trauma in 15, stroke in 12, and others in 20. The frequency of filter thrombus on CT and asymptomatic filter thrombus on CT was calculated. The frequency of pulmonary embolism (PE) in patients with filter thrombus was calculated. The frequency of thrombus progression or regression (on CT, available in 56) was calculated. The effect of anticoagulation on filter thrombus regression/progression was evaluated using the Fisher exact test by comparing the group of patients who received anticoagulants versus those who did not. A P-value of <0.05 was considered significant. The overall frequency of filter thrombus was 18.6%. Total occlusion of the IVC filter was seen in 12 of 598 (2%). The filter thrombus was asymptomatic in 110 (18.3%). Filter thrombus was detected after a median of 35 days (range, 0-2082) following filter placement. Thrombus extended above the filter in 4 (3.6%); IVC thrombus below the filter was seen in 35(31.5%). Thrombus in the filter occluded <25% of the filter volume in 58 (52.3%), 25-50% in 21 (18.9%), and 50-75% in 20 (18%). Total IVC occlusion was seen in 12 (10.8%). Eighty-three patients received anticoagulation. Sixteen patients developed symptoms of PE. PE was confirmed on CT in 3 of 15 (2.7%). On follow-up, filter thrombus regressed completely in 19 (33.9%) after a median of 6 months. Filter thrombus decreased in size in 13 (23.2%) and it progressed without IVC occlusion in 7 (12.6%). In one (1.7%), filter thrombus progressed to IVC occlusion. Filter thrombus remained stable in 16 (28.6%). There was no

  18. Inferior Vena Cava Filter Placement during Pregnancy: An Adjuvant Option When Medical Therapy Fails

    PubMed Central

    Serrano, Fátima; Torres, Rita; Borges, Augusta

    2013-01-01

    The authors present a case of a 27-year-old multiparous woman, with multiple thrombophilia, whose pregnancy was complicated with deep venous thrombosis requiring placement of a vena cava filter. At 15th week of gestation, following an acute deep venous thrombosis of the right inferior limb, anticoagulant therapy with low-molecular-weight heparin (LMWH) was instituted without improvement in her clinical status. Subsequently, at 18 weeks of pregnancy, LMWH was switched to warfarin. At 30th week of gestation, the maintenance of high thrombotic risk was the premise for placement of an inferior vena cava filter for prophylaxis of pulmonary embolism during childbirth and postpartum. There were no complications and a vaginal delivery was accomplished at 37 weeks of gestation. Venal placement of inferior vena cava filters is an attractive option as prophylaxis for pulmonary embolism during pregnancy. PMID:23781361

  19. Deep venous thrombosis caused by congenital absence of inferior vena cava, combined with hyperhomocysteinemia.

    PubMed

    Yun, Sang Seob; Kim, Ji Il; Kim, Kee Hwan; Sung, Gi Young; Lee, Do Sang; Kim, Jeong Soo; Moon, In Sung; Lim, Keun Woo; Koh, Young Bok

    2004-01-01

    We present a case of suprarenal and infrarenal absence of the inferior vena cava, combined with hyperhomocysteinemia in a 39-year-old woman who presented with symptoms of deep venous thrombosis. The patient also had a homozygous mutation of C677T methylenetetrahydrofolate reductase. Deep vein thrombosis has a multifactorial etiology involving both genetic and acquired factors. Absence of the inferior vena cava is a rare congenital anomaly, but recently it was confirmed as an important risk factor for the development of deep vein thrombosis, especially in young persons. Hypercoagulability due to hyperhomocysteinemia with a tendency toward venous stasis, mediated by congenital absence of the inferior vena cava is thought to have caused deep vein thrombosis in our patient. To our knowledge, this association has not yet been reported. The clinical features and prognosis of the entity are discussed. PMID:15043024

  20. Hepatic Veins and Inferior Vena Cava Thrombosis in a Child Treated by Transjugular Intrahepatic Portosystemic Shunt

    SciTech Connect

    Carnevale, Francisco Cesar Santos, Aline Cristine Barbosa; Tannuri, Uenis; Cerri, Giovanni Guido

    2010-06-15

    We report the case of a 9-year-old boy with portal hypertension, due to Budd-Chiari syndrome, and retrohepatic inferior vena cava thrombosis, submitted to a transjugular intrahepatic portosystemic shunt (TIPS) by connecting the suprahepatic segment of the inferior vena cava directly to the portal vein. After 3 months, the withdrawal of anticoagulants promoted the thrombosis of the TIPS. At TIPS revision, thrombosis of the TIPS and the main portal vein and clots at the splenic and the superior mesenteric veins were found. Successful angiography treatment was performed by thrombolysis and balloon angioplasty of a severe stenosis at the distal edge of the stent.

  1. Unusual Case of Parkes Weber Syndrome with Aneurysm of the Left Common Iliac Vein and Thrombus in Inferior Vena Cava.

    PubMed

    Banzic, Igor; Brankovic, Milos; Koncar, Igor; Ilic, Nikola; Davidovic, Lazar

    2015-10-01

    We report an unusual case of aneurysm of the left common iliac vein and thrombus formation in inferior vena cava associated with Parkes Weber syndrome (PWS). In addition to many already known clinical signs which determine PWS, common iliac vein aneurysm formation together with inferior vena cava thrombus present a new clinical feature and new challenges in treatment strategy of these patients. PMID:26122423

  2. Factors involved in the antinatriuretic effects of acute constriction of the thoracic and abdominal inferior vena cava.

    NASA Technical Reports Server (NTRS)

    Schrier, R. W.; Humphreys, M. H.

    1971-01-01

    Study of the antinatriuretic effect of acute thoracic inferior vena cava (TIVC) constriction in the absence of alterations in renal perfusion pressure. A comparison is made of the effects of equivalent degrees of TIVC and abdominal inferior vena cava constriction on arterial pressure, renal hemodynamics, and electrolyte excretion.

  3. Three-Dimensional Rotational Angiography of the Inferior Vena Cava as an Adjunct to Inferior Vena Cava Filter Retrieval

    SciTech Connect

    Bozlar, Ugur; Edmunds, J. Stewart; Turba, Ulku C.; Hartwell, Gary D.; Housseini, Ahmed M.; Hagspiel, Klaus D.

    2009-01-15

    The objective of this study was to explore the role of three-dimensional (3-D) rotational angiography (RA) of the inferior vena cava (IVC; 3-D CV) before filter retrieval and its impact on treatment planning compared with standard anteroposterior cavography (sCV). Thirty patients underwent sCV and 3-D CV before IVC filter retrieval. Parameters assessed were: projection of filter arms or legs beyond the caval lumen, thrombus burden within the filter and IVC, and orientation of the filter within IVC. Skin and effective radiation doses were calculated. Statistical analysis was performed using paired Student t test and nonparametric McNemar's test. Standard anteroposterior cavography detected 49 filter arms or legs projecting beyond the caval lumen in 25 patients. Three-dimensional CV demonstrated 89 filter arms or legs projecting beyond the caval lumen in 28 patients. Twenty-two patients had additional filter arms or legs projecting beyond the caval lumen detected on 3-D CV that were not detected on sCV (p < 0.001). Filter apex tilt detection differed significantly (p < 0.001) between sCV and 3-D CV, with 3-D CV being more accurate. The filter apex abutted the IVC wall in 10 patients (33%) on 3-D CV, but this was diagnosed in only 3 patients (10%) with sCV. Thrombus was detected in 8 patients (27%), 1 thrombus of which was seen only on 3-D CV, and treatment was changed in this patient because of thrombus size. Mean effective radiation doses for 3-D CV were approximately two times higher than for sCV (1.68 vs. 0.86 mSv), whereas skin doses were three times lower (12.87 vs. 35.86 mGy). Compared with sCV, performing 3-D CV before optional IVC filter retrieval has the potential to improve assessment of filter arms or legs projecting beyond the caval lumen, filter orientation, and thrombus burden.

  4. Retrieval of Cement Embolus from Inferior Vena Cava After Percutaneous Vertebroplasty

    SciTech Connect

    Athreya, S.; Mathias, N.; Rogers, P.; Edwards, R.

    2009-07-15

    Percutaneous vertebroplasty is an accepted treatment for painful vertebral compression fractures caused by osteoporosis and malignant disease. Venous leakage of cement and pulmonary cement embolism have been reported complications. We describe a paravertebral venous cement leak resulting in the deposition of a cement cast in the inferior vena cava and successful retrieval of the cement embolus.

  5. Procedural and Indwelling Complications with Inferior Vena Cava Filters: Frequency, Etiology, and Management

    PubMed Central

    Milovanovic, Lazar; Kennedy, Sean A.; Midia, Mehran

    2015-01-01

    Inferior vena cava (IVC) filters are commonly used in select high-risk patients for the prevention of pulmonary embolism. Potentially serious complications can arise from the use of IVC filters, including thrombosis of the filter itself and filter fragment embolization. This article discusses the utility of IVC filters and reviews the management of two cases of filter-related complications. PMID:25762846

  6. Acute Traumatic Renal Artery to Inferior Vena Cava Fistula Treated with a Covered Stent

    SciTech Connect

    Tam, J.; Kossman, T.; Lyon, S.

    2006-12-15

    A 34-year-old man presented within hours of suffering a penetrating stab wound and was diagnosed with a right renal artery to inferior vena cava fistula. Initial attempts at excluding the fistula with a balloon were unsuccessful. He was subsequently treated with a covered stent inserted into the right renal artery which successfully excluded the fistula.

  7. Creating a Fontan fenestration in a child with dextrocardia and interrupted inferior vena cava.

    PubMed

    Charlagorla, Pradeepkumar; Breinholt, John P

    2016-01-01

    Plastic bronchitis is a rare life-threatening complication of the Fontan operation. Transcatheter Fontan fenestration can ameliorate symptoms by decompressing elevated venous pressures. Transcatheter creation of a fenestration can be technically challenging in cases with complex venous anatomy. We report a case of a 5-year-old boy with heterotaxy, dextrocardia with unbalanced atrioventricular canal (AVC), atrial and visceral situs inversus, left-sided superior vena cava (SVC), and left-sided interrupted inferior vena cava (IVC) with azygos continuation. With few modifications to the equipment, a successful Fontan fenestration with stent implantation was performed via transjugular approach. At 2-year follow-up, his symptoms of plastic bronchitis improved significantly.

  8. [Agenesis of the infrarenal inferior vena cava with thrombosis of the renal vein in a fetus: a case report].

    PubMed

    Raposo Rodríguez, L; Recio Rodríguez, M; Alvarez Moreno, E; López Azorín, M

    2012-01-01

    Agenesis of the inferior vena cava, especially of the infrarenal segment, is exceptional. This condition is thought to result from thrombosis during gestation rather than from a true congenital malformation. Agenesis of the inferior vena cava can be associated with renal vein thrombosis, which in turn is related to suprarenal hemorrhage in the fetus. We present a case of agenesis of the inferior vena cava with preservation of the hepatic segment, thrombosis of the left renal vein, and secondary bilateral suprarenal hemorrhage diagnosed prenatally using sonography and magnetic resonance imaging.

  9. Treatment of Superior Vena Cava (SVC) Syndrome and Inferior Vena Cava (IVC) Thrombosis in a Patient with Colorectal Cancer: Combination of SVC Stenting and IVC Filter Placement to Palliate Symptoms and Pave the Way for Port Implantation

    SciTech Connect

    Sauter, Alexander; Triller, Juergen; Schmidt, Felix; Kickuth, Ralph

    2008-07-15

    Thrombosis of the inferior vena cava is a life-threatening complication in cancer patients leading to pulmonary embolism. These patients can also be affected by superior vena cava syndrome causing dyspnea followed by trunk or extremity swelling. We report the case of a 61-year-old female suffering from an extended colorectal tumor who became affected by both of the mentioned complications. Due to thrombus formation within the right vena jugularis interna, thrombosis of the inferior vena cava, and superior vena cava syndrome, a combined interventional procedure via a left jugular access with stenting of the superior vena cava and filter placement into the inferior vena cava was performed As a consequence, relief of the patient's symptoms, prevention of pulmonary embolism, and paving of the way for further venous chemotherapy were achieved.

  10. Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation

    PubMed Central

    Orgoi, Sergelen; Sandag, Erdene; Namkhai, Ulzii-Orshikh; Badarch, Bat-Ireedui; Batsuuri, Batsaikhan

    2016-01-01

    The sinusoidal obstructive syndrome (SOS) is a complication that usually follows hematopoietic stem cell transplantation. It is also known as veno-occlusive disease, which is a rare complication of living donor liver transplantation (LDLT). Herein, we reported a 34 year-old female patient presenting SOS after LDLT. Its underlying cause was presumed to be associated with liver abscess and subsequent inferior vena cava stenosis. SOS led to graft failure, thus requiring retransplantation with a deceased donor liver graft. The underlying causes of SOS are complex pathologic entity with multifactorial etiology. It is likely that its multifactorial etiology includes a decrease of hepatic venous outflow that is caused by graft liver infection and inferior vena cava stenosis.

  11. Local colloid trapping in the liver in the inferior vena cava syndrome

    SciTech Connect

    Lin, M.S.; Fletcher, J.W.; Donati, R.M.

    1981-04-01

    Local radioactive areas in the liver were observed as a result of superficial cavoportal shunting of radiocolloids in two patients with the inferior vena cava syndrome. In one patient a paraumbilical and/or a recanalized umbilical vein was apparently involved in the hepatopetal shunting. In the other patient a superficial anastomosis other than the paraumbilical vein shunted colloid to the liver. Relatively discrete areas of increased radioactivity, single or multiple, were seen in the left lobe. Virtually all reported instances of hepatopetal shunting of radioparticles in a superior or an inferior vena cava syndrome have demonstrated similar findings. Various hepatopetal collateral pathways in infrarenal caval obstruction are considered, and factors that could affect liver scan findings in the infrarenal obstruction are discussed.

  12. Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation.

    PubMed

    Bat-Erdene, Batsaikhan; Orgoi, Sergelen; Sandag, Erdene; Namkhai, Ulzii-Orshikh; Badarch, Bat-Ireedui; Batsuuri, Batsaikhan

    2016-08-01

    The sinusoidal obstructive syndrome (SOS) is a complication that usually follows hematopoietic stem cell transplantation. It is also known as veno-occlusive disease, which is a rare complication of living donor liver transplantation (LDLT). Herein, we reported a 34 year-old female patient presenting SOS after LDLT. Its underlying cause was presumed to be associated with liver abscess and subsequent inferior vena cava stenosis. SOS led to graft failure, thus requiring retransplantation with a deceased donor liver graft. The underlying causes of SOS are complex pathologic entity with multifactorial etiology. It is likely that its multifactorial etiology includes a decrease of hepatic venous outflow that is caused by graft liver infection and inferior vena cava stenosis. PMID:27621751

  13. Duplication of Inferior Vena Cava with Associated Anomalies: A Rare Case Report.

    PubMed

    Shaha, Pramod; Garg, Ashish; Sahoo, Kulamani; Kothari, Nupoor; Garg, Pooja

    2016-03-01

    Duplication of inferior vena cava is an uncommon abnormality and is important in daily today practice for vascular surgeons, radiologist and urologist especially during retroperitoneal surgeries and treatment of thromboembolic disease. Radiologically, Duplicated IVC can be mistaken for lymphadenopathy or left pyeloureteric dilatation. Crossed fused kidney with a single ureter defy the embryological theory of ureteric bud crossing the opposite side and induce nephron formation associated anomaly of Duplication of inferior vena cava and malrotation of gut are not reported in a same patient. On meticulous search of literature no such combination of abnormalities has been reported. In this case report we bring forward this rare type of combination of three congenital malformations that is Duplication of IVC, crossed fused kidney and malrotation of gut.

  14. Inferior vena cava stenosis-induced sinusoidal obstructive syndrome after living donor liver transplantation

    PubMed Central

    Orgoi, Sergelen; Sandag, Erdene; Namkhai, Ulzii-Orshikh; Badarch, Bat-Ireedui; Batsuuri, Batsaikhan

    2016-01-01

    The sinusoidal obstructive syndrome (SOS) is a complication that usually follows hematopoietic stem cell transplantation. It is also known as veno-occlusive disease, which is a rare complication of living donor liver transplantation (LDLT). Herein, we reported a 34 year-old female patient presenting SOS after LDLT. Its underlying cause was presumed to be associated with liver abscess and subsequent inferior vena cava stenosis. SOS led to graft failure, thus requiring retransplantation with a deceased donor liver graft. The underlying causes of SOS are complex pathologic entity with multifactorial etiology. It is likely that its multifactorial etiology includes a decrease of hepatic venous outflow that is caused by graft liver infection and inferior vena cava stenosis. PMID:27621751

  15. Extra-Adrenal Retroperitoneal Paraganglioma with Extensive Duodenal Invasion and Inferior Vena Cava Tumor Thrombus.

    PubMed

    Sadamori, Hiroshi; Monden, Kazuteru; Hioki, Masayoshi; Yoshimoto, Masashi; Ueki, Toru; Hyodo, Tsuyoshi; Omonishi, Kunihiro; Kioka, Yukio; Kuriyama, Mitsuhito; Ohno, Satoshi; Sakaguchi, Kohsaku; Matsuda, Tadakazu; Takakura, Norihisa

    2016-08-01

    We report a case of extra-adrenal retroperitoneal paraganglioma (RP) with extensive duodenal invasion and tumor thromboses both in the right testicular vein and in the inferior vena cava (IVC). Because there was rigid adherence between the RP and the abdominal aorta, pancreatoduodenectomy with replacement of the IVC and aorta was performed for complete surgical resection. In the present case, both the mode of progression of the RP and the surgical approach were extremely rare. PMID:26921027

  16. Inferior Vena Cava Filter-Related Thrombus/Deep Vein Thrombosis: Data and Management.

    PubMed

    Andreoli, Jessica M; Thornburg, Bartley G; Hickey, Ryan M

    2016-06-01

    Recurrent deep venous thrombosis and inferior vena cava (IVC) thrombosis are well-described complications following IVC filter placement. IVC thrombosis ranges in severity of clinical presentation, but can lead to significant morbidity and mortality with incidence rates depending on patient population and type of filter used. Endovascular therapies such as catheter-directed thrombolysis, mechanical thrombectomy, balloon venoplasty, and stenting are safe and effective in restoration of venous patency. PMID:27247478

  17. Nutcracker syndrome in a patient with a history of inferior vena cava ligation.

    PubMed

    Peker, Ahmet; Yagmurlu, Aydin; Ekim, Mesiha; Gokcora, Haluk; Fitoz, Suat

    2011-09-01

    We report the case of a child with clinical and radiological signs of nutcracker syndrome who had a history of inferior vena cava ligation during a previous surgery. He was referred for evaluation of abdominal pain and hematuria. Entrapment of the left renal vein between the superior mesenteric artery and the aorta with aneurysmal dilatation was detected on Doppler ultrasonography. Magnetic resonance angiography revealed paravertebral and epidural collateral vessels.

  18. Compartment syndrome in patients with massive venous thrombosis after inferior vena cava filter placement.

    PubMed

    Mesfin, Addisu; Lum, Ying Wei; Nayfeh, Tariq; Mears, Simon C

    2011-03-11

    Massive venous thrombosis, which can occur acutely after inferior vena cava filter placement, has 2 forms: phlegmasia cerulea dolens and phlegmasia alba dolens. In phlegmasia cerulea dolens, complete occlusion of venous outflow occurs. In the milder phlegmasia alba dolens version, collateral venous flow out of the limb remains despite the venous thrombosis. This article presents, to our knowledge, the first 2 cases of massive venous thrombosis (1 phlegmasia cerulea dolens, 1 phlegmasia alba dolens) below inferior vena cava filters occurring after the acute period. Phlegmasia cerulea dolens and phlegmasia alba dolens can present as compartment syndrome. Prompt fasciotomies were performed, but the underlying massive venous thrombosis was not addressed surgically. Phlegmasia cerulea dolens and phlegmasia alba dolens have high morbidity and mortality. The patient with phlegmasia alba dolens required leg and thigh fasciotomies and eventually required an above-knee amputation. The patient with phlegmasia cerulea dolens developed compartment syndrome in the left leg, right leg, and right thigh. Although he underwent decompression of all of these compartments, he died from multiple organ failure. A multidisciplinary approach with the vascular service and the intensivists is required in the treatment of patients with massive venous thrombosis. Treatment goals include preventing additional propagation of the thrombus via anticoagulation, with strong consideration for catheter-directed thrombolysis or thrombectomy and fasciotomies for compartment syndrome. The orthopedic surgeon should keep phlegmasia cerulea dolens and phlegmasia alba dolens in the differential for compartment syndrome, especially in patients who have had a history of acute or chronic inferior vena cava filter placement.

  19. Creating a Fontan fenestration in a child with dextrocardia and interrupted inferior vena cava

    PubMed Central

    Charlagorla, Pradeepkumar; Breinholt, John P.

    2016-01-01

    Plastic bronchitis is a rare life-threatening complication of the Fontan operation. Transcatheter Fontan fenestration can ameliorate symptoms by decompressing elevated venous pressures. Transcatheter creation of a fenestration can be technically challenging in cases with complex venous anatomy. We report a case of a 5-year-old boy with heterotaxy, dextrocardia with unbalanced atrioventricular canal (AVC), atrial and visceral situs inversus, left-sided superior vena cava (SVC), and left-sided interrupted inferior vena cava (IVC) with azygos continuation. With few modifications to the equipment, a successful Fontan fenestration with stent implantation was performed via transjugular approach. At 2-year follow-up, his symptoms of plastic bronchitis improved significantly. PMID:27212858

  20. Entrapment of Guide Wire in an Inferior Vena Cava Filter: A Technique for Removal

    SciTech Connect

    Abdel-Aal, Ahmed Kamel Saddekni, Souheil; Hamed, Maysoon Farouk; Fitzpatrick, Farley

    2013-04-15

    Entrapment of a central venous catheter (CVC) guide wire in an inferior vena cava (IVC) filter is a rare, but reported complication during CVC placement. With the increasing use of vena cava filters (VCFs), this number will most likely continue to grow. The consequences of this complication can be serious, as continued traction upon the guide wire may result in filter dislodgement and migration, filter fracture, or injury to the IVC. We describe a case in which a J-tipped guide wire introduced through a left subclavian access without fluoroscopic guidance during CVC placement was entrapped at the apex of an IVC filter. We describe a technique that we used successfully in removing the entrapped wire through the left subclavian access site. We also present simple useful recommendations to prevent this complication.

  1. Hypotension in the Right Lateral Position Secondary to Inferior Vena Cava Abnormality.

    PubMed

    Hutton, Meredith J H; Swamy, Ganesh; Shinkaruk, Kelly; Duttchen, Kaylene

    2015-09-15

    Surgical positioning is accompanied by numerous anesthetic considerations, particularly its potential effects on the cardiovascular, respiratory, and nervous systems. Clinical studies have shown that lateral positioning does not affect hemodynamics; however, with the addition of trunk flexion, there is a decrease in cardiac output, which may be secondary to caval compression. In this report, we describe a unique case of hypotension that arose in a patient positioned only in the right lateral decubitus position with flexion and that was exacerbated by an abnormally narrow inferior vena cava. PMID:26361387

  2. Inferior vena cava stent grafting closure of a high-flow portacaval shunt.

    PubMed

    Alhaizaey, Abdullah; Ghanekar, Anand; Oreopoulos, George

    2016-01-01

    Portacaval (PC) shunts can be of congenital or acquired types. Acquired PC shunts are usually created in patients with end-stage liver disease to manage complications associated with portal hypertension or may be part of selected adult-adult living donor liver transplantation procedures to decrease the chance of the small-for-size syndrome. The main potential complication of these acquired high-flow PC shunts is early hepatic encephalopathy. We present a case of a high-flow acquired PC shunt after liver transplantation that was complicated by uncontrolled encephalopathy. This was treated by endovascular inferior vena cava stent grafting for shunt closure. PMID:26946901

  3. The Typical Presentation Spectrum of Deep Vein Thrombosis Associated with Inferior Vena Cava Malformations

    PubMed Central

    El Lakis, Mustapha A.; Chamieh, Jad

    2016-01-01

    Congenital malformations of the inferior vena cava (IVC) are rare and underreported. They can be a risk factor for deep venous thrombosis (DVT) as a result of inadequate venous drainage of the lower extremities through collateral circulation. The significant number of cases reported in the literature highlights their importance, warranting investigating their existence in younger individuals with idiopathic DVT of the lower extremities and pelvic veins. In this systematic review, we depict the typical presentation of IVC malformations, their management, and the management of their associated DVT. PMID:27478635

  4. Unprovoked deep venous thrombosis in a young adult associated with membranous obstruction of inferior vena cava.

    PubMed

    Epperla, Narendranath; Usoltseva, Natalia

    2014-01-01

    Unprovoked deep venous thrombosis (DVT) in young adults is an unusual phenomenon, but it is associated with significant morbidity. Developmental anomalies of the inferior vena cava (IVC) should be considered as a possible aetiological factor, and appropriate investigations should be performed to determine the conclusive diagnosis and necessary treatment plan. We report a case of spontaneous thrombosis of the IVC and bilateral iliac venous system in a young man, associated with membranous obstruction of the IVC. He was diagnosed using several different investigational techniques, and successfully treated with mechanical thrombectomy, thrombolysis therapy and anticoagulation.

  5. Severe low back pain as the initial symptom of venous thrombosis of the inferior vena cava

    PubMed Central

    Tabatabai, Mohsen Abdul Wahab; Butros, Victor Mikhaeel; Mahdi, Shihab Ahmed; Ahmad, Mohammad Javad

    2014-01-01

    A 45-year-old previously well male truck driver presented to the emergency department with severe low back pain; lumbosacral X-ray was normal and he was given analgaesics and discharged. The following day, he presented to the emergency department again, his pain had not responded to the analgaesics; this time he also presented with massive bilateral swelling of lower limbs and left testicle that started 3 h earlier. The pain was severe, dull and interfered with the patient's ability to walk. An urgent workup revealed extensive thrombosis of the inferior vena cava. PMID:25155491

  6. Residual Inferior Vena Cava Thrombus Detected by Transesophageal Echocardiography After Resection of a Malignant Adrenal Mass.

    PubMed

    Burbano, Nelson H; Vlah, Claudene; Argalious, Maged

    2015-10-15

    A 43-year-old woman with a history of the Cushing syndrome secondary to adrenocortical carcinoma presented to the operating room for right adrenalectomy, hepatectomy, nephrectomy, and inferior vena cava (IVC) thrombectomy. Initial intraoperative transesophageal echocardiogram (TEE) confirmed the presence of an IVC tumor below the hepatic veins. Total vascular exclusion of the liver was necessary to perform the operation. A repeat TEE showed a residual thrombus within the IVC prompting an additional cavotomy to successfully remove the entire mass. The remainder of the procedure finalized uneventfully. The case highlights the importance of TEE monitoring for noncardiac surgery with thrombotic involvement of the IVC. PMID:26466307

  7. A massive retroperitoneal neuroblastoma with stenosis of the inferior vena cava in a 5-month-old boy

    PubMed Central

    Li, Jui-Ting; Dai, Yang-Hong; Kuo, Shih-Ming

    2014-01-01

    Neuroblastoma is the second most common retroperitoneal tumour in children after Wilms’ tumour. When it originates in the retroperitoneum, neuroblastoma usually presents as an abdominal mass with clinical manifestations of nausea, vomiting and weight loss. Imaging studies of this tumour demonstrate a heterogeneous mass with an irregular capsule and visible calcifications. Encasement and compression of the abdominal vessels, especially the inferior vena cava, are often observed. However, stenosis of the inferior vena cava has never been reported to be associated with this tumour. Here, we present a case of a 5-month-old boy with a right retroperitoneal tumour with extensive encasement of the inferior vena cava and significant narrowing of its distal part between the venous bifurcation and the tumour capsule. To our knowledge, this is the first case of neuroblastoma with this manifestation in a child. PMID:24671327

  8. Use of noncontrast computed tomography of the inferior vena cava for real-time imaging guidance for the placement of inferior vena cava filters.

    PubMed

    Winkler, Michael A; Majmudar, Palak M; Landwehr, Kevin P; Hobbs, Stephen B; Saha, Sibu P

    2015-03-01

    Appropriate placement of an inferior vena cava (IVC) filter necessitates imaging of the renal veins because when an IVC filter is deployed its tip should be at or below the inferior aspect of the inferiormost renal vein. Traditionally, imaging during placement of IVC filters has been with conventional cavography and fluoroscopy. Recently, intravascular ultrasound has been used for the same purpose but with additional expense. Morbidly obese patients often exceed the weight limit of fluoroscopy tables. In addition, short obese patients are at risk of falling from narrow fluoroscopy tables. For such patients, computed tomography (CT) guidance is a viable alternative to conventional fluoroscopic guidance. IVC placement was performed in the CT suite for two obese patients who exceeded the weight limits of the available fluoroscopy tables. In one case, a Vena-Tech filter (Braun Medical, Melsungen, Germany) was placed using CT fluoroscopy. In the second case, a Recovery (Bard, Murray Hill, NJ) filter was placed using intermittent limited z-axis scanning. In the first case, the filter was placed below the level of the renal veins and above the confluence of the iliac veins, which is acceptable placement. In the second case, with refinement of technique, the filter tip was placed less than 1 cm below the inferiormost renal vein, which is considered optimal placement. CT of the IVC precisely images the renal veins and can characterize their number and their confluence with the IVC. CT guidance is a viable alternative to fluoroscopic guidance for the placement of IVC filters in morbidly obese patients. PMID:25780332

  9. Intravenous leiomyomatosis with inferior vena cava or intracardiac extension and concurrent bilateral multiple pulmonary nodules

    PubMed Central

    Zhang, Guorui; Yu, Xin; Lang, Jinghe

    2016-01-01

    Abstract Background: Intravenous leiomyomatosis is a special type of uterine leiomyoma and features formation and growth of benign leiomyoma tissue within vascular wall. Benign metastatic leiomyoma refers to benign leiomyoma metastasizing to extra-uterine sites, dominantly lung. Solitary or multiple small nodules in the lung can be seen in image scans. Methods: We report 2 cases of intravenous leiomyomatosis with inferior vena cava or intracardiac extension and concurrent multiple nodules in bilateral lungs. Results: Case 1 was a 40-year-old woman with a large mass in pelvic cavity, masses in heart chambers, and disseminates pulmonary nodules detected at preoperative image scans. Masses in pelvic cavity and heart were resected in a 2-stage surgery. Histology examination confirmed the diagnosis of intravenous leiomyomatosis. Pulmonary nodules stayed stable during follow-up. Case 2 was a 37-year-old woman with 3 times of uterine-related surgeries. A pelvic mass appeared again and filling defect was observed in left ovarian vein, right renal vein, right common iliac vein, and inferior vena cava. Tumors in pelvic cavity and within vessels were removed in a 1-stage surgery. Histology examination confirmed the diagnosis of intravenous leiomyomatosis. Pulmonary nodules remained stable during follow-up. Conclusion: The incidence of benign metastatic leiomyoma in patients with intravenous leiomyomatosis might be relatively high. Metastasis of intravenous leiomyomatosis lesions was a possible source of benign metastatic leiomyoma in these cases. PMID:27583911

  10. Inferior Vena Cava Resection and Reconstruction for Tumoral Recurrence after Right Nephrectomy.

    PubMed

    Botianu, Pv-H; Chirtes, R; Marcu, C; Kosza, H; Stoian, M; Brusnic, O; Botianu, Amv; Dobre, A

    2016-01-01

    We report a 60 years old patient who was admitted for a local recurrence after a right nephrectomy performed 2 years ago (papillary renal carcinoma with areas of sarcomatoid differentiation - pT3a). CT scan showed a retroperitoneal mass with invasion of the inferior vena cava. We performed a complete en-bloque excision of the tumor with the infrarenal portion of the inferior vena cava and lympha-denectomy. The vascular reconstruction was performed by the interposition of a 20 mm diameter Dacron prosthesis. The postoperative course was complicated due to an episode of digestive bleeding (duodenal ulcer) which stopped after conservative treatment (antisecretory and hemostatics, including rFVIIa), but eventually favourable. At 6 months follow-up the patient presents no sign of tumoral relapse and a functional vascular prosthesis. The case is interesting due to the rarity of the surgical procedure and the indication. The surgical approach of the retroperitoneal tumors with vascular involvement is possible in centers with adequate technical endownment and human expertise. PMID:27604673

  11. CT of inferior vena cava filters: normal presentations and potential complications.

    PubMed

    Georgiou, Nicholas A; Katz, Douglas S; Ganson, George; Eng, Kaitlin; Hon, Man

    2015-12-01

    With massive pulmonary embolism (PE) being the first or second leading cause of unexpected death in adults, protection against PE is critical in appropriately selected patients. The use of inferior vena cava (IVC) filters has increased over the years, paralleling the increased detection of deep venous thrombosis (DVT) and PE by improved and more available imaging techniques. The use of IVC filters has become very common as an alternative and/or as a supplement to anticoagulation, and these filters are often seen on routine abdominal CT, including in the emergency setting; therefore, knowledge of the normal spectrum of findings of IVC filters by the radiologist on CT is critical. Additionally, CT can be used specifically to identify complications related to IVC filters, and CT may alternatively demonstrate IVC filter-related problems which are not specifically anticipated clinically. With multiple available IVC filters on the US market, and even more available outside of the USA, it is important for the emergency and the general radiologist to recognize the different models and various appearances and positioning on CT, as well as their potential complications. These complications may be related to venous access, but also include thrombosis related to the filter, filter migration and penetration, and problems associated with filter deployment. With the increasing number of inferior vena cava filters placed and their duration within patients increasing over time, it is critical for emergency and other radiologists to be aware of these findings on CT.

  12. Development of a fluid resuscitation protocol using inferior vena cava and lung ultrasound.

    PubMed

    Lee, Christopher W C; Kory, Pierre D; Arntfield, Robert T

    2016-02-01

    Appropriate fluid resuscitation has been a major focus of critical care medicine since its inception. Currently, the most accurate method to guide fluid administration decisions uses "dynamic" measures that estimate the change in cardiac output that would occur in response to a fluid bolus. Unfortunately, their use remains limited due to required technical expertise, costly equipment, or applicability in only a subset of patients. Alternatively, point-of-care ultrasound (POCUS) has become widely used as a tool to help clinicians prescribe fluid therapy. Common POCUS applications that serve as guides to fluid administration rely on assessments of the inferior vena cava to estimate preload and lung ultrasound to identify the early presence of extravascular lung water and avoid fluid overresuscitation. Although application of these POCUS measures has multiple limitations that are commonly misunderstood, current evidence suggests that they can be used in combination to sort patients among 3 fluid management categories: (1) fluid resuscitate, (2) fluid test, and (3) fluid restrict. This article reviews the pertinent literature describing the use of inferior vena cava and lung ultrasound for fluid responsiveness and presents an evidence-informed algorithm using these measures to guide fluid resuscitation decisions in the critically ill. PMID:26475100

  13. Effectiveness of Inferior Vena Cava Filters without Anticoagulation Therapy for Prophylaxis of Recurrent Pulmonary Embolism

    PubMed Central

    Zektser, Miri; Bartal, Carmi; Zeller, Lior; Nevzorov, Roman; Jotkowitz, Alan; Stavi, Vered; Romanyuk, Vitaly; Chudakov, Gregory; Barski, Leonid

    2016-01-01

    Objective The optimal treatment of deep vein thrombosis (DVT) is anticoagulation therapy. Inferior vena cava filter (IVC) placement is another option for the prevention of pulmonary embolism (PE) in patients with deep vein thrombosis. This is used mostly in patients with a contraindication to anticoagulant therapy. The purpose of the present study was to compare the two options. Methods A retrospective cohort study of two groups of patients with DVT: patients who received an IVC filter and did not receive anticoagulation due to contraindications; and patients with DVT and similar burden of comorbidity treated with anticoagulation without IVC insertion. To adjust for a potential misbalance in baseline characteristics between the two groups, we performed matching for age, gender, and Charlson’s index, which is used to compute the burden of comorbid conditions. The primary outcome was an occurrence of a PE. Results We studied 1,742 patients hospitalized with the diagnosis of DVT in our hospital;93 patients from this population received IVC filters. Charlson’s score index was significantly higher in the IVC filter group compared with the anticoagulation group. After matching of the groups of patients according to Charlson’s score index there were no significant differences in primary outcomes. Conclusion Inferior vena cava filter without anticoagulation may be an alternative option for prevention of PE in patients with contraindications to anticoagulant therapy. PMID:27487310

  14. CT of inferior vena cava filters: normal presentations and potential complications.

    PubMed

    Georgiou, Nicholas A; Katz, Douglas S; Ganson, George; Eng, Kaitlin; Hon, Man

    2015-12-01

    With massive pulmonary embolism (PE) being the first or second leading cause of unexpected death in adults, protection against PE is critical in appropriately selected patients. The use of inferior vena cava (IVC) filters has increased over the years, paralleling the increased detection of deep venous thrombosis (DVT) and PE by improved and more available imaging techniques. The use of IVC filters has become very common as an alternative and/or as a supplement to anticoagulation, and these filters are often seen on routine abdominal CT, including in the emergency setting; therefore, knowledge of the normal spectrum of findings of IVC filters by the radiologist on CT is critical. Additionally, CT can be used specifically to identify complications related to IVC filters, and CT may alternatively demonstrate IVC filter-related problems which are not specifically anticipated clinically. With multiple available IVC filters on the US market, and even more available outside of the USA, it is important for the emergency and the general radiologist to recognize the different models and various appearances and positioning on CT, as well as their potential complications. These complications may be related to venous access, but also include thrombosis related to the filter, filter migration and penetration, and problems associated with filter deployment. With the increasing number of inferior vena cava filters placed and their duration within patients increasing over time, it is critical for emergency and other radiologists to be aware of these findings on CT. PMID:26183040

  15. [Bilateral renal vein thrombosis and acute renal failure due to inferior vena cava filter thrombosis. Report of one case].

    PubMed

    Vega, Jorge; Díaz, Rienzi

    2014-11-01

    Bilateral renal vein thrombosis is an unusual etiology of acute renal failure and usually is associated with nephrotic syndrome. We report a 77-year-old man, consulting in the emergency room for anuria that appeared 24 hours after a syncope. The patient was carrier of an inferior vena cava filter prophylactically installed 17 months earlier and was not receiving anticoagulation. Serum creatinine on admission was 5.45 mg/dl and blood urea nitrogen was 54 mg/dl. Computed tomography and Doppler ultrasonography showed an extensive thrombosis of inferior vena cava and both renal veins. Heparin therapy was started with a rapid recovery of renal function and diuresis.

  16. [Intraluminal dilation of inferior vena cava stenosis after repair of the scimitar syndrome in an adult patient].

    PubMed

    Benito Bartolomé, Fernando; González García, Ana; Oliver Ruiz, José M

    2002-02-01

    A 39 year-old woman diagnosed with anomalous drainage of middle and lower right pulmonary veins to the inferior vena cava was corrected surgically by means of baffle with patch up to the left atrium. Early after the operation the patient related intolerance to small efforts and an episode of syncope. The cardiac catheterization demonstrated the presence of a severe stenosis in the inferior vena cava, in its union with the right atrium, that was successfully treated by means of intraluminal percutaneous dilation with a catheter of Inoue. After the procedure the gradient decreased and she improved tolerance to effort, which persisted 10 months later.

  17. Compression of the Inferior Vena Cava by the Right Iliac Artery: A Rare Variant of May-Thurner Syndrome

    SciTech Connect

    Fretz, V.; Binkert, C. A.

    2010-10-15

    May-Thurner syndrome is known as compression of the left common iliac vein by the right common iliac artery. We describe a case of an atypical compression of the inferior vena cava by the right common iliac artery secondary to a high aortic bifurcation. Despite an extensive collateral network, there was a significant venous gradient between the iliac veins and the inferior vena cava above the compression. After stenting the venous pressure gradient disappeared. Follow-up 4 months later revealed a good clinical response with a patent stent.

  18. Multiorgan resection with inferior vena cava reconstruction for hepatic alveolar echinococcosis

    PubMed Central

    Li, Wei; Wu, Hong

    2016-01-01

    Abstract Alveolar echinococcosis (AE) is a life-threatening parasitic disease characterized by its tumor-like growth. Radical operation is deemed the curable method for AE treatment if R0-resection is achievable. We present a 26-year-old AE patient with AE lesions invading the right lobe of the liver, the inferior vena cava, inferior lobe of right lung, the right hemidiaphragm, and the right kidney. On the basis of precise preoperative and intraoperative evaluations, a radical surgery that removed the huge lesion en bloc was performed successfully with skillful surgical techniques. This patient had an uneventful postoperative recovery and a good prognosis. Multiorgan resection is justified and unavoidable in selected patients when AE lesions invade different organs and the main vascular structures. PMID:27281076

  19. Pancreatic and multiorgan resection with inferior vena cava reconstruction for retroperitoneal leiomyosarcoma

    PubMed Central

    Stauffer, John A; Fakhre, G Peter; Dougherty, Marjorie K; Nakhleh, Raouf E; Maples, William J; Nguyen, Justin H

    2009-01-01

    Background Inferior vena cava (IVC) leiomyosarcoma is a rare tumor of smooth muscle origin. It is often large by the time of diagnosis and may involve adjacent organs. A margin-free resection may be curative, but the resection must involve the tumor en bloc with the affected segment of vena cava and locally involved organs. IVC resection often requires vascular reconstruction, which can be done with prosthetic graft. Case presentation We describe a 39-year-old man with an IVC leiomyosarcoma that involved the adrenal gland, distal pancreas, and blood supply to the spleen and left kidney. Tumor excision involved en bloc resection of all involved organs with reimplantation of the right renal vein and reconstruction of the IVC with a polytetrafluoroethylene graft. The patient recovered without renal insufficiency, graft infection, or other complications. Follow-up abdominal imaging at 1 year showed a patent IVC graft and no locally recurrent tumor. Prosthetic graft provides a sufficient diameter and length for replacement conduit in extensive resection of IVC leiomyosarcoma. Conclusion To our knowledge, this is the first case of resection of an IVC sarcoma with prosthetic graft reconstruction in combination with pancreatic resection. Aggressive surgical resection including vascular reconstruction is warranted for select IVC tumors to achieve a potentially curative outcome. PMID:19126222

  20. Azygos Vein Dialysis Catheter Placement Using the Translumbar Approach in a Patient with Inferior Vena Cava Occlusion

    SciTech Connect

    Jaber, Mohammad R.; Thomson, Matthew J.; Smith, Douglas C.

    2008-07-15

    We describe percutaneous, translumbar placement of a 14-Fr dialysis catheter into an ascending lumbar vein to achieve tip position in an enlarged azygos vein. The patient had thrombosis of all traditional vascular sites, as well as the inferior vena cava. This catheter functioned well for 7 months before fatal catheter-related infection developed.

  1. Catheter-directed thrombolysis for double inferior vena cava with deep venous thrombosis: A case report and literature review.

    PubMed

    Wang, Xiaodong; Chen, Zhengxin; Cai, Qianrong

    2014-08-01

    Double inferior vena cava (DIVC) with deep venous thrombosis (DVT) is rare, and there is only one reported case of DIVC with DVT treated by catheter-directed thrombolysis. We report a case of a 32-year-old man with an extensive venous clot involving the infrarenal segment of a double IVC who received filter implantation and catheter-directed thrombolysis.

  2. Transapical closure of paraprosthetic mitral leak in a patient with inferior vena cava interruption and azygos continuation.

    PubMed

    Mega, Simona; Patti, Giuseppe; Carminati, Mario; Sedati, Pietro; D'Ambrosio, Andrea; Di Sciascio, Germano

    2015-01-01

    Para-valvular leaks represent a relevant post-operative complication of cardiac valve replacement, often causing heart failure or severe hemolysis. We report a case of a 72 year-old woman with aortic and mitral mechanical prostheses who developed hemolytic anemia because of a para-prosthetic mitral leak. Chest tomography in such patient unexpectedly documented inferior vena cava interruption with azygos continuation into superior vena cava. Given the high surgical risk, the venous anomaly and the presence of the aortic valve prosthesis, transcatheter leak closure via antero-lateral mini-thoracotomy and transapical approach was performed.

  3. Computational Modeling of Blood Flow in the TrapEase Inferior Vena Cava Filter

    SciTech Connect

    Singer, M A; Henshaw, W D; Wang, S L

    2008-02-04

    To evaluate the flow hemodynamics of the TrapEase vena cava filter using three dimensional computational fluid dynamics, including simulated thrombi of multiple shapes, sizes, and trapping positions. The study was performed to identify potential areas of recirculation and stagnation and areas in which trapped thrombi may influence intrafilter thrombosis. Computer models of the TrapEase filter, thrombi (volumes ranging from 0.25mL to 2mL, 3 different shapes), and a 23mm diameter cava were constructed. The hemodynamics of steady-state flow at Reynolds number 600 was examined for the unoccluded and partially occluded filter. Axial velocity contours and wall shear stresses were computed. Flow in the unoccluded TrapEase filter experienced minimal disruption, except near the superior and inferior tips where low velocity flow was observed. For spherical thrombi in the superior trapping position, stagnant and recirculating flow was observed downstream of the thrombus; the volume of stagnant flow and the peak wall shear stress increased monotonically with thrombus volume. For inferiorly trapped spherical thrombi, marked disruption to the flow was observed along the cava wall ipsilateral to the thrombus and in the interior of the filter. Spherically shaped thrombus produced a lower peak wall shear stress than conically shaped thrombus and a larger peak stress than ellipsoidal thrombus. We have designed and constructed a computer model of the flow hemodynamics of the TrapEase IVC filter with varying shapes, sizes, and positions of thrombi. The computer model offers several advantages over in vitro techniques including: improved resolution, ease of evaluating different thrombus sizes and shapes, and easy adaptation for new filter designs and flow parameters. Results from the model also support a previously reported finding from photochromic experiments that suggest the inferior trapping position of the TrapEase IVC filter leads to an intra-filter region of recirculating

  4. Hypoplasia of the inferior vena cava in a young man presenting with extensive deep venous thrombosis.

    PubMed

    Alderman, Bryony Eloise Pfyffer; de Boisanger, James; Bottomley, Thomas

    2015-01-01

    We present a case of a 34-year-old man with extensive deep venous thrombosis (DVT) who was found to have multiple abnormalities of venous anatomy, notably hypoplasia of the inferior vena cava with azygous continuation. DVT has an annual incidence of around 1 in 1000 people in the UK. Many cases will have readily identifiable risk factors, such as underlying malignancy, immobility or thrombophilia, but at times, these might not be so straightforward and unexpected contributing factors may be found. Although relatively uncommon in the general population, congenital venous abnormalities have been found at higher incidence in young adults presenting with spontaneous DVT and should therefore remain a consideration when classical risk factors are absent.

  5. Inferior Vena Cava Filtration in the Management of Venous Thromboembolism: Filtering the Data

    PubMed Central

    Molvar, Christopher

    2012-01-01

    Venous thromboembolism (VTE) is a common cause of morbidity and mortality. This is especially true for hospitalized patients. Pulmonary embolism (PE) is the leading preventable cause of in-hospital mortality. The preferred method of both treatment and prophylaxis for VTE is anticoagulation. However, in a subset of patients, anticoagulation therapy is contraindicated or ineffective, and these patients often receive an inferior vena cava (IVC) filter. The sole purpose of an IVC filter is prevention of clinically significant PE. IVC filter usage has increased every year, most recently due to the availability of retrievable devices and a relaxation of thresholds for placement. Much of this recent growth has occurred in the trauma patient population given the high potential for VTE and frequent contraindication to anticoagulation. Retrievable filters, which strive to offer the benefits of permanent filters without time-sensitive complications, come with a new set of challenges including methods for filter follow-up and retrieval. PMID:23997414

  6. Incidental Finding of Inferior Vena Cava Atresia Presenting with Deep Venous Thrombosis following Physical Exertion

    PubMed Central

    Koppisetty, Shalini; Smith, Alton G.; Dhillon, Ravneet K.

    2015-01-01

    Inferior vena cava atresia (IVCA) is a rare but well described vascular anomaly. It is a rare risk factor for deep venous thrombosis (DVT), found in approximately 5% of cases of unprovoked lower extremity (LE) DVT in patients <30 years of age. Affected population is in the early thirties, predominantly male, often with a history of major physical exertion and presents with extensive or bilateral DVTs. Patients with IVC anomalies usually develop compensatory circulation through the collateral veins with enlarged azygous/hemizygous veins. Despite the compensatory circulation, the venous drainage of the lower limbs is often insufficient leading to venous stasis and thrombosis. We describe a case of extensive and bilateral deep venous thrombosis following physical exertion in a thirty-six-year-old male patient with incidental finding of IVCA on imaging. PMID:26640723

  7. A Dedicated Inferior Vena Cava Filter Service Line: How to Optimize Your Practice.

    PubMed

    Karp, Jennifer K; Desai, Kush R; Salem, Riad; Ryu, Robert K; Lewandowski, Robert J

    2016-06-01

    Despite the increased placement of retrievable inferior vena cava filters (rIVCFs), efforts to remove these devices are not commensurate. The majority of rIVCFs are left in place beyond their indicated usage, and often are retained permanently. With a growing understanding of the clinical issues associated with these devices, the United States Food and Drug Administration (FDA) has prompted clinicians to remove rIVCF when they are no longer indicated. However, major obstacles exist to filter retrieval, chief among them being poor clinical follow-up. The establishment of a dedicated IVC filter service line, or clinic, has been shown to improve filter retrieval rates. Usage of particular devices, specifically permanent versus retrievable filters, is enhanced by prospective physician consultation. In this article, the rationale behind a dedicated IVC filter service line is presented as well as described the structure and activities of the authors' IVC filter clinic; supporting data will also be provided when appropriate.

  8. [Sinus histiocytosis with massive lymphadenopathy with complete occlusion of the superior and inferior vena cava].

    PubMed

    Runde, J; Ebbecke, H; Kurlemann, G; Frosch, M; Schuierer, G

    1997-01-01

    Sinus histiocytosis with massive lymphadenopathy (SHML) is a rare disease of the lymph nodes, still of unknown origin. We are reporting the case of a 16 year old boy with SHML which occurred in 1983. Investigations showed a massive lymphadenopathy of the mediastinal and abdominal nodes, causing displacement and compression of surrounding tissue. The patient further developed a blockage of the vena cava superior and inferior, leading to numerous collateral circulation routes in the upper and lower extremities. The etiology of the venous blockage is still disputed. It is possible that they are the result of compression of the major veins. Alternatively, the cause could lie in the disruption of the coagulation system. Finally and more likely, the problem could be the result of fibrosis developing through the healing process.

  9. Renal Failure Secondary to Thrombotic Complications of Suprarenal Inferior Vena Cava Filter in Cancer Patients

    SciTech Connect

    Marcy, Pierre-Yves; Magne, Nicolas; Frenay, Marc; Bruneton, Jean-Noel

    2001-07-15

    Purpose: To evaluate renal function before and after suprarenal inferior vena cava (IVC) filter placement.Methods: We describe, in a personal series of 13 consecutive cases (all of them stage IV cancer patients, one LGM filter, one Antheor filter, 11 Greenfield filters) in our institution, two cases of fatal renal vein thrombosis after placement of a suprarenal filter. Evaluation of renal function was based on serum urea (in mmol/L; normal 3.30-6.60), serum creatinine (in {mu}mol/L; normal <115.1), and calculation of serum creatinine clearance. Results and conclusion: This study suggests that in advanced-stage cancer patients who have a single functional kidney, renal functional insufficiency, or previous renal vein thrombosis, IVC filter placement above the renal veins may not be appropriate. Suprarenal filter placement should be performed only after analysis of predicted survival, after detailed discussions with the patient, and most importantly after renal function evaluation.

  10. Acute wiiitis representing as thrombosis of the inferior vena cava and left pelvic veins.

    PubMed

    Brodmann, M; Gary, T; Hafner, F; Eller, P; Deutschmann, H; Pilger, E; Seinost, G

    2015-08-01

    Deep venous thrombosis as a result of venous wall injury provoked by trauma is a common finding. It often occurs in patients with sportive overstraining, caused by over fatigue of the body structures. In 2007, the entity of "acute wiiitis" was first described in a letter to the New England Journal of Medicine. Acute wiiitis sums up all affections, mainly skeletal and muscle affections, provoked by playing Nintendo Wii, a very common and loved video-game system. Deep venous thrombosis as a consequence of Nintendo Wii has not been described so far. We present a patient with a massive free floating thrombus of the left pelvic veins originating from the gluteal veins and reaching into the inferior vena cava after playing Nintendo Wii.

  11. Adult liver transplantation in the congenital absence of inferior vena cava.

    PubMed

    Angelico, R; Stonelake, S; Perera, D S; Mirza, D F; Russell, S; Muiesan, P; Perera, M T P R

    2015-10-01

    Whereas congenital absence of inferior vena cava observed in paediatric population more often than not, as an isolated or syndromic variety, this is seldom encountered in adult liver transplant recipients. There appear few sporadic reports in the literature on experience of such anomaly in adults. Given the rarity of situation, surprising encounters of such anomalies may pose challenge to the unprepared transplant surgeon and unfavourable outcomes may even have resulted in under-reportage of this condition. In this brief report we document our recent experience with two such cases and this is supplemented with extensive reference to the literature on classification of such anomalies with the endeavour to document implications of such in the adult liver transplant setting. PMID:26278662

  12. Endometrial Stromal Sarcoma Metastatic from the Uterus to the Inferior Vena Cava and Right Atrium

    PubMed Central

    Nghiem, William; Aziz, Salim; Rahbar, Rodeen; Banks, Whitney; Venbrux, Anthony; Sarin, Shawn

    2015-01-01

    Endometrial stromal sarcoma metastases usually occur within the pelvis and rarely involve the great vessels or the heart. We present the case of a 55-year-old woman who was referred for endovascular therapy to treat presumed thrombosis of the inferior vena cava. The suspected thrombus was recalcitrant to endovascular removal with use of an AngioVac venous drainage device. Results of an intraprocedural transvenous biopsy revealed the mass to be the intravascular extension of an endometrial stromal sarcoma. The patient underwent surgical excision of the tumor, and, shortly thereafter, a hysterectomy and salpingo-oophorectomy. This complex case highlights both the rarity of malignancy masquerading as caval thrombus and the importance of multispecialty collaboration. PMID:26664311

  13. Klippel-Trenaunay and Sturge-Weber syndromes with renal hemangioma and double inferior vena cava.

    PubMed

    Schofield, D; Zaatari, G S; Gay, B B

    1986-08-01

    We describe a 3 1/2-year-old boy with the Klippel-Trenaunay and Sturge-Weber syndromes. The child had congenital superficial capillary hemangiomas, congenital glaucoma and mild hydrocephalus. During the first year of life he experienced intermittent hematuria. When he was 3 years old he presented with seizures and left hemihypertrophy first was noted. Several months later radiological examination of a large abdominal mass demonstrated its origin to be in the right kidney. Radical nephrectomy documented the presence of renal hemangioma with complicating perirenal hematoma. A double inferior vena cava was another unexpected surgical finding that complicated the course of this patient. All of these unusual features in these rare syndromes with their clinical, pathogenetic and therapeutic implications are discussed. The differential diagnosis of renal masses in these syndromes also is presented. PMID:3016342

  14. Studies on Budd-chiari syndrome complicated with hepatocellular carcinoma: most patients without inferior vena cava obstruction

    PubMed Central

    Dang, Xiaowei; Li, Luhao; Li, Suxin; Wang, Yafei; Li, Hai; Xu, Shaokai; Xu, Peiqin

    2015-01-01

    Background: To investigate the characteristics of Budd-Chiari syndrome (B-CS) types, rate of HCC complicated by different types of B-CS and values of CTA in diagnosis of B-CS and HCC complicated by B-CS. Material and Methods: 494 patients with B-CS were analyzed retrospectively. All patients underwent CTA, which was used to assess the accuracy of diagnosing B-CS and the rate of HCC complicated by various kinds of B-CS. Digital subtraction angiography (DSA) and pathological examination were used as gold standard. Results: Among 494 patients diagnosed by DSA, there were 21 (4.3%) cases of inferior vena cava type, 80 (16.2%) cases of hepatic vein type and 393 (79.6%) cases of hepatic vein combined with inferior vena cava complex type. The accuracy of diagnosing B-CS by CTA was 86.6% (428/494), in which the accuracy of diagnosing inferior vena cava type was 85.7% (18/21), 83.8% (67/80) for hepatic vein type and 87.3% (343/393) for complex type. The rate of HCC complicated by B-CS was 12.8% (63/494), among which inferior vena cava type was 4.8% (1/21), hepatic vein type was 11.3% (9/80) and complex type was 13.5% (53/393). There were no statistic differences between these three types (P=0.459). The accuracy of diagnosing HCC by CTA was 82.5% (52/63). Conclusion: B-CS in patients from China’s Yellow River basin is mainly hepatic vein combined with inferior vena cava complex type, which is more likely to be complicated by HCC. CTA plays an important role in diagnosing B-CS and HCC complicated by B-CS. PMID:26309561

  15. Right Double Inferior Vena Cava (IVC) with Preaortic Iliac Confluence - Case Report and Review of Literature.

    PubMed

    Babu, C S Ramesh; Lalwani, Rekha; Kumar, Indra

    2014-02-01

    Anomalies of the inferior vena cava (IVC) are uncommon and most of them remain asymptomatic. Though rare, anomalies of IVC can lead to severe hemorrhagic complications especially during aortoiliac surgery. Prior knowledge of these variations facilitates proper interpretation of radiological images and safe performance of interventional procedures and surgeries. During routine anatomical dissection of abdomen in a female cadaver we observed the presence of right sided duplication of IVC. Both IVCs were present on the right side of abdominal aorta, one ventral and the other more dorsal in position and named ventral right IVC and dorsal right IVC. The ventrally and medially placed IVC, which appeared to be the main IVC was formed by the union of two common iliac veins in front of the right common iliac artery (Preaortic iliac confluence-"Marsupial Cava"). The right external iliac vein continued as the more dorsally and laterally placed dorsal right IVC. The right internal iliac vein after receiving a transverse anastomotic vein from the external iliac continued as the right common iliac vein. This transverse anastomosis was present behind the right common iliac artery. The narrower dorsal right IVC joined the wider ventral right IVC just below the level of renal veins to form a single IVC. The abdominal aorta presented a convexity to the left.

  16. Modeling Flow Past a TrapEase Inferior Vena Cava Filter

    NASA Astrophysics Data System (ADS)

    Singer, Michael; Henshaw, William; Wang, Stephen

    2008-11-01

    This study uses three-dimensional computational fluid dynamics to evaluate the efficacy of the TrapEase inferior vena cava (IVC) filter. Hemodynamics of the unoccluded and partially occluded filter are examined, and the clinical implications are assessed. The IVC, which is the primary vein that drains the legs, is modeled as a straight pipe, and a geometrically accurate model of the filter is constructed using computer aided design. Blood is modeled as a homogeneous, incompressible, Newtonian fluid, and the method of overset grids is used to solve the Navier-Stokes equations. Results are corroborated with in-vitro studies. Flow around the unoccluded filter demonstrates minimal disruption, but spherical clots in the downstream trapping position lead to regions of stagnant and recirculating flow that may promote further clotting. The volume of stagnant flow and the peak wall shear stress increase with clot volume. For clots trapped in the upstream trapping position, flow is disrupted along the cava wall downstream of the clot and within the filter. The shape and location of trapped clots also effect the peak wall shear stress and may impact the efficacy of the filter.

  17. Deep venous thrombosis caused by congenital inferior vena cava agenesis and heterozygous factor V Leiden mutation – a case report

    PubMed Central

    Vasco, Pablo Guisado; López, Angel Ruedas; Piñeiro, María Laiño; Rivera, José Ignacio Gallego

    2009-01-01

    The unusual clinical presentation, importance of imaging techniques and role of low molecular weight heparin are described for an initial treatment of thrombosis in inferior vena cava agenesis associated with heterozygous factor V Leiden. The patient, a 36-year-old woman, presented to the emergency room with sudden onset of back pain, swelling of the legs and thighs, and claudication while walking. Abdominal ultrasonography was immediately ordered. Anomalies in vascular blood flow were detected. Computed tomography was performed, and initially showed a complete absence of the infrarenal segment of inferior vena cava caudally to the origin of both renal veins. Treatment with enoxaparin (1 mg/kg twice per day) was started. The patient was discharged and returned to her activities of daily living two weeks after admission. This vascular abnormality is mostly incidentally diagnosed in adults and only a few cases are described as being associated with thrombophilia. PMID:22477517

  18. Renal transplantation with venous drainage through the superior mesenteric vein in cases of thrombosis of the inferior vena cava.

    PubMed

    Aguirrezabalaga, Javier; Novas, Serafín; Veiga, Francisco; Chantada, Venancio; Rey, Ignacio; Gonzalez, Marcelino; Gomez, Manuel

    2002-08-15

    Renal transplantation usually is performed by placing the graft in the iliac fossa, anastomosing the renal vein to the iliac vein or, when this is not possible, to the vena cava. When vascular complications occur, particularly on the venous side, the position of the graft may have to be changed. This report describes orthotopic renal grafts and positioning of the organ with anastomosis to the splenic vessels. Venous drainage was established directly into the mesenteric-portal territory, with two cases to the portal vein and one to the inferior mesenteric vein. A new technique for the venous drainage of the renal graft is shown. We have used this model in two cases of infrarenal inferior vena cava thrombosis. The kidney was located in a retroperitoneal position, with venous drainage to the superior mesenteric vein through an orifice in the posterior peritoneum.

  19. You see what you know … gas bubbles in the inferior vena cava, an unusual presentation of necrotizing soft tissue infection.

    PubMed

    Winter, Thomas C; Rudolf, Lou; Sommers, Daniel N

    2015-06-01

    Gas detected within the systemic circulation as an unexpected finding is a very rare phenomenon. A case of multiple bubbles within the inferior vena cava detected incidentally during a sonogram requested to assess for portal vein thrombosis is presented. These were eventually determined to be sequelae of a fatal, clinically silent necrotizing soft tissue infection. The differential diagnosis for gas within the inferior vena cava is reviewed, and teaching points that may help future patients are presented.

  20. Fractured inferior vena cava filter strut presenting as a penetrating foreign body in the right ventricle: report of a case.

    PubMed

    Kumar, S Prathap; Mahtabifard, Ali; Young, J Nilas

    2008-01-01

    Migration of a fractured strut of an inferior vena cava (IVC) filter to the heart is a rare complication. We report the case of a 40-year-old woman who had this complication eight months after infrarenal IVC filter placement. She presented with chest pain. The broken arm of the IVC filter had migrated to the heart and penetrated the free wall of the right ventricle. It was removed successfully by cardiac surgery without the aid of cardiopulmonary bypass.

  1. Renal Artery Stump to Inferior Vena Cava Fistula: Unusual Clinical Presentation and Transcatheter Embolization with the Amplatzer Vascular Plug

    SciTech Connect

    Taneja, Manish; Lath, Narayan Soo, Tan Bien; Hiong, Tay Kiang; Htoo, Maung Myint; Richard, Lo; Fui, Alexander Chung Yaw

    2008-07-15

    Fistulous communication between the renal artery stump and inferior vena cava following nephrectomy is rare. We describe the case of a 52-year-old man with a fistula detected on investigation for hemolytic anemia in the postoperative period. The patient had had a nephrectomy performed 2 weeks prior to presentation for blunt abdominal trauma. The fistula was successfully occluded percutaneously using an Amplatzer vascular plug. The patient recovered completely and was discharged 2 weeks later.

  2. Management of Primitive Neuroectodermal Tumor of the Kidney with Inferior Vena Cava Thrombus

    PubMed Central

    Gupta, Sahil; Majumder, Kaustav; Chahal, Anurag; Saini, Ashish K.; Gupta, Arjun

    2016-01-01

    Primitive neuroectodermal tumors (PNET) are an aggressive group of small round cell tumors usually arising in the nervous system and affecting children. They have a tendency for local invasion, distant spread and formation of tumor thrombi. The kidney is a rare primary location for these tumors. Outcomes are frequently poor due to late diagnosis (Wilms tumor is a more common tumor in this population) and early spread. Immunohistochemistry is invaluable in making the diagnosis of PNET. We report a case of a primary renal PNET with extensive tumor thrombus into the inferior vena cava, and lung metastasis in a pediatric patient, and its successful management. Our 14-year-old patient with renal PNET was managed with radical nephrectomy, thrombectomy and chemotherapy and remains disease free to date. The diagnosis of renal PNETs should be considered in young adult patients who present with aggressive renal masses at initial presentations. Despite its aggressive nature, good outcomes can be achieved by a multimodality therapeutic strategy. PMID:26989372

  3. Histology of Tissue Adherent to OptEase Inferior Vena Cava Filters Regarding Indwelling Time

    SciTech Connect

    Rimon, Uri Volkov, Alexander; Garniek, Alexander; Golan, Gil; Bensaid, Paul; Khaitovich, Boris; Abu-Salah, Kamel; Zissin, Rivka; Simon, Daniel; Konen, Eli

    2009-01-15

    The purpose of this paper is to report on the histology of tissues found on retrieved filters with regard to indwelling time. Between February 2006 and January 2007, 28 Optease inferior vena cava filters (Cordis Europa, Roden, The Netherlands) were retrieved from 27 patients. Twenty-two filters were inserted prophylactically for trauma patients and six for patients with venous thromboembolism. Cavography was performed both before and after filter removal to evaluate the presence of thrombi or wall damage. Filters were retrieved with the snare and sheath method. All material adherents to the filters were examined histologically.The mean indwelling time of the filters was 24.9 days (range, 6-69 days). Red tissue fragments were seen on all the filters, consistent microscopically with clots and fibrin. On five filters (18%; mean indwelling time, 45.4 days) white tissue consistent with vascular intima was found. All postprocedure cavographies were normal. We conclude that most material adherent to the retrieved filters is thrombi, while vascular intima can be found in the minority of filters with a longer indwelling time.

  4. Computational Simulations of Inferior Vena Cava (IVC) Filter Placement and Hemodynamics in Patient-Specific Geometries

    NASA Astrophysics Data System (ADS)

    Aycock, Kenneth; Sastry, Shankar; Kim, Jibum; Shontz, Suzanne; Campbell, Robert; Manning, Keefe; Lynch, Frank; Craven, Brent

    2013-11-01

    A computational methodology for simulating inferior vena cava (IVC) filter placement and IVC hemodynamics was developed and tested on two patient-specific IVC geometries: a left-sided IVC, and an IVC with a retroaortic left renal vein. Virtual IVC filter placement was performed with finite element analysis (FEA) using non-linear material models and contact modeling, yielding maximum vein displacements of approximately 10% of the IVC diameters. Blood flow was then simulated using computational fluid dynamics (CFD) with four cases for each patient IVC: 1) an IVC only, 2) an IVC with a placed filter, 3) an IVC with a placed filter and a model embolus, all at resting flow conditions, and 4) an IVC with a placed filter and a model embolus at exercise flow conditions. Significant hemodynamic differences were observed between the two patient IVCs, with the development of a right-sided jet (all cases) and a larger stagnation region (cases 3-4) in the left-sided IVC. These results support further investigation of the effects of IVC filter placement on a patient-specific basis.

  5. Congenital agenesis of inferior vena cava: a rare cause of unprovoked deep venous thrombosis.

    PubMed

    Parsa, Pouria; Lane, John S; Barleben, Andrew R; Owens, Erik L; Bandyk, Dennis

    2015-07-01

    Congenital anomalies of the inferior vena cava (IVC), although rare, are a risk factor for lower limb deep venous thrombosis (DVT). A 19-year-old male presented with a left flank and groin pain caused by iliofemoral venous thrombosis. Vascular imaging by computed tomography (CT) scanning and venography demonstrated agenesis of the IVC. Catheter-directed thrombolysis via a popliteal vein was attempted but did not alter the patency of the common femoral vein outflow collaterals into the retroperitoneal azygous venous system. The patient was anticoagulated using systemic heparin infusion and clinical symptoms resolved within 5 days. He was transitioned to oral Coumadin anticoagulation, and follow-up venous duplex testing demonstrated no infrainguinal DVT and phasic venous flow with respiration in the femoral vein indicating patent collateral veins. Anomalies of the IVC are present in 0.3-0.5% of otherwise healthy individuals. Agenesis of the IVC has an incidence of 0.0005-1% in the general population but is found in almost 5% of patients <30 years of age with unprovoked lower limb DVT. In adults, IVC agenesis anomaly can cause diagnostic problems in the paravertebral area because of the tumor-like appearance of the azygous venous collaterals on noncontrast CT imaging. In young adults presenting with unprovoked lower limb DVT, the presence of an IVC anomaly should be considered and evaluated for by venous duplex testing and if necessary CT venography.

  6. Assessment of Snared-Loop Technique When Standard Retrieval of Inferior Vena Cava Filters Fails

    SciTech Connect

    Doody, Orla Noe, Geertje; Given, Mark F.; Foley, Peter T.; Lyon, Stuart M.

    2009-01-15

    Purpose To identify the success and complications related to a variant technique used to retrieve inferior vena cava filters when simple snare approach has failed. Methods A retrospective review of all Cook Guenther Tulip filters and Cook Celect filters retrieved between July 2006 and February 2008 was performed. During this period, 130 filter retrievals were attempted. In 33 cases, the standard retrieval technique failed. Retrieval was subsequently attempted with our modified retrieval technique. Results The retrieval was successful in 23 cases (mean dwell time, 171.84 days; range, 5-505 days) and unsuccessful in 10 cases (mean dwell time, 162.2 days; range, 94-360 days). Our filter retrievability rates increased from 74.6% with the standard retrieval method to 92.3% when the snared-loop technique was used. Unsuccessful retrieval was due to significant endothelialization (n = 9) and caval penetration by the filter (n = 1). A single complication occurred in the group, in a patient developing pulmonary emboli after attempted retrieval. Conclusion The technique we describe increased the retrievability of the two filters studied. Hook endothelialization is the main factor resulting in failed retrieval and continues to be a limitation with these filters.

  7. Disintegration of the 'waterfall phenomenon' in the inferior vena cava due to right heart failure.

    PubMed

    Kira, S; Dambara, T; Mieno, T; Tamaki, S; Natori, H

    1996-03-01

    The concept of the waterfall phenomenon in Zone 2 in the pulmonary vasculature is well known from West's lung model. It is believed that the flow through this zone is determined by the pressure difference between the pulmonary artery and alveoli, and the left atrial pressure is not transmissible to the alveolar capillaries. However, it is impossible to see whether alveolar capillaries are really displaying the waterfall phenomenon or not. In this review, the interrelation between the flow and geometry of the alveolar capillaries in the waterfall phenomenon is analyzed based on physiological studies using a model system and isolated lung lobe experiments. Further, extending the concept to the analysis of ventilatory changes of the inferior vena cava (IVC) configuration, it is ascertained that the waterfall phenomenon normally occurs in the IVC during inspiration just before it enters the thorax and the waterfall phenomenon in the IVC disintegrates with elevation of the central venous pressure. Because these configurations of the IVC in normal and abnormal conditions are visible with ultrasonography, the technique is very useful as a noninvasive approach to diagnose right heart failure.

  8. Management of inferior vena cava tumor thrombus in locally advanced renal cell carcinoma

    PubMed Central

    Psutka, Sarah P.

    2015-01-01

    The diagnosis of renal cell carcinoma is accompanied by intravascular tumor thrombus in up to 10% of cases, of which nearly one-third of patients also have concurrent metastatic disease. Surgical resection in the form of radical nephrectomy and caval thrombectomy represents the only option to obtain local control of the disease and is associated with durable oncologic control in approximately half of these patients. The objective of this clinical review is to outline the preoperative evaluation for, and operative management of patients with locally advanced renal cell carcinoma with venous tumor thrombi involving the inferior vena cava. Cornerstones of the management of these complex patients include obtaining high-quality imaging to characterize the renal mass and tumor thrombus preoperatively, with further intraoperative real-time evaluation using transesophageal echocardiography, careful surgical planning, and a multidisciplinary approach. Operative management of patients with high-level caval thrombi should be undertaken in high-volume centers by surgical teams with capacity for bypass and invasive intraoperative monitoring. In patients with metastatic disease at presentation, cytoreductive nephrectomy and tumor thrombectomy may be safely performed with simultaneous metastasectomy if possible. In the absence of level one evidence, neoadjuvant targeted therapy should continue to be viewed as experimental and should be employed under the auspices of a clinical trial. However, in patients with significant risk factors for postoperative complications and mortality, and especially in those with metastatic disease, consultation with medical oncology and frontline targeted therapy may be considered. PMID:26445601

  9. Adrenal cortical carcinoma with extension into the inferior vena cava – case report and literature review

    PubMed Central

    2014-01-01

    Adrenocortical carcinoma (ACC) is a rare endocrine malignancy with an incidence rate of 1 to 2 per million person-years. ACC most commonly arises sporadically, but may be associated with familial tumour syndromes. Clinical symptoms are mainly related to an excess of steroid hormones. We present an unusual case of adrenocortical carcinoma in a 27-year-old male who complained of non specific mass-effect related symptoms of slowly growing intensity differing from others described in literature because of the patient’s age and the sudden deterioration of the clinical course. The tumour was resected with the left kidney with an extension into the inferior vena cava. Histological examination revealed morphological features characteristic of an adrenal cortical tumour. The immunohistochemical results (positive reactions for vimentin, CD56, inhibin, melan A, synaptophysin, bcl-2, calretinin) confirmed the diagnosis. According to the most widely used modified Weiss criteria and the Van Slooten system, a diagnosis of adrenal cortical carcinoma was strongly confirmed. The postoperative condition was poor. Reoperation was conducted, including abdominal aorta thrombectomy and aortic prosthesis implantation. The patient died two days after the second operation. Autopsy revealed a metastatic tumour in the left lung and morphological symptoms of acute circulatory collapse due to a massive haemorrhage into the abdominal cavity, which was the direct cause of death. Virtual slides The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1602226377106882. PMID:24602387

  10. Transcatheter Arterial Chemoembolization for Advanced Hepatocellular Carcinoma with Inferior Vena Cava and Right Atrial Tumors

    SciTech Connect

    Chern, M. C. Chuang, V. P. Cheng, T. Lin, Z. H. Lin, Y. M.

    2008-07-15

    Advanced hepatocelluar carcinoma (HCC) with invasion of venous systems usually indicates not only a poor prognosis but also a contraindication for transcatheter arterial chemoembolization (TACE). This study evaluated the feasibility of TACE for advanced HCC with inferior vena cava (IVC) and right atrium (RA) tumors and, also, to search for the ideal embolization particle size. Twenty-six patients who had HCC invasion into the IVC included five patients with coexistent RA tumors that were treated with TACE. The chemoembolization method was cisplatin, doxorubicin, and mitomycin C mixed with Lipiodol and Ivalon. The selection of Ivalon particles was divided into two groups based on their size: (A) >180 {mu}m, N = 9; and (B) 47-180 {mu}m, N = 17. The overall response rate was 53.8% (14/26). Based on the response to TACE, the median survival period of the entire group was 4.2 months (range, 1.5 to 76.7 months). The median survival period of the 14 responders was 13.5 months (1.5-76.7 months), and that of the 12 nonresponders, 3.3 months (2.1 to 24.3 months) (p < 0.002). Comparing the two Ivalon particle sizes, the response rate was 12.5% (1/9 patients) for group A and 76.5% for group B (13/17 patients) (p < 0.02). No serious complication was observed post-chemoembolization. In conclusion, TACE is a safe and effective treatment for advanced HCC with IVC and RA tumors, and small Ivalon particles (47-180 {mu}m) are superior to large ones (>180 {mu}m).

  11. Indications, applications, and outcomes of inferior vena cava filters for venous thromboembolism in Japanese patients.

    PubMed

    Yamashita, Yugo; Unoki, Takashi; Takagi, Daisuke; Hamatani, Yasuhiro; Ishii, Mitsuru; Iguchi, Moritake; Ogawa, Hisashi; Masunaga, Nobutoyo; Wada, Hiromichi; Hasegawa, Koji; Abe, Mitsuru; Akao, Masaharu

    2016-07-01

    A recent multicenter registry study of venous thromboembolism (VTE) patients in Japan demonstrated a high prevalence of inferior vena cava (IVC) filter placement. However, data regarding indications, applications, and outcomes of IVC filters in Japanese patients are quite limited. This study was an observational, single-center, retrospective cohort study of all consecutive patients with acute VTE treated between March 2006 and February 2014. Data extracted included patient demographics, indications, applications, and complications of IVC filters, as well as VTE recurrence and death. A total of 257 consecutive patients were analyzed. Seventy-eight patients (30 %) received IVC filters. The proportions of IVC filter placement were 26 % for deep-vein thrombosis (DVT) alone, 10 % for pulmonary embolism (PE) alone, and 46 % for both DVT and PE. There was no significant difference in patient demographics between the IVC filter group and no-IVC filter group. Stated indications for filter placement were 24 cases (30 %) of DVT in intrapelvic veins, 16 cases (20 %) of DVT in proximal veins, and 11 cases (14 %) of contraindication to anticoagulant therapy. In the IVC filter group, cases of class I indication (guidelines: JCS 75:1258-1281, 2009) numbered only 6 (8 %). Many of the retrievable IVC filters were not removed and placed permanently and the retrieval rate was 42 %. We found complications of IVC filters in 8 cases (10 %). IVC filter placement was significantly associated with a better survival rate and a higher incidence of DVT recurrence during a mean observation period of 541 days. Our research suggests the frequent use of IVC filters for VTE treatment, combined with a low retrieval rate. Most of the stated indications of IVC filter placement for VTE in Japanese patients were cases of DVT in intrapelvic veins or proximal veins, not cases of contraindication to anticoagulant therapy.

  12. Successful Kidney Transplantation in Children With a Compromised Inferior Vena Cava

    PubMed Central

    Shishido, Seiichiro; Kawamura, Takeshi; Hamasaki, Yuko; Takahashi, Yusuke; Itabashi, Yoshihiro; Muramatsu, Masaki; Satoh, Hiroyuki; Aikawa, Atsushi

    2016-01-01

    Background Children with a compromised inferior vena cava (IVC) were previously considered unsuitable for kidney transplantation because of the technical difficulties and the increased risk of graft thrombosis secondary to inadequate renal venous outflow. Methods We conducted a retrospective study of 11 transplants in 9 patients with end-stage renal disease and thrombosed IVCs who received adult kidney allografts between 2000 and 2015. The mean age at transplantation was 7.5 ± 3.5 years. A pretransplant diagnosis of the IVC thrombosis was made in 7 patients by magnetic resonance imaging and computerized tomography, whereas there were 2 instances of intraoperative discovery of the IVC thrombosis. Results In the early cases, a kidney was placed intraperitoneally at the right iliac fossa with a venous anastomosis to the patent segment of the suprarenal IVC. After 2008, however, 6 adult-sized kidneys were subsequently placed in the left orthotopic position. Venous drainage was attained to the infrahepatic IVC (n = 3), left native renal vein (n = 2), and ascending lumbar vein (n = 1). Moreover, a venous bypass was created between the graft and the splenic vein in 2 children who showed high return pressure after the vessel was declamped. The mean glomerular filtration rate of the functioning 8 grafts 1 year posttransplant was 73.4 ± 20.4 mL/min per 1.73 m2. Of note, 6 of the grafts have been functioning well, with a mean follow-up of 66 months. Both 1- and 5-year graft survival were 81.8%. Conclusions Transplantation into the left orthotopic position and the revascularization methods are an effective set of surgical techniques that could potentially be adopted as safe and reliable transplant approaches in children with IVC thrombosis. PMID:27500272

  13. Polymer-Based Reconstruction of the Inferior Vena Cava in Rat: Stem Cells or RGD Peptide?

    PubMed Central

    Pontailler, Margaux; Illangakoon, Eranka; Williams, Gareth R.; Marijon, Camille; Bellamy, Valérie; Balvay, Daniel; Autret, Gwenhael; Vanneaux, Valérie; Larghero, Jérôme; Planat-Benard, Valérie; Perier, Marie-Cécile; Bruneval, Patrick; Menasché, Philippe

    2015-01-01

    As part of a program targeted at developing a resorbable valved tube for replacement of the right ventricular outflow tract, we compared three biopolymers (polyurethane [PU], polyhydroxyalkanoate (the poly(3-hydroxybutyrate-co-3-hydroxyvalerate-co-4-hydroxyvalerate) [PHBVV]), and polydioxanone [PDO]) and two biofunctionalization techniques (using adipose-derived stem cells [ADSCs] or the arginine-glycine-aspartate [RGD] peptide) in a rat model of partial inferior vena cava (IVC) replacement. Fifty-three Wistar rats first underwent partial replacement of the IVC with an acellular electrospun PDO, PU, or PHBVV patch, and 31 nude rats subsequently underwent the same procedure using a PDO patch biofunctionalized either by ADSC or RGD. Results were assessed both in vitro (proliferation and survival of ADSC seeded onto the different materials) and in vivo by magnetic resonance imaging (MRI), histology, immunohistochemistry [against markers of vascular cells (von Willebrand factor [vWF], smooth muscle actin [SMA]), and macrophages ([ED1 and ED2] immunostaining)], and enzyme-linked immunosorbent assay (ELISA; for the expression of various cytokines and inducible NO synthase). PDO showed the best in vitro properties. Six weeks after implantation, MRI did not detect significant luminal changes in any group. All biopolymers were evenly lined by vWF-positive cells, but only PDO and PHBVV showed a continuous layer of SMA-positive cells at 3 months. PU patches resulted in a marked granulomatous inflammatory reaction. The ADSC and RGD biofunctionalization yielded similar outcomes. These data confirm the good biocompatibility of PDO and support the concept that appropriately peptide-functionalized polymers may be successfully substituted for cell-loaded materials. PMID:25611092

  14. Laparoscopic radical nephrectomy with inferior vena cava thrombectomy: highlight of key surgical steps

    PubMed Central

    Sim, A.; Todenhöfer, T.; Mischinger, J.; Fahmy, O.; Boettge, J.; Rausch, S.; Bier, S.; Aufderklamm, S.; Stenzl, A.; Gakis, G.; Schwentner, C.

    2016-01-01

    ABSTRACT Objective: Vascular involvement in the form of renal vein (RV) or inferior vena cava (IVC) thrombus can be seen in 4-10% of patients presented with RCC. In patients without presence of metastasis, surgical treatment in the form of radical nephrectomy remains the treatment of choice with 5-year survival rates of 45-70%. Open surgery is still the first treatment option of choice at the moment for RCC patients with IVC thrombus. Materials and Methods: In our study, we are reporting a case of patient with RCC and level I IVC thrombus treated with laparoscopy. Our patient is a 72 years old man with underlying co-morbidity of hypertension and chronic kidney disease (CKD) presented with right-sided RCC. The CT scan done showed a large right renal upper pole tumor measuring 8.4x5.2cm with level I IVC thrombus (Figure-1). There were no regional lymphadenopathy and the staging scans were negative. Results: The operative time was 124 minutes and blood loss was minimal. The patient was progressed to diet on POD 1 with bowel movement on POD 2. There was no significant change in the pre and post-operative glomerular filtration rate (GFR). The surgical drain was removed on POD2. The patient was discharged well on POD 5. There were no perioperative complications. The pathology was pT3bN0M0 Fuhrman grade II clear cell RCC. Conclusions: As a conclusion, laparoscopic radical nephrectomy and IVC thrombectomy is a complex and technically demanding surgery. With advancement of surgical skills as well as technology, more cases of minimally invasive laparoscopic radical nephrectomy and IVC thrombectomy can performed to improve the perioperative outcomes of carefully selected patients in a high volume center. PMID:27564306

  15. Inferior Vena Cava Thrombosis in Young Adults – a review of two cases

    PubMed Central

    McAree, Barry J; O'Donnell, Mark E; Boyd, Chris; Spence, Roy AJ; Lee, Bernard; Soong, Chee V

    2009-01-01

    We present two cases of clinically extensive bilateral DVTs associated with inferior vena caval thrombosis. Young patients presenting with symptoms of DVT should be investigated not only to establish any thrombophilic pre-disposition, but to ascertain the proximal extent of thrombus which may itself influence treatment. PMID:19568450

  16. Use of a Trellis Device for Endovascular Treatment of Venous Thrombosis Involving a Duplicated Inferior Vena Cava

    SciTech Connect

    Saettele, Megan R.; Morelli, John N.; Chesis, Paul; Wible, Brandt C.

    2013-12-15

    Congenital anomalies of the inferior vena cava (IVC) are increasingly recognized with CT and venography techniques. Although many patients with IVC anomalies are asymptomatic, recent studies have suggested an association with venous thromboembolism. We report the case of a 62-year-old woman with extensive venous clot involving the infrarenal segment of a duplicated left IVC who underwent pharmacomechanical thrombectomy and tissue plasminogen activator catheter-directed thrombolysis with complete deep venous thrombosis resolution. To our knowledge this is the first reported case in the English literature of the use of a Trellis thrombectomy catheter in the setting of duplicated IVC.

  17. Acute Kidney Injury Associated with Renal Cell Carcinoma Complicated by Renal Vein and Inferior Vena Cava Involvement.

    PubMed

    Sugase, Taro; Akimoto, Tetsu; Kubo, Taro; Imai, Toshimi; Otani-Takei, Naoko; Miki, Takuya; Takeda, Shin-Ichi; Nukui, Akinori; Muto, Shigeaki; Morita, Tatsuo; Nagata, Daisuke

    2016-01-01

    Acute kidney injury (AKI) is caused by diverse pathologies, although it may occasionally result from concurrent renal efflux disturbances. We herein describe a case of AKI in a patient complicated by renal cell carcinoma (RCC) with renal vein and inferior vena cava (IVC) involvement. A neoplastic thrombus which disrupted the blood flow in the renal vein appeared to play a role in the rapid decline in the renal function. Such a scenario has rarely been mentioned in the previous literature describing the cases of RCC complicated by AKI. Concerns regarding the diagnostic and therapeutic strategies for RCC are also discussed. PMID:27580548

  18. CT Findings of Intrarenal Yolk Sac Tumor with Tumor Thrombus Extending into the Inferior Vena Cava: A Case Report

    PubMed Central

    Lin, ShaoChun; Li, XueHua; Feng, ShiTing; Peng, ZhenPeng; Huang, SiYun; Li, ZiPing

    2014-01-01

    Yolk sac tumor (YST) is a rare germ cell neoplasm of childhood that usually arises from the testis or ovary. The rare cases of YST in various extragonadal locations have been reported, but the primary intrarenal YST is even more uncommon. Here, we report a case of a primary intrarenal YST with tumor thrombus of the inferior vena cava and left renal vein in a 2-year-old boy, with an emphasis on the CT features. To our knowledge, this is the first reported case of an intrarenal YST with intravascular involvement. PMID:25246826

  19. Congenital anomaly of the inferior vena cava and factor V Leiden mutation predisposing to deep vein thrombosis.

    PubMed

    Lamparello, Brooke M; Erickson, Cameron R; Kulthia, Arun; Virparia, Vasudev; Thet, Zeyar

    2014-01-01

    A previously healthy 21-year-old man presented with back pain, bilateral extremity pain, and right lower extremity weakness, paresthesias, and swelling. Sonographic examination revealed diffuse deep vein thrombosis (DVT) in the femoral and popliteal venous system. CT imaging revealed hypoplasia of the hepatic inferior vena cava (IVC) segment with formation of multiple varices and collateral veins around the kidneys. Hematologic workup also discovered a factor V Leiden mutation, further predisposing the patient to DVT. The rare, often overlooked occurrence of attenuated IVC, especially in the setting of hypercoagulable state, can predispose patients to significant thrombosis.

  20. Catheter-Directed Thrombolysis of Inferior Vena Cava Thrombosis in a 13-Day-Old Neonate and Review of Literature

    SciTech Connect

    Khan, Jawad U.; Takemoto, Clifford M.; Casella, James F.; Streiff, Michael B.; Nwankwo, Ikechi J.; Kim, Hyun S.

    2008-07-15

    Complete inferior vena cava thrombosis (IVC) in neonates is uncommon, but may cause significant morbidity. A 13-day-old neonate suffered IVC thrombosis secondary to antithrombin III deficiency, possibly contributed to by a mutation in the methyl tetrahydrofolate reductase gene. Catheter-directed thrombolysis (CDT) with recombinant tissue plasminogen activator (rt-PA, Alteplase) was used successfully to treat extensive venous thrombosis in this neonate without complications. We also review the literature on CDT for treatment of IVC thrombosis in critically ill neonates and infants.

  1. Nickel hypersensitivity in patients with inferior vena cava filters: case report and literature and MAUDE database review.

    PubMed

    Morshedi, Maud M; Kinney, Thomas B

    2014-08-01

    Placement of a prophylactic retrievable inferior vena cava (IVC) filter was requested in a 73-year-old woman with nickel hypersensitivity resulting in a clinical dilemma. Given that all retrievable filters contain nickel, the published literature and the Manufacturer and User Facility Device Experience (MAUDE) database were reviewed; no documented case of IVC filter placement in a patient with nickel hypersensitivity or reported hypersensitivity reaction in a patient after IVC filter placement could be identified. This article presents the uneventful course of the case described and a review of the literature and recommendations on use of nickel-containing devices in patients with nickel hypersensitivity.

  2. Congenital anomaly of the inferior vena cava and factor V Leiden mutation predisposing to deep vein thrombosis

    PubMed Central

    Lamparello, Brooke M; Erickson, Cameron R; Kulthia, Arun; Virparia, Vasudev; Thet, Zeyar

    2014-01-01

    A previously healthy 21-year-old man presented with back pain, bilateral extremity pain, and right lower extremity weakness, paresthesias, and swelling. Sonographic examination revealed diffuse deep vein thrombosis (DVT) in the femoral and popliteal venous system. CT imaging revealed hypoplasia of the hepatic inferior vena cava (IVC) segment with formation of multiple varices and collateral veins around the kidneys. Hematologic workup also discovered a factor V Leiden mutation, further predisposing the patient to DVT. The rare, often overlooked occurrence of attenuated IVC, especially in the setting of hypercoagulable state, can predispose patients to significant thrombosis. PMID:25395858

  3. The role for prophylaxis inferior vena cava filters in patients undergoing bariatric surgery: replacing anecdote with evidence.

    PubMed

    Shamian, Ben; Chamberlain, Ronald S

    2012-12-01

    The number of patients choosing surgical alternatives for weight reduction continues to increase. Despite common thromboembolic preventive methods, which include perioperative subcutaneous heparin injections, early mobilization, and sequential compression devices, postoperative deep vein thrombosis/pulmonary embolism remains a devastating complication after bariatric surgery. The role prophylactic inferior vena cava (IVC) filters may play in bariatric surgery remains controversial, and this article aims to address the risks and benefits of prophylactic IVC filters in high-risk bariatric patients and suggest an evidence-based algorithm for their use.

  4. [THE CHOICE OF SURGICAL TREATMENT METHOD FOR THE DEEP VEINS THROMBOSIS IN SYSTEM OF VENA CAVA INFERIOR].

    PubMed

    Rusyn, V I; Korsak, V V; Popovych, Ya M; Boyko, S O

    2015-05-01

    There were analyzed the results of examination and treatment of 455 patients, suffering deep veins thrombosis in a system of vena cava inferior, of whom 175 (38.5%) were operated on. Inclusion of ultrasound duplex scanning, roentgencontrast phlebography, multispiral computer tomography with intravenous contrasting, radionuclide phleboscintigraphy into complex of clinic-instrumental examination of the patients gives possibility to estimate the disorders of the main trunk and collateral venous blood flow in the deep veins thrombosis, as well as to substantiate indications and choice of the operative treatment method.

  5. Physiologic Effect of Stent Therapy for Inferior Vena Cava Obstruction Due to Malignant Liver Tumor

    SciTech Connect

    Kishi, Kazushi Sonomura, Tetsuo; Fujimoto, Hisashi; Kimura, Masashi; Yamada, Katsuya; Sato, Morio; Juri, Masanobu

    2006-02-15

    Purpose. To understand systemic the influence of stent therapy for inferior vena cava (IVC) obstruction due to advanced liver tumor. Methods. Seven patients with symptomatic IVC obstruction due to advanced primary (n 4) or secondary (n = 3) liver tumor were subjected to stent therapy. Enrollment criteria included high IVC pressure over 15 mmHg and the presence of edema and ascites. Z-stents were deployed using coaxial sheath technique via femoral venous puncture. Physiologic and hematobiochemical parameters were analyzed. Results. All procedures were successful, and the stents remained patent until patient death. Promptly after stent placement, the IVC flow recovered, and the venous blood pressure in the IVC below the obstruction level showed a significant decrease from 20.8 {+-} 1.2 mmHg (mean {+-} SE) to 10.7 {+-} 0.7 mmHg (p < 0.01). Transient mild increase of right atrial pressure was observed in 1 patient. During the following week prominent diuresis was observed in all patients. Mean urine output volume in the 3 days before the stent therapy was 0.81 {+-} 0.09 l/day compared with 2.1 {+-} 0.2 l/day (p < 0.01) in the 3 days after. The edema and ascites decreased in all patients. The caval pressure change correlated well (r > 0.6) with the urine volume increase, and with the decreased volume of edema and ascites. The urine volume increase correlated well with the decrement of edema, but not with that of ascites. Improvements for various durations in the levels of blood urea nitrogen, serum creatinine, lactate dehydrogenase, fibrinogen, and platelet count were found (p < 0.05). These hematobiochemical changes were well correlated with each other and with the decrement of ascites. Two patients showed a low blood sodium level of 128.5 mEq/l after intensive natriuresis, and one of them died on day 21 with hepatic failure, which was interpreted as maladaptation aggravation. The mean survival time was 94.1 {+-} 34.1 days (mean {+-} SD), ranging from 21 to 140 days

  6. British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry

    SciTech Connect

    Uberoi, Raman Tapping, Charles Ross; Chalmers, Nicholas; Allgar, Victoria

    2013-12-15

    Purpose: The British Society of Interventional Radiology (BSIR) Inferior Vena Cava (IVC) Filter Registry was produced to provide an audit of current United Kingdom (UK) practice regarding placement and retrieval of IVC filters to address concerns regarding their safety. Methods: The IVC filter registry is a web-based registry, launched by the BSIR on behalf of its membership in October 2007. This report is based on prospectively collected data from October 2007 to March 2011. This report contains analysis of data on 1,434 IVC filter placements and 400 attempted retrievals performed at 68 UK centers. Data collected included patient demographics, insertion and retrieval data, and patient follow-up. Results: IVC filter use in the majority of patients in the UK follows accepted CIRSE guidelines. Filter placement is usually a low-risk procedure, with a low major complication rate (<0.5 %). Cook Gunther Tulip (560 filters: 39 %) and Celect (359 filters: 25 %) filters constituted the majority of IVC filters inserted, with Bard G2, Recovery filters, Cordis Trapease, and OptEase constituting most of the remainder (445 filters: 31 %). More than 96 % of IVC filters deployed as intended. Operator inexperience (<25 procedure) was significantly associated with complications (p < 0.001). Of the IVC filters initially intended for temporary placement, retrieval was attempted in 78 %. Of these retrieval was technically successful in 83 %. Successful retrieval was significantly reduced for implants left in situ for >9 weeks versus those with a shorter dwell time. New lower limb deep vein thrombosis (DVT) and/or IVC thrombosis was reported in 88 patients following filter placement, there was no significant difference of incidence between filter types. Conclusions: This registry report provides interventional radiologists and clinicians with an improved understanding of the technical aspects of IVC filter placement to help improve practice, and the potential consequences of IVC filter

  7. Use of Retrievable Compared to Permanent Inferior Vena Cava Filters: A Single-Institution Experience

    SciTech Connect

    Ha, Thuong G. Van Chien, Andy S.; Funaki, Brian S.; Lorenz, Jonathan; Piano, Giancarlo; Shen, Maxine; Leef, Jeffrey

    2008-03-15

    The purpose of this study was to review the use, safety, and efficacy of retrievable inferior vena cava (IVC) filters in their first 5 years of availability at our institution. Comparison was made with permanent filters placed in the same period. A retrospective review of IVC filter implantations was performed from September, 1999, to September, 2004, in our department. These included both retrievable and permanent filters. The Recovery nitinol and Guenther tulip filters were used as retrievable filters. The frequency of retrievable filter used was calculated. Clinical data and technical data related to filter placement were reviewed. Outcomes, including pulmonary embolism, complications associated with placement, retrieval, or indwelling, were calculated. During the study period, 604 IVC filters were placed. Of these, 97 retrievable filters (16%) were placed in 96 patients. There were 53 Recovery filter and 44 Tulip filter insertions. Subjects were 59 women and 37 men; the mean age was 52 years, with a range of from 18 to 97 years. The placement of retrievable filters increased from 2% in year 1 to 32% in year 5 of the study period. The total implantation time for the permanent group was 145,450 days, with an average of 288 days (range, 33-1811 days). For the retrievable group, the total implantation time was 21,671 days, with an average of 226 days (range, 2-1217 days). Of 29 patients who returned for filter retrieval, the filter was successfully removed in 28. There were 14 of 14 successful Tulip filter retrievals and 14 of 15 successful Recovery filter retrievals. In one patient, after an indwelling period of 39 days, a Recovery nitinol filter could not be removed secondary to a large clot burden within the filter. For the filters that were removed, the mean dwell time was 50 days for the Tulip type and 20 days for the Recovery type. Over the follow-up period there was an overall PE incidence of 1.4% for the permanent group and 1% for the retrieval group. In

  8. Guenther Tulip Filter Retrieval from a Left-sided Inferior Vena Cava

    SciTech Connect

    Brountzos, Elias N.; Kaufman, John A. Lakin, Paul L.

    2004-01-15

    Optional (retrievable) inferior cava filters (IVC) may have advantages over permanent filters in a certain subset of patients, especially in view of recent concerns about the long-term thrombotic complications of the latter. Retrieval of the Guenther Tulip Filter (GTF), an optional filter, has been reported in a total of 76 patients. We present the first description of GTF retrieval from a left-sided IVC using the right internal jugular approach.

  9. Calcific thrombi of the inferior vena cava in infants and children.

    PubMed

    Schullinger, J N; Santulli, T V; Berdon, W E; Wigger, H J; MacMillan, R W; Demartini, P D; Baker, D H

    1978-08-01

    Calcified caval thrombus should be considered in any infant or child where calcifications are noted in the high right retroperitoneal area on plain x-rays of the abdomen. Although typically bullet-shaped in configuration, the calcium distribution in the neonate may be atypical or incompletely developed, suggesting neuroblastoma. Definitive diagnosis can be made by inferior vena cavagram. As no deaths or complications have been attributed to the lesion in the cases thus far reported, no specific treatment is recommended.

  10. Biaxial Mechanical Properties of the Inferior Vena Cava in C57BL/6 and CB-17 SCID/bg Mice

    PubMed Central

    Lee, Y.U.; Naito, Y.; Kurobe, H.; Breuer, C.K.; Humphrey, J.D.

    2013-01-01

    Multiple murine models have proven useful in studying the natural history of neovessel development in the tissue engineering of vascular grafts. Nevertheless, to better understand longitudinal changes in the biomechanics of such neovessels, we must first quantify native tissue structure and properties. In this paper, we present the first biaxial mechanical data for, and nonlinear constitutive modeling of, the inferior vena cava from two models used in tissue engineering: wild-type C57BL/6 and immunodeficient CB-17 SCID/bg mice. Results show that inferior vena cava from the latter are significantly stiffer in the circumferential direction, both materially (as assessed by a stored energy function) and structurally (as assessed by the compliance), despite a lower intramural content of fibrillar collagen and similar wall thickness. Quantifying the natural history of neovessel development in different hosts could lead to increased insight into the mechanisms by which cells fashion and maintain extracellular matrix in order to match best the host stiffness while ensuring sufficient vascular integrity. PMID:23859752

  11. Can the Right Kidney be Salvaged in the Surgical Management of Leiomyosarcoma of the Inferior Vena Cava-a Rare Case Report.

    PubMed

    Chakrabarti, Suvadip; Agarwal, Deepak; Desai, Sanjay M; Mehta, Dharmendra Y

    2016-09-01

    Primary leiomyosarcoma is rare malignant tumour arising from the smooth muscles and can appear at any site where smooth muscle is present. It is more common in the peripheral vessels and has predilection for the female sex. We here report a rare case of leiomyosarcoma involving the segment I & II of inferior vena cava with extension into the renal veins in a 70 year old male patient. Midline transperitoneal approach was taken to excise the tumour along with the vessel wall with anastomosis between the right renal vein and the infrarenal inferior vena cava with a reversed great saphenous vein graft thereby salvaging the right kidney. PMID:27651700

  12. Sonographic assessment of the inferior vena cava/aorta index measured with the transducer placed in the anterior median line and right anterior axillary line – a comparison

    PubMed Central

    Łoś, Magdalena; Szmygel, Łukasz; Kosiak, Wojciech

    2014-01-01

    The aim of the study was to compare the values of the sonographic inferior vena cava/ aorta index obtained with the transducer placed in the median line and right anterior axillary line. Material and methods The study enrolled 45 volunteers, including 33 women, aged 22.5 ± 1.26 with a negative history of circulatory and renal diseases. The study consisted in a sonographic assessment and measurement of the inferior vena cava and aorta by placing the transducer in the anterior median line and right anterior axillary line. The value of the inferior vena cava/aorta index was obtained by calculating the ratio of the diameters of the inferior vena cava and aorta. The diameter measurements were taken by placing the ultrasound transducer in the anterior median line and right anterior axillary line. Two examiners performed the measurement three times and used convex probes of 3.5–5 MHz. Additionally, the subjects’ weight, height and arterial blood pressure were taken. Results Following a statistical analysis with the use of STATISTICA software, the following values of the inferior vena cava/aorta index were obtained: in the anterior median line – 1.43 ± 0.21, and in the right anterior axillary line – 1.285 ± 0.19. There was no statistically significant difference between the measurements obtained by the two examiners (p = 0.17). A strong correlation was noted between the inferior vena cava/ aorta indices calculated in both sites of transducer placement, which was irrespective of the examiners (the correlation coefficient: r = 0.61 and r = 0.71). The study indicate that the inferior vena cava/aorta index measured in the right anterior axillary line is a simple and reproducible method for determining the body fluid status; the examinations conducted in both sites may be used interchangeably. Further studies are needed to determine reference values for the inferior vena cava/aorta index measured in the right anterior axillary line. PMID:26674356

  13. Extensive Thrombosis of the Inferior Vena Cava and Left Renal Vein in a Neonate.

    PubMed

    Kdous, Moez; Khlifi, Oussema; Brahem, Marwene; Khrouf, Mohamed; Amari, Sarah; Ferchiou, Monia; Zhioua, Fethi

    2015-01-01

    Antenatal renal vein thrombosis is a rarely described diagnostic finding, with variable consequences on kidney function. We present the case of an affected fetus, born at 35-week gestation, with intrauterine oligohydramnios and two small kidneys. A renal ultrasound carried out after birth confirmed the presence of prenatal abnormalities. Renal vein thrombosis was not diagnosed at the time. The baby died 20 days later of kidney failure, metabolic acidosis, and polypnea with severe hypotrophy. Autopsy revealed atrophied kidneys and adrenal glands. The vena cava had thrombosis occupying most of its length. The right renal vein was normal, while the left renal vein was threadlike and not permeable. Histologically, there was necrosis of the left adrenal gland with asymmetrical bilateral renal impairment and signs of ischemic and hemorrhagic lesions. A review of thrombophilia was carried out and a heterozygous mutation in Factor V was found in both the mother and the child.

  14. Experimental investigation of the effects of inserting a bovine venous valve in the inferior vena cava of Fontan circulation

    NASA Astrophysics Data System (ADS)

    Santhanakrishnan, Arvind; Johnson, Jacob; Kotz, Monica; Tang, Elaine; Khiabani, Reza; Yoganathan, Ajit; Maher, Kevin

    2012-11-01

    The Fontan procedure is a palliative surgery performed on patients with single ventricle (SV) congenital heart defects. The SV is used for systemic circulation and the venous return from the inferior vena cava (IVC) and superior vena cava (SVC) is routed to the pulmonary arteries (PA), resulting in a total cavopulmonary connection (TCPC). Hepatic venous hypertension is commonly manifested in the Fontan circulation, leading to long-term complications including liver congestion and cirrhosis. Respiratory intrathoracic pressure changes affect the venous return from the IVC to the PA. Using a physical model of an idealized TCPC, we examine placement of a unidirectional bovine venous valve within the IVC as a method of alleviating hepatic venous hypertension. A piston pump is used to provide pulsatility in the internal flow through the TCPC, while intrathoracic pressure fluctuations are imposed on the external walls of the model using a pair of linear actuators. When implanted in the extrathoracic position, the hepatic venous pressure is lowered from baseline condition. The effects of changing caval flow distribution and intrathoracic pressure on TCPC hemodynamics will be examined.

  15. A Giant Mesenteric Desmoid Tumor Revealed by Acute Pulmonary Embolism due to Compression of the Inferior Vena Cava

    PubMed Central

    Palladino, Elisa; Nsenda, Joseph; Siboni, Renaud; Lechner, Christian

    2014-01-01

    Patient: Male, 69 Final Diagnosis: Mesenteric desmoid tumor Symptoms: — Medication: — Clinical Procedure: — Specialty: Surgery Objective: Rare disease Background: Intra-abdominal fibromatosis is a benign rare tumor of fibrous origin with a significant potential for local invasion and no ability to metastasize, but it can recur. The etiology of desmoid tumors is unknown. It is often associated with conditions such as familial adenomatous polyposis and Gardner syndrome. Case Report: We report the case of a 69-year-old man who presented to our hospital with an acute pulmonary embolism. The patient had a past history of colic surgery for a polyp with a high-grade dysplasia. Pulmonary angiography showed partial occlusion of the right superior lobe artery and partial occlusion of the middle lobe artery. The patient was given thrombolytic therapy. Abdominal computerized tomography revealed a mesenterial giant mass with compression of the inferior vena cava (IVC). A biopsy of the mass, confirming aggressive fibromatosis. A laparotomy was performed, which revealed a massive growth occupying the abdomen and attached to the previous ileocolic anastomosis. One day after surgery, his condition deteriorated. Conclusions: This report underlines the potential of imaging investigations of abdomen and vena cava if pulmonary embolism is suspected, especially when there is no evidence of peripheral venous thrombosis or other predisposing factors. Unfortunately, data on the surgical management of desmoid tumor is scarce. Therefore, the standard of treatment is a surgical resection for resectable tumors. PMID:25180474

  16. [Inferior vena cava thrombosis reaching the right atrium after removal of the central venous catheter at femoral vein in a patient with diabetic ketoacidosis].

    PubMed

    Morita, Yoko; Ariyama, Jun; Mieda, Tsutomu; Terao, Kazuhisa; Ueshima, Hironobu; Imanishi, Hirokazu; Kitamura, Akira

    2014-05-01

    A 19-year-old male was admitted with diabetic ketoacidosis. A central venous catheter for fluid loading and insulin administration was inserted from the right femoral vein. The catheter was placed for 4days and was removal. Three days after removal thrombus was pointed out with echocardiography. Cardiac ultrasound revealed floating thrombi in the right atrium. Venography demonstrated a large thrombus from the right femoral vein to the end of the inferior vena cava. Emergency surgery was performed. A tubular thrombus was trapped from the inferior vena cava departure at the right atrium under cardiopulmonary bypass. The surgeon also implanted an inferior vena caval filter. The patient was weaned from ventilator assist next day and was discharged from the hospital 13 days later. This case suggests that deep vein thrombosis should be checked in diabetic ketoacidosis even after removal of a central venous catheter implanted at the femoral vein.

  17. CT-Guided Percutaneous Fine-Needle Aspiration Biopsy of the Inferior Vena Cava Wall: A Posterior Coaxial Approach

    SciTech Connect

    Kos, Sebastian Bilecen, Deniz; Baumhoer, Daniel; Guillaume, Nicolas; Jacob, Augustinus L.

    2010-02-15

    A 72-year-old man was referred to our department with an incidentally diagnosed bronchogenic carcinoma of the right upper lobe. Positron emission tomography (PET) combined with computed tomography (PET-CT) revealed an unexpected hot spot in the ventral wall of the infrarenal segment of the inferior vena cava (IVC). Diagnostic biopsy of this lesion was performed under CT guidance with semiautomated 20G fine-needle aspiration (FNA) through a 19G coaxial needle. Cytology revealed few carcinoma cells, which led to the remarkable diagnosis of a distant metastasis to the IVC wall. Both the immediate postinterventional CT control and the further surveillance period of the patient were unremarkable; in particular, no signs of bleeding complications were detected. We conclude that coaxial FNA of an IVC wall lesion is technically feasible and may even help diagnose distant metastasis.

  18. Streptococcus constellatus Causing Septic Thrombophlebitis of the Right Ovarian Vein with Extension into the Inferior Vena Cava

    PubMed Central

    Haidar, Abdallah; Haddad, Amy; Naqvi, Amir; Onyesoh, Ngozi U.; Malik, Rushdah; Williams, Michael

    2015-01-01

    Introduction. Streptococcus constellatus collectively with Streptococcus anginosus and Streptococcus intermedius constitute the Streptococcus anginosus (formerly Streptococcus milleri) group. Though they are commonly associated with abscesses, bacteremia with subsequent septic thrombophlebitis is extremely rare, and resulting mortality is infrequent. Case Presentation. We report a case of a previously healthy 60-year-old African American female who presented with Streptococcus constellatus bacteremia associated with septic thrombophlebitis to the right ovarian vein extending into the inferior vena cava. She was urgently treated with antibiotics and anticoagulation. Conclusion. Septic thrombophlebitis has a clinical presentation that is often misleading. Therefore, a high clinical index of suspicion and the use of appropriate imaging modalities (computed tomography) are essential in recognizing and confirming this diagnosis. Prompt treatment is warranted. Surgical thrombectomies have been successfully replaced by a combination of antibiotics and anticoagulation therapy. PMID:26171262

  19. The Transmediastinal, Intrapericardial Inferior Vena Cava Approach for Hepatectomy of a Large Liver Tumor Invading the Hepatic Vein Confluence.

    PubMed

    Tohyama, Taiji; Tamura, Kei; Takai, Akihiro; Hatano, Masahide; Kageyama, Shoichi; Inoue, Hitoshi; Watanabe, Jota; Takada, Yasutsugu

    2015-05-01

    We report the case of a large multilocular upper liver tumor invading the hepatic vein confluence in a 41-year-old male, and the safe resection of the tumor using a transmediastinal, intrapericardial inferior vena cava (IVC) approach. Several methods for exposing suprahepatic IVCs on the cranial side of the diaphragm have been reported. However, the approach to supradiaphragmatic IVCs varies, and there are currently no reports that provide a detailed description of the anatomical landmarks during the intrapericardial IVC approach. In the case reported herein, anatomic landmarks, including the prepericardial fat in the pericardial trigone, were confirmed during the transmediastinal, intrapericardial IVC approach. We believe that such anatomic landmarks are important to ensure a safe approach to the pericardium and the intrapericardial IVC through the anterior mediastinum. We think this case report is useful in elucidating the resection of large liver tumors invading the hepatic vein confluence.

  20. Permanent versus Retrievable Inferior Vena Cava Filters: Rethinking the "One-Filter-for-All" Approach to Mechanical Thromboembolic Prophylaxis.

    PubMed

    Ghatan, Christine E; Ryu, Robert K

    2016-06-01

    Inferior vena cava (IVC) filtration for thromboembolic protection is not without risks, and there are important differences among commercially available IVC filters. While retrievable filters are approved for permanent implantation, they may be associated with higher device-related complications in the long term when compared with permanent filters. Prospective patient selection in determining which patients might be better served by permanent or retrievable filter devices is central to resource optimization, in addition to improved clinical follow-up and a concerted effort to retrieve filters when no longer needed. This article highlights the differences between permanent and retrievable devices, describes the interplay between these differences and the clinical indications for IVC filtration, advises against a "one-filter-for-all" approach to mechanical thromboembolic prophylaxis, and discusses strategies for optimizing personalized device selection.

  1. Retrievable Inferior Vena Cava Filters Can Be Placed and Removed with a High Degree of Success: Initial Experience

    PubMed Central

    Cohoon, Kevin P.; McBride, Joseph; Friese, Jeremy L.; McPhail, Ian R.

    2014-01-01

    Objectives Evaluate the success rate of retrievable inferior vena cava filter (IVC) removal in a tertiary care practice. Background Retrievable IVC filters became readily available in the United States following Food and Drug Administration approval in 2003, and their use has increased dramatically. They represent an attractive option for patients with contraindications to anticoagulation who may only need short-term protection against pulmonary embolism. Methods All patients who had undergone placement of a retrievable IVC filter at Mayo Clinic between 2003 and 2005 were retrospectively reviewed to evaluate our initial experience with retrievable inferior vena cava filters at a large tertiary care center. Results During a three-year-period of time, Mayo Clinic, Rochester, MN placed 892 IVC filters, of which 460 were retrievable. Of the 460 retrievable filters placed (249 Günther Tulip®, 207 Recovery®, and 4 OptEase®), retrieval was attempted in 223 (48.5%). Of 223 initial attempts, 196 (87.9%) were initially successful and 27 (12.1%) were unsuccessful. Of the 27 unsuccessful initial retrieval attempts, 23 (85.2%) were due to the presence of significant thrombus within the filter and 4 (14.8%) were due to tilting and strut perforation. Of the 23 filters containing significant thrombus, 9 (39.1%) were later retrieved after a period of anticoagulation and resolution of the thrombus. Conclusions Retrievable IVC filters can be removed with a high degree of success. Approximately one in ten retrievable IVC filter removal attempts may fail initially, usually because of significant thrombus within the filter. This does not preclude possible removal at a later date. PMID:25367646

  2. [A Case of Long-Term Survival of a Patient with Liver Metastasis of Colon Cancer and Suspected Inferior Vena Cava Invasion].

    PubMed

    Otani, Takahiro; Kameyama, Hitoshi; Kaneko, Kazuhiro; Sato, Tomoi; Suzuki, Susumu; Okada, Takayuki; Aono, Takashi; Muto, Ichiro; Hasegawa, Masaki; Sakata, Jun; Kobayashi, Takashi; Minagawa, Masahiro; Kosugi, Shin-ichi; Kurosaki, Isao; Wakai, Toshifumi

    2015-11-01

    A 58-year-old woman was diagnosed with a sigmoid colon cancer and synchronous liver metastasis. Because an obstruction of the sigmoid colon was identified, the patient underwent sigmoidectomy. Computed tomography(CT)findings suggested possible vena cava and hepatic vein invasion. Therefore, the decision was made to offer systemic chemotherapy. The patient underwent 6 courses of chemotherapy with 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX6). After 4 courses of chemotherapy, CT scans showed a significant reduction of the liver metastasis (reduction rate of 5 0%; a partial response) and demonstrated improved exclusion of the inferior vena cava and hepatic vein. After 6 courses of chemotherapy, we performed right trisegmentectomy of the liver and resection of the inferior vena cava and diaphragm. Postoperative pathological findings revealed negative margins, and no invasion of the inferior vena cava. The pathological response grade of the tumor after chemotherapy was determined to be Grade 2. Adjuvant chemotherapy was not performed because of the patient 's poor performance status. The patient was alive with no recurrence 8 years after resection of the liver metastasis. PMID:26805305

  3. On determining the characteristics of a Greenfield Inferior Vena Cava Filter using CFD

    NASA Astrophysics Data System (ADS)

    Swaminathan, Tirumani; Hu, Howard; Patel, Aalpen

    2004-11-01

    In those patients with deep venous thrombosis (DVT) or those at a high risk for DVT, and who have contraindications to or are unresponsive to anticoagulation therapy, vena cava filters are often used to prevent recurrent pulmonary emboli. Ideally, the filter should be efficacious while being non-thrombogenic and non-impeding to the blood flow. In reality, the filter has to establish a balance between clot capture efficiency and flow impedance before and after clot capture. The development and use of numerical tools to study the characteristics of filters and its application to the case of a Greenfield filter has been presented here. A detailed model resolving the flow field around the filter to a fine detail is described. The thrombogenecity of the filter in un-occluded flows is determined by analyzing plots of shear stresses and velocity fields. To evaluate a filter's clot capturing efficacy, a Thin Wire Model (TWM) has been developed and used in conjunction with a moving finite element scheme to study the probability of clot capturing for the Greenfield filter.

  4. Supra hepatic inferior vena cava and right atrial thrombosis following a traffic car crash

    PubMed Central

    Sabzi, Feridoun; Karim, Hosein; Haghi, Marjan

    2016-01-01

    Abstract: We present a case of nephrotic syndrome associated with right atrial and supra hepatic vein part of inferior vena caval thrombosis. This patient presented with dyspena, lower extremity edema and back pain after a vehicle accident and blunt trauma to the abdomen. Trauma should be considered not only as a thrombophilic pre-disposition, but also as a predisposing factor to IVC endothelium injury and thrombosis formation. Echocardiography revealed supra hepatic vein IVC thrombosis floating to the right atrium. A C-T scan with contrast also showed pulmonary artery emboli to the left upper lobe. With open heart surgery, the right atrial and IVC clot were extracted and the main left and right pulmonary arteries were evaluated for possible clot lodging. The patient had an uneventful postoperative recovery and thrombosis has not reoccurred with periodical follow-up examinations. PMID:26836612

  5. Supra hepatic inferior vena cava and right atrial thrombosis following a traffic car crash.

    PubMed

    Sabzi, Feridoun; Karim, Hosein; Haghi, Marjan

    2016-07-01

    We present a case of nephrotic syndrome associated with right atrial and supra hepatic vein part of inferior vena caval thrombosis. This patient presented with dyspena, lower extremity edema and back pain after a vehicle accident and blunt trauma to the abdomen. Trauma should be considered not only as a thrombophilic pre-disposition, but also as a predisposing factor to IVC endothelium injury and thrombosis formation. Echocardiography revealed supra hepatic vein IVC thrombosis floating to the right atrium. A C-T scan with contrast also showed pulmonary artery emboli to the left upper lobe. With open heart surgery, the right atrial and IVC clot were extracted and the main left and right pulmonary arteries were evaluated for possible clot lodging. The patient had an uneventful postoperative recovery and thrombosis has not reoccurred with periodical follow-up examinations. PMID:26836612

  6. [The vena cava--reflections on nomenclature].

    PubMed

    Kaiser, E

    1984-01-01

    In the course of standardization of anatomical nomenclature old nomenclatures are retained although their sense is not clear. One example is the term " Hohl "- Vene (= "hollow" vein). During the time of ancient medicine the names artery/vein signified a hollow structure and later the meaning was limited to vessels. At that time two names existed for the inferior vena cava: vena magna (the "big" vein) and vena cava (the "hollow" vein). Later authors thought that the name vena cava was an error of translation. But the history of medicine demonstrates a clear coherence between the words "hollow space" and "spirit". Therefore the name " Hohl "- Vene indicates that people supposed the animal spirit being in the hollow part of the blood circulation. PMID:6721176

  7. Limitations of using synthetic blood clots for measuring in vitro clot capture efficiency of inferior vena cava filters

    PubMed Central

    Robinson, Ronald A; Herbertson, Luke H; Das, Srilekha Sarkar; Malinauskas, Richard A; Pritchard, William F; Grossman, Laurence W

    2013-01-01

    The purpose of this study was first to evaluate the clot capture efficiency and capture location of six currently-marketed vena cava filters in a physiological venous flow loop, using synthetic polyacrylamide hydrogel clots, which were intended to simulate actual blood clots. After observing a measured anomaly for one of the test filters, we redirected the focus of the study to identify the cause of poor clot capture performance for large synthetic hydrogel clots. We hypothesized that the uncharacteristic low clot capture efficiency observed when testing the outlying filter can be attributed to the inadvertent use of dense, stiff synthetic hydrogel clots, and not as a result of the filter design or filter orientation. To study this issue, sheep blood clots and polyacrylamide (PA) synthetic clots were injected into a mock venous flow loop containing a clinical inferior vena cava (IVC) filter, and their captures were observed. Testing was performed with clots of various diameters (3.2, 4.8, and 6.4 mm), length-to-diameter ratios (1:1, 3:1, 10:1), and stiffness. By adjusting the chemical formulation, PA clots were fabricated to be soft, moderately stiff, or stiff with elastic moduli of 805 ± 2, 1696 ± 10 and 3295 ± 37 Pa, respectively. In comparison, the elastic moduli for freshly prepared sheep blood clots were 1690 ± 360 Pa. The outlying filter had a design that was characterized by peripheral gaps (up to 14 mm) between its wire struts. While a low clot capture rate was observed using large, stiff synthetic clots, the filter effectively captured similarly sized sheep blood clots and soft PA clots. Because the stiffer synthetic clots remained straight when approaching the filter in the IVC model flow loop, they were more likely to pass between the peripheral filter struts, while the softer, physiological clots tended to fold and were captured by the filter. These experiments demonstrated that if synthetic clots are used as a surrogate for animal or human blood

  8. Relationship of the lumbar lordosis angle to the abdominal aortic bifurcation and inferior vena cava confluence levels.

    PubMed

    Moussallem, Charbel D; Abou Hamad, Ibrahim; El-Yahchouchi, Christine A; Moussallem, Maroun D; Arnalsteen, Damien M; Mertl, Patrice; Havet, Eric

    2012-10-01

    The objective of this study is to determine the relationship of the variations of the lumbar lordosis angle (LLA) to the aortic bifurcation level and inferior vena cava (IVC) confluence level using CT angiography. A retrospective study was conducted using the data available on abdominopelvic CT angiography scans. The LLA, the level and angle of bifurcation of the aorta, the level and angle of confluence of the IVC were identified using multiplanar and 3D reconstruction. Linear regression models were fitted to the data. We interpreted 181 scans for 181 individuals having a mean age of 55 years (18-89). The most common site of aortic bifurcation was at L4-L5 disc space (34.8%) and that of vena confluence was at the upper of L5 (29.3%). The mean LLA was 34.65° (13°-77°). The mean aortic bifurcation angle was 47.43° (17°-100°) and the mean IVC confluence angle was 71.86° (30°-120°). The positions of the aortic bifurcation and venous confluence levels showed a proximal shift with an increasing LLA P < 0.001. This study showed that the level of bifurcation of the aorta and the level of confluence of the IVC may vary with the variations of the LLA.

  9. Iodine-125 Seeds Strand for Treatment of Tumor Thrombus in Inferior Vena Cava: An Experimental Study in a Rabbit Model

    SciTech Connect

    Zhang, Wen Yan, Zhiping Luo, Jianjun Fang, Zhuting Wu, Linlin Liu, QingXin Qu, Xudong Liu, Lingxiao Wang, Jianhua

    2013-10-15

    Objective: The purpose of this study was to establish an animal model of implanted inferior vena cava tumor thrombus (IVCTT) and to evaluate the effect of linear iodine-125 seeds strand in treating implanted IVCTT. Methods: Tumor cell line VX{sub 2} was inoculated subcutaneously into New Zealand rabbit to develop the parent tumor. The tumor strip was inoculated into inferior vena cava (IVC) to establish the IVCTT model. The IVCTT was confirmed by multidetector computed tomography (MDCT) after 2 weeks. Twelve rabbits with IVCTT were randomly divided into two groups. Treatment group (group T; n = 6) underwent Iodine-125 seeds brachytherapy, and the control group (group C; n = 6) underwent blank seeds strand. The blood laboratory examination (including blood routine examination, hepatic and renal function), body weight, survival time, and IVCTT volume by MDCT were monitored. All rabbits were dissected postmortem, and the therapeutic effects were evaluated on the basis of histopathology. The proliferating cell nuclear antigen index (PI) and apoptosis index (AI) of IVCTT were compared between two groups. T test, Wilcoxon rank test, and Kaplan-Meier survival curve analysis were used. Results: The success rate of establishing IVCTT was 100 %. The body weight loss and cachexia of rabbits in group C appeared earlier than in group T. Body weight in the third week, the mean survival time, PI, AI in groups T and C were 2.23 {+-} 0.12 kg, 57.83 {+-} 8.68 days, (16.73 {+-} 5.18 %), (29.47 {+-} 7.18 %), and 2.03 {+-} 0.13 kg, 43.67 {+-} 5.28 days, (63.01 {+-} 2.01 %), (6.02 {+-} 2.93 %), respectively. There were statistically significant differences between group T and group C (P < 0.05). The IVCTT volume of group T was remarkably smaller than that of group C. Conclusions: Injecting and suspensory fixing VX2 tumor strip into IVC is a reliable method to establish IVCTT animal model. The linear Iodine-125 seeds strand brachytherapy was a safe and effective method for treating IVCTT

  10. [Radical nephrectomy and thrombectomy in patients with renal cell cancer complicated by tumoral thrombosis of the renal vein and vena cava inferior].

    PubMed

    Rusyn, V I; Korsak, V V; Rusyn, A V; Boĭko, S O

    2013-01-01

    Surgical treatment was conducted in 81 patients, suffering renocellular cancer (RCC), complicated by a renal vein and vena cava inferior thrombosis. According to the Mayo clinic classification, the level of a tumoral thrombus spread was established: the 0 level--in 37 patients, the level I--in 19, the level II--in 17, the level III --in 6, and the level IV--in 2. There were substantiated the optimal surgical accesses and technique of radical nephrectomy and thrombectomy for RCC, complicated by a renal vein and vena cava inferior thrombosis. It is recommended to apply transabdominal accesses: the extended median laparotomic, bilateral subcostal of a "Chevron" or "Mercedes" type. There was shown, that the access choice depends on the level of the tumoral thrombus localization.

  11. Simultaneous removal of a tumour of the right atrium and inferior vena cava and coronary bypass-grafting in a patient with recurrent clear renal cell carcinoma

    PubMed Central

    Pietrzyk, Edward; Głuszek, Stanisław; Michta, Kamil; Kot, Marta; Wożakowska-Kapłon, Beata

    2015-01-01

    Metastatic cardiac tumours are the most common malignant cardiac tumours. In the early stages they are usually asymptomatic, but their consequences can be very serious, and the prognosis is poor. We present a patient with recurrent renal cell carcinoma as a tumour of the right atrium and the vena cava inferior in whom cancerous masses were removed with simultaneously coronary artery bypass-grafting. PMID:26855653

  12. Fontan's circulation with dextrocardia, recent pulmonary embolism, and inferior vena cava filter: Anesthetic challenges for urgent hysterectomy

    PubMed Central

    Singh, Preet Mohinder; Borle, Anuradha; Ramachandran, Rashmi; Trikha, Anjan; Goudra, Basavana Gouda

    2016-01-01

    Fontan's circulation is a unique challenge for the anesthesiologist. Venous pressure is the only source of blood flow for the pulmonary circulation. Patients with such circulation are extremely sensitive to progression of cyanosis (decreased pulmonary blood flow) or circulatory failure. Any major venous compression can compromise the pulmonary blood flow worsening cyanosis; simultaneously, an increased afterload can precipitate circulatory failure. We present a rare patient of surgically corrected Ivemark syndrome with Fontan's physiology with dextrocardia who developed a large uterine fibroid compressing inferior vena cava (IVC). As a result of compression, not only the pulmonary circulation was compromised but she also developed stasis-induced venous thrombosis in the lower limbs that lead to pulmonary embolism (PE) (increased afterload). In addition to oral anticoagulation an IVC filter was inserted to prevent ongoing recurrent PE. Further, to prevent both circulatory compromise and deep venous thrombosis an urgent myomectomy/hysterectomy was planned. In the present case, we discuss the issues involved in the anesthetic management of such patients and highlight the lacunae in the present guidelines for managing perioperative anticoagulation these situations. PMID:26750698

  13. Fontan's circulation with dextrocardia, recent pulmonary embolism, and inferior vena cava filter: Anesthetic challenges for urgent hysterectomy.

    PubMed

    Singh, Preet Mohinder; Borle, Anuradha; Ramachandran, Rashmi; Trikha, Anjan; Goudra, Basavana Gouda

    2016-01-01

    Fontan's circulation is a unique challenge for the anesthesiologist. Venous pressure is the only source of blood flow for the pulmonary circulation. Patients with such circulation are extremely sensitive to progression of cyanosis (decreased pulmonary blood flow) or circulatory failure. Any major venous compression can compromise the pulmonary blood flow worsening cyanosis; simultaneously, an increased afterload can precipitate circulatory failure. We present a rare patient of surgically corrected Ivemark syndrome with Fontan's physiology with dextrocardia who developed a large uterine fibroid compressing inferior vena cava (IVC). As a result of compression, not only the pulmonary circulation was compromised but she also developed stasis-induced venous thrombosis in the lower limbs that lead to pulmonary embolism (PE) (increased afterload). In addition to oral anticoagulation an IVC filter was inserted to prevent ongoing recurrent PE. Further, to prevent both circulatory compromise and deep venous thrombosis an urgent myomectomy/hysterectomy was planned. In the present case, we discuss the issues involved in the anesthetic management of such patients and highlight the lacunae in the present guidelines for managing perioperative anticoagulation these situations.

  14. Primary Renal Rhabdomyosarcoma in an Adolescent With Tumor Thrombosis in the Inferior Vena Cava and Right Atrium

    PubMed Central

    Lin, Wei-Ching; Chen, Jeon-Hor; Westphalen, Antonio; Chang, Han; Chiang, I-Ping; Chen, Cheng-Hong; Wu, Hsi-Chin; Lin, Chien-Heng

    2016-01-01

    Abstract Although the second peak of the age distribution of rhabdomyosarcoma (RMS) is at adolescence, renal RMS is extremely rare at this age group. This tumor is indistinguishable from other renal tumors based on clinical and imaging findings, and the diagnosis relies on histology and immunohistochemical staining. We report a unique case of adolescent renal RMS associated with tumor thrombus extending into the inferior vena cava (IVC) and right atrium. An 18-year-old female adolescent presented with shortness of breath and palpitations, associated with right flank discomfort, and hematuria. A pleomorphic-type renal RMS with Budd–Chiari syndrome and arrhythmia induced by IVC and RA thrombosis was diagnosed. Despite complete tumor resection, the patient developed multiple lung metastases a month after surgery. Chemotherapy was recommended, but the patient declined. She died within a year of the initial operation. Adolescent renal RMS is rare and associated with poor outcome. Early aggressive multimodal therapy seems to be appropriate, in particular, in the presence of tumor thrombosis. PMID:27227946

  15. [Survival after Sorafenib Treatment for Advanced Recurrent Hepatocellular Carcinoma with Tumor Thrombus in the Inferior Vena Cava].

    PubMed

    Matoba, Hideaki; Seta, Shinsuke

    2015-11-01

    A 72-year-old man with chronic viral hepatitis type B undergoing surgery for hepatocellular carcinoma was found to have a recurrent tumor in the left liver with peritoneal dissemination near the inferior vena cava(IVC)and tumor thrombus in the IVC. For this patient diagnosed with Barcelona clinic liver cancer (BCLC) classification stage C hepatocellular carcinoma, we initiated 800 mg/body sorafenib. Two weeks after the initiation of sorafenib, the patient experienced grade 3 hand-foot syndrome, after which, the dose of sorafenib was reduced to 400 mg/body. After 1 year, CT showed an enlarged tumor in the left liver and multiple metastases to the lung. However, no remarkable difference was observed in the peritoneal dissemination and the tumor thrombus. He has been receiving sorafenib for 19 months with a good quality of life. Sorafenib can be provided on an outpatient basis and it may facilitate long-term survival for patients with advanced recurrent hepatocellular carcinoma with IVC tumor thrombus. This clinical condition is very rare, and the standard treatment for it still has not been established.

  16. Endovascular Treatment of Ruptured Abdominal Aneurysm into the Inferior Vena Cava in Patient After Stent Graft Placement

    SciTech Connect

    Juszkat, Robert; Pukacki, Fryderyk; Zarzecka, Anna; Kulesza, Jerzy; Majewski, Waclaw

    2009-07-15

    We report the case of a patient who underwent endovascular repair and then reintervention as a result of the presence of a persistent endoleak complicated by an aortocaval fistula. A 76-year-old patient with a history of endovascular treatment for abdominal aortic aneurysm 2 years earlier had a palpable abdominal mass, high-output cardiac failure, and renal failure. A computed tomographic scan and angiography revealed bending of the right iliac limb, a type I endoleak, and rupture of the aneurysm into the inferior vena cava with aortocaval fistula formation. An iliac extension was positioned in the right external iliac artery. The procedure was finished successfully. Control angiography showed normal flow within the endoprosthesis, and both iliac arteries were without signs of endoleakage and aortocaval fistula. Ectatic common iliac artery may lead to a late distal attachment site endoleak. The application of a stent graft in cases of secondary aortocaval fistula after stent graft repair is a good option, particularly in emergency cases.

  17. A Non-invasive Method for Assessment of Intravascular Fluid Status: Inferior Vena Cava Diameters and Collapsibility Index

    PubMed Central

    Karacabey, Sinan; Sanri, Erkman; Guneysel, Ozlem

    2016-01-01

    Objective: To evaluate the correlation between central venous pressure (CVP) and inferior vena cava (IVC) diameters measured by ultrasonography (Ultrasound) in critically ill patients. Methods: Intubated critically ill patients were enrolled. The CVP values were measured using a U-tube manometer and were compared to the IVC diameters and collapsibility index, which were measured by bedside Ultrasound. Patients younger than 18 years old, who were not intubated, who had an abdominal pressure greater than 12 mmHg, and/or who were admitted for trauma were excluded from the study. Results: Eighty three patients with a mean age of 73.6±11.2 years were enrolled. The most common diagnosis was sepsis (21 patients, 25.30%). IVC inspiration measurements were statistically significantly correlated with CVP measurements (p0.05, r: 0.1). IVC collapsibility measurements showed a negative correlation with CVP measurements (p<0.01, r: 0.68). Conclusions: There is a strong correlation between CVP and IVC diameters and the collapsibility index. This is a new formula for evaluating CVP, based on our statistical analyses. PMID:27648024

  18. Right Double Inferior Vena Cava (IVC) with Preaortic Iliac Confluence – Case Report and Review of Literature

    PubMed Central

    Babu, C.S. Ramesh; Lalwani, Rekha; Kumar, Indra

    2014-01-01

    Anomalies of the inferior vena cava (IVC) are uncommon and most of them remain asymptomatic. Though rare, anomalies of IVC can lead to severe hemorrhagic complications especially during aortoiliac surgery. Prior knowledge of these variations facilitates proper interpretation of radiological images and safe performance of interventional procedures and surgeries. During routine anatomical dissection of abdomen in a female cadaver we observed the presence of right sided duplication of IVC. Both IVCs were present on the right side of abdominal aorta, one ventral and the other more dorsal in position and named ventral right IVC and dorsal right IVC. The ventrally and medially placed IVC, which appeared to be the main IVC was formed by the union of two common iliac veins in front of the right common iliac artery (Preaortic iliac confluence-“Marsupial Cava”). The right external iliac vein continued as the more dorsally and laterally placed dorsal right IVC. The right internal iliac vein after receiving a transverse anastomotic vein from the external iliac continued as the right common iliac vein. This transverse anastomosis was present behind the right common iliac artery. The narrower dorsal right IVC joined the wider ventral right IVC just below the level of renal veins to form a single IVC. The abdominal aorta presented a convexity to the left. PMID:24701503

  19. [Survival after Sorafenib Treatment for Advanced Recurrent Hepatocellular Carcinoma with Tumor Thrombus in the Inferior Vena Cava].

    PubMed

    Matoba, Hideaki; Seta, Shinsuke

    2015-11-01

    A 72-year-old man with chronic viral hepatitis type B undergoing surgery for hepatocellular carcinoma was found to have a recurrent tumor in the left liver with peritoneal dissemination near the inferior vena cava(IVC)and tumor thrombus in the IVC. For this patient diagnosed with Barcelona clinic liver cancer (BCLC) classification stage C hepatocellular carcinoma, we initiated 800 mg/body sorafenib. Two weeks after the initiation of sorafenib, the patient experienced grade 3 hand-foot syndrome, after which, the dose of sorafenib was reduced to 400 mg/body. After 1 year, CT showed an enlarged tumor in the left liver and multiple metastases to the lung. However, no remarkable difference was observed in the peritoneal dissemination and the tumor thrombus. He has been receiving sorafenib for 19 months with a good quality of life. Sorafenib can be provided on an outpatient basis and it may facilitate long-term survival for patients with advanced recurrent hepatocellular carcinoma with IVC tumor thrombus. This clinical condition is very rare, and the standard treatment for it still has not been established. PMID:26805098

  20. Topographic anatomy of the fetal inferior vena cava, coronary sinus, and pulmonary veins: Variations in Chiari's network.

    PubMed

    Naito, Michiko; Yu, Hee Chul; Kim, Ji Hyun; Rodríguez-Vázquez, José Francisco; Murakami, Gen; Cho, Baik Hwan

    2015-07-01

    To understand anomalies in Chiari's network better, we assessed the topographical anatomy of the fetal inferior vena cava (IVC), coronary sinus, and atria. We examined sagittal serial paraffin sections of 15 human fetuses of crown-rump length 24-36 mm, corresponding to a gestational age of 8 weeks. Although their outflow tract morphologies were similar, these 15 specimens could be classified into two groups. In eight specimens, the left common cardinal vein reached the body wall, whereas in the other seven the vein was obliterated near the left pulmonary vein. Irrespective of the group in which the specimen was included, the anteroposterior arrangement of the coronary sinus, the sinus septum (septum), and the right sinus valve (right valve) could be classified into three types: the right valve-septum-coronary sinus arrangement in seven specimens; the right valve-coronary sinus-septum arrangement in five; and the coronary sinus-right valve-septum arrangement in three. Depending on differences in topographical anatomy, the sinus septum separated the coronary sinus opening from either the right or the left atrium. Likewise, the coronary sinus opening was either adjacent to or distant from the IVC terminal. Rather than the counter-side position of the right valve being at the IVC terminal, the left sinus valve protruded leftward, forming an incomplete interatrial septum. Fetal variations seemed to be closely connected with individual variations and a high frequency of Chiari's network anomalies in adults.

  1. Failed Retrieval of an Inferior Vena Cava Filter During Pregnancy Because of Filter Tilt: Report of Two Cases

    SciTech Connect

    McConville, R. M. Kennedy, P. T.; Collins, A. J.; Ellis, P. K.

    2009-01-15

    Thromboembolic disease during pregnancy is an important cause of obstetric morbidity and mortality. Pregnant patients with venous thromboembolism are usually managed by conventional anticoagulation. However, this must be discontinued during vaginal or caesarian delivery to avoid haemorrhage and to reduce the risk of possible epidural haematoma. Retrievable inferior vena cava filters (IVCFs) offer protection against pulmonary embolism during this high-risk period, when anticoagulation is discontinued, while avoiding potential long-term sequelae of a permanent IVCF. Here we report two patients who presented in the third trimester of pregnancy with floating ileofemoral deep vein thrombosis. Both patients were initially treated with standard anticoagulation; however, shortly before delivery both patients had a retrievable IVCF placed in a suprarenal position. In both patients, retrieval failed at 28 days after insertion because of filter tilt. The timing and mechanism of filter tilt remains uncertain. We believe that a number of factors could have been involved, including change in the anatomic configuration with lateral displacement of the IVCF as a result of the gravid uterus as well as forceful uterine contractions during labour, which modified the shape and diameter of the IVC. We showed that failure to retrieve the IVCF has had considerable implications for the two young patients regarding long-term anticoagulation and have highlighted the need for further clinical trials regarding the safe use of retrievable IVCFs during pregnancy.

  2. Chemoembolization and stenting combined with iodine-125 seed strands for the treatment of hepatocellular carcinoma with inferior vena cava obstruction

    PubMed Central

    LI, WENHUI; DAI, ZHENYU; YAO, LIZHENG; LUO, JIANJUN; YAN, ZHIPING

    2015-01-01

    The aim of the present study was to investigate the efficacy and safety of stenting combined with radioactive iodine-125 seed strands following chemoembolization for the treatment of patients with hepatocellular carcinoma and inferior vena cava (IVC) obstruction. A retrospective analysis was conducted of 52 hepatocellular carcinoma patients with IVC obstruction. All patients received chemoembolization of tumor-supplying arteries and IVC stents, and 18 patients additionally received iodine-125 seed strands, which were fixed to the stents. Improvement of IVC obstruction and the tumor response rates were compared between the two groups with a median follow-up time of 2.5 months. In both groups the stents were successfully deployed. At the 2-month post-procedural follow-up, the mean diameter of the IVC obstruction site, the mean pressure difference between the distal IVC obstructive segment and the right atrium as well as the obstruction scoring did not differ significantly between the two groups. By contrast, the tumor response rate of the iodine-125 seed strand group was 94.4%, whereas for the group without iodine-125 seed strands it was 35.3% (P<0.001). The combination of stent and iodine-125 seed strands was effective and safe for the treatment of hepatocellular carcinoma with IVC obstruction. PMID:26622424

  3. [Anomalies of the subrenal inferior vena cava in the surgery of non-specific and inflammatory abdominal aortic aneurysms].

    PubMed

    Gargiulo, M; Stella, A; Caputo, M; Brusori, S; Pedrini, L; Tarantini, S; Curti, T

    1993-01-01

    The sub-renal abnormalities of the lower vena cava (LVC) (left LVC, double LVC) are determined by a deterioration of the alteration process of supra-cardinal veins. Though they are rare, it is necessary to look for them during surgery of abdominal aorta in order to lower the risk of iatrogenic venous injuries. You will find below the description of six cases of sub-renal lower vena cava abnormality (3 double LVC, 3 left LVC) associated with an abdominal aorta aneurism (4 non specific aneurisms, 2 inflammations ones) as well as the diagnostic aspects and the technical issues they cause during the reconstruction of a non specific and inflammation aneurism of the abdominal aorta. PMID:8248315

  4. Inferior vena cava diameter correlates with invasive hemodynamic measures in mechanically ventilated intensive care unit patients with sepsis.

    PubMed

    Schefold, Joerg C; Storm, Christian; Bercker, Sven; Pschowski, Rene; Oppert, Michael; Krüger, Anne; Hasper, Dietrich

    2010-06-01

    Early optimization of fluid status is of central importance in the treatment of critically ill patients. This study aims to investigate whether inferior vena cava (IVC) diameters correlate with invasively assessed hemodynamic parameters and whether this approach may thus contribute to an early, non-invasive evaluation of fluid status. Thirty mechanically ventilated patients with severe sepsis or septic shock (age 60 +/- 15 years; APACHE-II score 31 +/- 8; 18 male) were included. IVC diameters were measured throughout the respiratory cycle using transabdominal ultrasonography. Consecutively, volume-based hemodynamic parameters were determined using the single-pass thermal transpulmonary dilution technique. This was a prospective study in a tertiary care academic center with a 24-bed medical intensive care unit (ICU) and a 14-bed anesthesiological ICU. We found a statistically significant correlation of both inspiratory and expiratory IVC diameter with central venous pressure (p = 0.004 and p = 0.001, respectively), extravascular lung water index (p = 0.001, p < 0.001, respectively), intrathoracic blood volume index (p = 0.026, p = 0.05, respectively), the intrathoracic thermal volume (both p < 0.001), and the PaO(2)/FiO(2) oxygenation index (p = 0.007 and p = 0.008, respectively). In this study, IVC diameters were found to correlate with central venous pressure, extravascular lung water index, intrathoracic blood volume index, the intrathoracic thermal volume, and the PaO(2)/FiO(2) oxygenation index. Therefore, sonographic determination of IVC diameter seems useful in the early assessment of fluid status in mechanically ventilated septic patients. At this point in time, however, IVC sonography should be used only in addition to other measures for the assessment of volume status in mechanically ventilated septic patients.

  5. Effect of Antithrombotic Agents on the Patency of PTFE-Covered Stents in the Inferior Vena Cava: An Experimental Study

    SciTech Connect

    Makutani, Shiro; Kichikawa, Kimihiko; Uchida, Hideo; Maeda, Munehiro; Konishi, Noboru; Hiasa, Yoshio; Yoshikawa, Tomohiro; Kimura, Yukio

    1999-05-15

    Purpose: To evaluate the efficacy of antithrombotic agents in the prevention of stenosis of polytetrafluoroethylene (PTFE)-covered stents in the venous system. Methods: Spiral Z stents covered with PTFE (PTFE-covered stents) were placed in the inferior vena cava (IVC) of 34 dogs. Nineteen dogs, used as a control group, were sacrificed at 2, 4, and 12 weeks. Fifteen dogs, previously given antithrombotic agents [cilostazol (n= 5), warfarin potassium (n= 5), cilostazol plus warfarin potassium (n= 5)] were sacrificed at 4 weeks, and then examined angiographically and histopathologically. The effect of the antithrombotic agents was compared between groups. Results: The patency rate of the antithrombotic agent group was 93% (14/15), which was higher than the control group rate of 63% (12/19). The mean stenosis rate of the patent stent at both ends and at the midportion was lower at 4 weeks in the antithrombotic agent group than in the control group. In particular, the mean stenosis rate in the cilostazol plus warfarin potassium group was significantly lower than the control group (Tukey's test, p < 0.05). The mean neointimal thickness of the patent stent at both ends and at the midportion was thinner at 4 weeks in the antithrombotic agent group than in the control group. In particular, the thickness of the neointima in the cilostazol plus warfarin potassium group was significantly decreased when compared with the control group (Tukey's test p < 0.05). At 4 weeks, endothelialization in the antithrombotic agent group tended to be almost identical to that in the control group. Conclusion: The present study suggests that administration of an antithrombotic agent is an effective way of preventing the stenosis induced by a neointimal thickening of PTFE-covered stents in the venous system.

  6. Outpatient Use of Focused Cardiac Ultrasound to Assess the Inferior Vena Cava in Patients With Heart Failure.

    PubMed

    Saha, Narayan M; Barbat, Julian J; Fedson, Savitri; Anderson, Allen; Rich, Jonathan D; Spencer, Kirk T

    2015-10-15

    Accurate assessment of volume status is critical in the management of patients with heart failure (HF). We studied the utility of a pocket-sized ultrasound device in an outpatient cardiology clinic as a tool to guide volume assessment. Inferior vena cava (IVC) size and collapsibility were assessed in 95 patients by residents briefly trained in focused cardiac ultrasound (FCU). Cardiologist assessment of volume status and changes in diuretic medication were also recorded. Patients were followed for occurrence of 30-day events. There was a 94% success rate of obtaining IVC size and collapsibility, and agreement between visual and calculated IVC parameters was excellent. Most patients were euvolemic by both FCU IVC and clinical bedside assessment (51%) and had no change in diuretic dose. Thirty-two percent had discrepant FCU IVC and clinical volume assessments. In clinically hypervolemic patients, the FCU evaluation of the IVC suggested that the wrong diuretic management plan might have been made 46% of the time. At 30 days, 14 events occurred. The incidence of events increased significantly with FCU IVC imaging categorization, from 11% to 23% to 36% in patients with normal, intermediate, and plethoric IVCs. By comparison, when grouped in a binary manner, there was no significant difference in event rates for patients who were deemed to be clinically volume overloaded. Assessment of volume status in an outpatient cardiology clinic using FCU imaging of the IVC is feasible in a high percentage of patients. A group of patients were identified with volume status discordant between FCU IVC and routine clinic assessment, suggesting that IVC parameters may provide a valuable supplement to the in-office physical examination.

  7. Social and Demographic Factors Influencing Inferior Vena Cava Filter Retrieval at a Single Institution in the United States

    SciTech Connect

    Smith, S. Christian Shanks, Candace Guy, Gregory Yang, Xiangyu Dowell, Joshua D.

    2015-10-15

    PurposeRetrievable inferior vena cava filters (IVCFs) are associated with long-term adverse events that have increased interest in improving filter retrieval rates. Determining the influential patient social and demographic factors affecting IVCF retrieval is important to personalize patient management strategies and attain optimal patient care.Materials and MethodsSeven-hundred and sixty-two patients were retrospectively studied who had a filter placed at our institution between January 2011 and November 2013. Age, gender, race, cancer history, distance to residence from retrieval institution, and insurance status were identified for each patient, and those receiving retrievable IVCFs were further evaluated for retrieval rate and time to retrieval.ResultsOf the 762 filters placed, 133 were permanent filters. Of the 629 retrievable filters placed, 406 met the inclusion criteria and were eligible for retrieval. Results revealed patients with Medicare were less likely to have their filters retrieved (p = 0.031). Older age was also associated with a lower likelihood of retrieval (p < 0.001) as was living further from the medical center (p = 0.027). Patients who were white and had Medicare were more likely than similarly insured black patients to have their filters retrieved (p = 0.024).ConclusionsThe retrieval rate of IVCFs was most influenced by insurance status, distance from the medical center, and age. Race was statistically significant only when combined with insurance status. The results of this study suggest that these patient groups may need closer follow-up in order to obtain optimal IVCF retrieval rates.

  8. Outcomes of retrievable inferior vena cava filters in patients with deep vein thrombosis and transient contraindication for anticoagulation

    PubMed Central

    Kim, Hyung-Kee; Song, Incheol; Jang, Ji-Hoon; Oh, Chang-Wug; Lee, Jong-Min

    2015-01-01

    Purpose To determine the efficacy of a retrievable inferior vena cava filter (IVCF) for patients with deep vein thrombosis (DVT) and transient contraindication for anticoagulant therapy, and to analyze the risk factors for filter thrombus in these patients. Methods We retrospectively reviewed the records of 70 patients who received a retrievable IVCF from January 2007 to June 2014 because of documented DVT and transient contraindication for anticoagulant therapy. The protocol for follow-up care generally consisted of anticoagulant therapy after high-risk periods, follow-up CT around 2 weeks after IVCF placement, and retrieval if possible. Results The 70 patients had a mean age of 61.8 years (range, 17-88 years), and 30 were male (43%). The indications for IVCF were recent trauma including surgery in 48 patients, recent hemorrhage in 14, and planned major surgery with DVT in 8 patients. Follow-up CT of 61 patients (87%) was performed. Aggravation or new development of pulmonary embolism (PE) was not found in any patient. Filter thrombus was detected in 23% of patients with follow-up CT (14/61). Filter thrombus was not detected in patients with isolated calf vein thrombosis (ICVT) (P = 0.079). The risk factor for filter thrombus was DVT progression on follow-up CT (P = 0.007) on multivariate analysis. Conclusion For patients with DVT and transient contraindication for anticoagulant therapy, a retrievable IVCF could prevent the aggravation or new development of PE. DVT progression on follow-up CT was associated with filter thrombus and ICVT was not related to filter thrombus in the present study. PMID:26131442

  9. Efficacy and Safety of Endovascular Intervention for the Management of Primary Entire-Inferior Vena Cava Occlusion

    SciTech Connect

    Zhang, Qingqiao Huang, Qianxin Shen, Bin Sun, Jingmin Wang, Xiaolong Liu, Hongtao

    2015-06-15

    PurposeThis study was designed to investigate the safety and efficacy of endovascular intervention for the treatment of primary entire-inferior vena cava (IVC) occlusion.MethodsEndovascular interventions were performed in six patients for the treatment of primary entire-IVC occlusion. IVC and hepatic venography were performed via the jugular and femoral veins. Balloon angioplasty was used to revascularize the hepatic vein and IVC and a stent was placed in the IVC to maintain patency. Postoperative color Doppler ultrasonography was performed at 1, 3, 6, and 12 months, and then annually, to monitor the patency of the hepatic vein and IVC.ResultsThe IVC and one or two hepatic veins were successfully revascularized in five patients. Revascularization was successful in the right and left hepatic veins in one patient; however, IVC patency could not be established in this patient. Eleven Z-type, self-expanding stents were placed into the IVCs of five patients (three stents in two patients, two stents in two patients, and one stent in one patient). There were no instances of postoperative bleeding or mortality. Follow-up was conducted for 18–90 months (42.8 ± 26.5 months). None of the five patients suffered restenosis of the IVC or hepatic veins. However, there was one of the six cases of right hepatic vein restenosis at 18 months postprocedure that was revascularized after a second balloon dilatation.ConclusionsEndovascular intervention is safe and efficacious for the treatment of primary entire-IVC occlusion.

  10. Efficacy of Lower-Extremity Venous Thrombolysis in the Setting of Congenital Absence or Atresia of the Inferior Vena Cava

    SciTech Connect

    Ganguli, Suvranu Kalva, Sanjeeva; Oklu, Rahmi; Walker, T. Gregory; Datta, Neil; Grabowski, Eric F.; Wicky, Stephan

    2012-10-15

    Purpose: A rare but described risk factor for deep venous thrombosis (DVT), predominately in the young, is congenital agenesis or atresia of the inferior vena cava (IVC). The optimal management for DVT in this subset of patients is unknown. We evaluated the efficacy of pharmacomechanical catheter-directed thrombolysis (PCDT) followed by systemic anticoagulation in the treatment of acute lower-extremity DVT in the setting of congenital IVC agenesis or atresia. Materials and Methods: Between November of 2005 and May of 2010, six patients (three women [average age 21 years]) were referred to our department with acute lower-extremity DVT and subsequently found to have IVC agenesis or atresia on magnetic resonance imaging. A standardized technique for PCDT (the Angiojet Rheolytic Thrombectomy System followed by the EKOS Microsonic Accelerated Thrombolysis System) was used for all subjects. Successful thrombolysis was followed by systemic heparinization with transition to Coumadin or low molecular-weight heparin and compression stockings. Subjects were followed-up at 1, 3, and then every 6 months after the procedure with clinical assessment and bilateral lower-extremity venous ultrasound. Results: All PCDT procedures were technically successful. No venous stenting or angioplasty was performed. The average thrombolysis time was 28.6 h (range 12-72). Two patients experienced heparin-induced thrombocytopenia, and one patient developed a self-limited knee hemarthrosis, No patients were lost to follow-up. The average length of follow-up was 25.8 {+-} 20.2 months (range 3.8-54.8). No incidence of recurrent DVT was identified. There were no manifestations of postthrombotic syndrome. Conclusions: PCDT followed by systemic anticoagulation and the use of compression stockings appears to be safe and effective in relatively long-term follow-up treatment of patients who present with acute DVT and IVC agenesis or atresia.

  11. [Outcome of Resection of Inferior Vena Cava Superior to the Renal Vein in Renal Cell Carcinoma with Vena Caval Tumor Thrombus].

    PubMed

    Kashima, Soki; Narita, Shintaro; Saito, Mitsuru; Takahashi, Makoto; Maita, Shinya; Tsuruta, Hiroshi; Numakura, Kazuyuki; Maeno, Atsushi; Inoue, Takamitsu; Tsuchiya, Norihiko; Satoh, Shigeru; Yamamoto, Hiroshi; Yamamoto, Yuzo; Habuchi, Tomonori

    2016-06-01

    Surgical management with radical nephrectomy and thrombectomy has often been performed in renal cell carcinoma (RCC) with tumor thrombus infiltrating the inferior vena cava (IVC). We retrospectively reviewed the outcomes of IVC resection without venous reconstruction in patients with RCC and IVC thrombus at our institution. Eight patients with right RCC underwent radical nephrectomy and IVC resection superior to the level of the renal vein without venous reconstruction from August 2005 to February 2015. Thoracotomy, liver mobilization, and extracorporeal circulation were performed based on the IVC thrombus level. We assessed surgical outcomes, perioperative complications, and survival. At presentation, four patients had level IIIa IVC thrombus, three had level IIIb IVC thrombus, and one had level IV IVC thrombus. Perioperative imaging showed that three of the four patients who underwent neoadjuvant molecular targeting therapy achieved down-staging of the tumor thrombus level. The median operative time was 406 min, and the median estimated blood loss was 3,135 ml. With regard to IVC resectionassociated perioperative complications, one patient needed extracorporeal circulation with IVC ligation and Pringle maneuver owing to low blood pressure. Another patient underwent temporary hemodialysis for 8 days after surgery. There were no perioperative deaths, and none of the patients required permanent hemodialysis. Three patients survived the mean observation period of 25 months, including one patient with no recurrence. Three patients achieved long-term survival of more than 2 years. IVC resection without venous reconstruction may be a feasible option for patients with RCC and IVC tumor thrombus. Further study is needed to determine the most appropriate candidates for this procedure. PMID:27452491

  12. Congenital atresia of the inferior vena cava and antithrombin III deficiency in a young adult: compounding risk factors for deep vein thrombosis.

    PubMed

    Muscianese, Laura; Seese, Ronald R; Graham, William; Williams, James H

    2015-01-01

    Atresia, or absence, of the inferior vena cava (AIVC) is a rare, usually fortuitous finding on advanced imaging that predisposes patients to deep venous thrombosis (DVT). In young adults who lack predisposing risk factors but nonetheless develop extensive or bilateral DVTs, AIVC should be considered. We describe a case of a previously healthy 17-year-old male patient who developed an extensive renal vein thrombus due to the absence of the superior portion of his IVC compounded with previously undiagnosed antithrombin III deficiency. We discuss the diagnosis and management of this complicated condition.

  13. Role of bilateral inferior petrosal sinus sampling (BIPSS) in the diagnosis of Cushing's disease in a patient with double superior vena cava.

    PubMed

    Tashi, Sonam; Ng, Keng Sin

    2015-08-01

    Cushing's syndrome is known to have a wide spectrum of clinical presentation with debilitating consequences and morbidity if not diagnosed and treated in time. Sometimes the diagnosis of Cushing's syndrome can be challenging to the endocrinologist, especially when the usual battery of biochemical tests and advanced cross-sectional imaging is negative or inconclusive. We described a case in which the use of bilateral inferior petrosal sinus sampling (BIPSS) was conclusive albeit being technically challenging (due to a rare incidental finding of double superior vena cava) and invasive in nature.

  14. A South Indian Cadaveric Study About the Relationship of Hepatic Segment of Inferior Vena Cava with the Liver

    PubMed Central

    Surendran, Sudarshan; Nelluri, Venu Madhav; Kumar, Naveen; Aithal, Ashwini P

    2016-01-01

    Introduction Inferior Vena Cava (IVC) is the largest vein of the body. It runs vertically upwards in the abdomen, behind the liver. Its course is very constant in relation to liver. However, the amount of liver parenchyma related to it can vary from person to person. The data regarding its course and relations may be very useful to radiologists and surgeons during surgical treatment procedures for Budd-Chiari syndrome, liver carcinoma, liver transplant, venous cannulations and many other clinical procedures. Aim Aim of this study was to document the incidence of straight and curved course of IVC in relation to liver and also to note the pattern in which the liver tissue was related to the IVC. Materials and Methods In the current study, 95 adult cadaveric livers were observed; specifically to study the course/direction of the hepatic segment of IVC in relation to the liver. The extent of liver tissue related to various aspects of IVC was also studied. The course of the IVC was classified as straight and curved; and the relationship of liver parenchyma to the IVC was classified into 6 categories. The data was expressed as percentage incidence. Results In 78.94% cases, the IVC had a straight course in relation to the liver; whereas in 21.06% cases, it had a left sided curve (concavity of the curve towards the caudate lobe) in its course. In 6.31% cases, IVC travelled in a tunnel, being encircled by the liver parenchyma all around; in 36.84% cases, it was covered by liver parenchyma on front and sides so that only posterior surface of IVC was visible; in 3.15% cases it was covered by liver tissue on front, sides and also partly on posterior aspect; in 50.52% of cases, its anterior surface, sides and left edge of the posterior surface was covered by liver tissue; and in 3.15% cases it was covered only from the front by the liver tissue. Conclusion The data being reported here might be useful for surgeons while planning and executing various hepatic surgeries and also

  15. Inferior vena cava filter misplacement in the right atrium and migration to the right ventricle followed by successful removal using the endovascular technique: A case report and review of the literature

    PubMed Central

    Takeuchi, Wataru; Yamazaki, Kyohei

    2015-01-01

    Inferior vena cava filters are effective for preventing the passage of thrombi into the pulmonary arteries in patients with pulmonary embolism and deep vein thrombosis. These filters are indicated in patients with contraindications to anticoagulant therapy or in patients with recurrent acute pulmonary embolism despite the administration of anticoagulant therapy. However, the occurrence of filter-related complications, such as filter migration to the heart, has been increasing. Herein, we report a case of OptEase inferior vena cava filter misplacement in the right atrium. Although the filter migrated to the right ventricle, it was successfully removed and repositioned in the inferior vena cava using endovascular techniques. Unfortunately, moderate tricuspid regurgitation developed, due to the damage to the tricuspid valve that was caused by the procedure. We have also reviewed the relevant literature and discussed the possible strategies for managing cases of filter migration to the heart and preventing filter misplacement. PMID:27489693

  16. Gunther Tulip Inferior Vena Cava Filter Placement During Treatment for Deep Venous Thrombosis of the Lower Extremity

    SciTech Connect

    Yamagami, Takuji Kato, Takeharu; Iida, Shigeharu; Hirota, Tatsuya; Nishimura, Tsunehiko

    2005-05-15

    Purpose. To evaluate the efficacy and safety of Gunther tulip retrievable vena cava filter (GTF) implantation to prevent pulmonary embolism during intravenously administered thrombolytic and anticoagulation therapy and interventional radiological therapy for occlusive or nonocclusive deep venous thrombosis (DVT) of the lower extremity. Methods. We evaluated placement of 55 GTFs in 42 patients with lower extremity DVT who had undergone various treatments including those utilizing techniques of interventional radiology. Results. Worsening of pulmonary embolism in patients with existing pulmonary embolism or in those without pulmonary embolism at the time of GTF insertion was avoided in all patients. All attempts at implantation of the GTF were safely accomplished. Perforation and migration experienced by one patient was the only complication. Mean period of treatment for DVT under protection from pulmonary embolism by the GTF was 12.7 {+-} 8.3 days (mean {+-} SD, range 4-37 days). We attempted retrieval of GTFs in 18 patients in whom the venous thrombus had disappeared after therapy, and retrieval in one of these 18 cases failed. GTFs were left in the vena cava in 24 patients for permanent use when the DVT was refractory to treatment. Conclusion. The ability of the GTF to protect against pulmonary embolism during treatment of DVT was demonstrated. Safety in both placement and retrieval was clarified. Because replacement with a permanent filter was not required, use of the GTF was convenient when further protection from complicated pulmonary embolism was necessary.

  17. Inferior vena cava/aorta diameter index in the assessment of the body fluid status - a comparative study of measurements performed by experienced and inexperienced examiners in a group of young adults.

    PubMed

    Durajska, Kaja; Januszkiewicz, Emilia; Szmygel, Łukasz; Kosiak, Wojciech

    2014-09-01

    The assessment of the body fluid status is one the most challenging tasks in clinical practice. Although there are many methods to assess the body fluid status of patients, none of them is fully satisfactory in contemporary medical sciences. In the article below, we compare the results of measurements performed by experienced and inexperienced examiners based on the inferior vena cava/aorta diameter index in a sonographic hydration assessment. The study enrolled 50 young students at the age of 19-26 (the median age was 22.95) including 27 women and 23 men. The volunteers were examined in the supine position with GE Logiq 7 system and a convex transducer with the frequency of 2-5 MHz. The measurements were performed in the longitudinal and transverse planes by two inexperienced examiners - the authors of this paper, following a four-hour training conducted by an experienced sonographer. The longitudinal values of the inferior vena cava/aorta diameter index obtained in this study were similar to those found in the literature. The reference value for the inferior vena cava/aorta index determined by Kosiak et al., which constituted 1.2 ± 2 SD, for SD = 0.17, was similar to the values obtained by the authors of this paper which equaled 1.2286 ± 2 SD, for SD = 0.2. The article presented below proves that measuring the inferior vena cava/aorta diameter index is not a complex examination and it may be performed by physicians with no sonographic experience. Furthermore, the paper demonstrates that the inferior vena cava/aorta diameter index measured in the transverse plane is similar to the inferior vena cava/aorta diameter index determined in the longitudinal plane. Thus, both measurements may be used interchangeably to assess the hydration status of patients.

  18. Primary epithelial tumour in the right atrium of the heart and inferior vena cava in NZR/gd inbred rats; pathology of 18 cases.

    PubMed

    Goodall, C M; Christie, G S; Hurley, J V

    1975-08-01

    In NZR/Gd inbred albino rats, tumours occurred in the right atrium or inferior vena cava of approximately 20 per cent. of untreated animals, of both sexes, over the age of 1 yr. The tumours were centred in the wall of the right atrium in 15 cases, and in the inferior vena cava in another three cases; they appeared to be primary in these sites. The tumours were slowly growing, but eventually malignant. Light- and electron-microscopic study showed the tumours were composed of epithelial alveoli imbedded in a collagenous connective tissue containing spindle cells and thin-walled blood capillaries. The epithelium varied from flat to low columnar, and often secreted mucoid material into the lumina, or sometimes into surrounding tissue. This tumour, for which the name atrio-caval epithelial mesothelioma is suggested, very closely resembles a rare epithelial tumour of the right atrium previously described in humans under a variety of names. An underlying embryological anomaly had been postulated in these tumours in humans, and the occurrence of pathologically similar lesions in high incidence in hearts of NZR/Gd inbred rats should help test the hypothesis of genetic and developmental causes in the genesis of this rare cardiac neoplasm.

  19. Bilateral massive pulmonary thromboembolism in a young patient treated with supportive measures and an inferior vena cava filter with excellent outcome

    PubMed Central

    Sule, Ashish Anil; Chin, Tay J; Pandit, Nihar; Rajendran, Joseph

    2010-01-01

    Acute pulmonary embolism (PE) is a common and often fatal disease with a mortality rate of more than 30% in untreated patients. There is a twofold increase in mortality in patients with massive PEs who do not receive treatment. Recurrent embolism is the most common cause of death. A 48-year-old woman presented to Tan Tock Seng Hospital, Singapore, on December 16, 2009, with a massive pulmonary thromboembolism. She was admitted to the intensive care unit and treated with supportive measures, ventilatory support, antibiotics and ionotropes. The patient was diagnosed with urosepsis with septicemic shock, disseminated intravascular coagulation, acute renal failure, high anion gap metabolic acidosis, iron-deficiency anemia secondary to menorrhagia, and a uterine mass with high cancer antigen 125, although malignancy was ruled out. Anticoagulation or thrombolysis could not be provided in view of coagulopathy. The patient subsequently underwent inferior vena cava filter insertion on December 31, 2009. The patient showed clinical improvement over the next two weeks with antibiotics and supportive measures. If there is a contraindication to anticoagulation or thrombolysis, massive pulmonary thromboembolism should be treated aggressively with supportive measures. Inferior vena cava filter insertion should be instituted early to prevent recurrent PE, which can be fatal. It may take weeks before the patient displays clinical improvement. PMID:22477620

  20. The relationship between cerebral and somatic oxygenation and superior and inferior vena cava flow, arterial oxygenation and pressure in infants during cardiopulmonary bypass.

    PubMed

    White, M C; Edgell, D; Li, J; Wang, J; Holtby, H

    2009-03-01

    We investigated blood flow and regional oxygenation (rSO(2)) during cardiopulmonary bypass (CPB). Twenty infants (mean (SD) age 5 (3) months, weight 5.4 (1.6) kg) were prospectively studied. Total CPB and superior vena cava (SVC) flow were measured using Transonic Bypass Flowmeters, inferior vena cava (IVC) flow derived arithmetically and rSO(2) measured using Near Infra-Red Spectroscopy. Mean SVC flow was 51.3 (14.8) ml.kg(-1).min(-1) and mean IVC flow 62.5 (19.0) ml.kg(-1).min(-1). Mean cerebral rSO(2) was 71 (11)% and somatic rSO(2) 55 (13)%. Cerebral and somatic rSO(2) showed no correlation with SVC and IVC flow. Cerebral rSO(2) showed a positive correlation with P(a)co(2), mean arterial pressure (MAP) and haematocrit (p < 0.0001). Somatic rSO(2) showed a positive correlation with MAP and haematocrit (p = 0.01, p = 0.02). In conclusion, the distribution of blood flow during CPB varies. The most important factor affecting this is P(a)CO(2). Cerebral and somatic oxygenation are unaffected by flow but significantly influenced by MAP, haematocrit and P(a)CO(2). PMID:19302636

  1. Usefulness of ultrasonographic measurement of the diameter of the inferior vena cava to predict responsiveness to intravascular fluid administration in patients with cancer

    PubMed Central

    Arredondo-Armenta, Juan M.; Guevara-García, Humberto; Barragán-Dessavre, Mireya; García-Guillén, Francisco J.; Sánchez-Hurtado, Luis A.; Córdova-Sánchez, Bertha; Bautista-Ocampo, Andoreni R.; Herrera-Gómez, Angel; Meneses-García, Abelardo

    2016-01-01

    We conducted an observational, longitudinal prospective study in which we measured the diameters of the inferior vena cava (IVC) of 47 patients using ultrasonography. The aim of our study was to assess the state of blood volume and to determine the percentage of patients who responded to intravascular volume expansion. Only 17 patients (36%) responded to fluid management. A higher number of responding patients had cardiovascular failure compared with nonresponders (82% vs. 50%, P = 0.03). Among the patients with cardiovascular failure, the probability of finding responders was 4.6 times higher than that of not finding responders (odds ratio, 4.66; 95% confidence interval, 1.10–19.6; P = 0.04). No significant difference was observed in the mortality rate between the two groups (11% vs. 23%, P = 0.46). In conclusion, responding to intravascular volume expansion had no impact on patient survival in the intensive care unit. PMID:27695165

  2. Catheter-Directed Thrombolysis of Acute Deep Vein Thrombosis in the Lower Extremity of a Child with Interrupted Inferior Vena Cava

    SciTech Connect

    Oguzkurt, Levent Ozkan, Ugur; Tercan, Fahri; Koc, Zafer

    2007-04-15

    We present the case of a 14-year-old girl who developed acute deep vein thrombosis (DVT) in her right lower extremity. Laboratory testing revealed protein S deficiency, and the patient's father also had this abnormality with a history of lower extremity DVT. Manual thromboaspiration followed by catheter-directed thrombolysis resulted in total clearance of all thrombi. Computed tomography and later venography revealed an interrupted inferior vena cava. Catheter-directed thrombolysis is an established treatment for adults with acute DVT. To the best of our knowledge, this report is the first to describe catheter-directed thrombolysis in a pediatric patient with lower extremity DVT. Our results suggest that catheter-directed thrombolysis is safe and effective for use in selected older children and adolescents with acute DVT in the lower extremity.

  3. Usefulness of ultrasonographic measurement of the diameter of the inferior vena cava to predict responsiveness to intravascular fluid administration in patients with cancer

    PubMed Central

    Arredondo-Armenta, Juan M.; Guevara-García, Humberto; Barragán-Dessavre, Mireya; García-Guillén, Francisco J.; Sánchez-Hurtado, Luis A.; Córdova-Sánchez, Bertha; Bautista-Ocampo, Andoreni R.; Herrera-Gómez, Angel; Meneses-García, Abelardo

    2016-01-01

    We conducted an observational, longitudinal prospective study in which we measured the diameters of the inferior vena cava (IVC) of 47 patients using ultrasonography. The aim of our study was to assess the state of blood volume and to determine the percentage of patients who responded to intravascular volume expansion. Only 17 patients (36%) responded to fluid management. A higher number of responding patients had cardiovascular failure compared with nonresponders (82% vs. 50%, P = 0.03). Among the patients with cardiovascular failure, the probability of finding responders was 4.6 times higher than that of not finding responders (odds ratio, 4.66; 95% confidence interval, 1.10–19.6; P = 0.04). No significant difference was observed in the mortality rate between the two groups (11% vs. 23%, P = 0.46). In conclusion, responding to intravascular volume expansion had no impact on patient survival in the intensive care unit.

  4. Invasive pulmonary aspergillosis presenting as thoracic mass causing obstruction of the superior and inferior vena cava in an immunocompetent patient: a diagnostic dilemma.

    PubMed

    Bunkar, Moti lal; Takhar, Rajendra Prasad; Arya, Savita

    2015-01-01

    Invasive pulmonary aspergillosis (IPA) is a disease of immunocompromised patients, but its prevalence is increasing in immunocompetent persons. Patients usually present with non-specific symptoms, sometimes consistent with bronchopneumonia. We discuss the case of a 19-year-old boy who presented with constitutional respiratory symptoms along with signs of obstruction of the superior and inferior vena cava. A chest radiograph was suggestive of a thoracic mass raising suspicion of bronchogenic carcinoma/ benign mass, sarcoidosis and tuberculosis, but a diagnosis of invasive aspergillosis was established. The patient showed excellent clinico-radiological improvement with administration of voriconazole. Invasive pulmonary aspergillosis may also present with atypical findings and should be considered in differentials when investigating a case even if the patient does not have a risk factor. PMID:26506978

  5. Pharmacomechanical thrombectomy and catheter-directed thrombolysis of acute lower extremity deep venous thrombosis in a 9-year-old boy with inferior vena cava atresia.

    PubMed

    Hamidian Jahromi, Alireza; Coulter, Amy H; Bass, Patrick; Zhang, Wayne W; Tan, Tze-Woei

    2015-04-01

    Lower extremity deep venous thrombosis (DVT) is uncommon in the pediatric population, but it can be associated with severe symptoms and potential long-term morbidity secondary to post-thrombotic syndrome. Inferior vena cava (IVC) atresia can predispose a patient to the development of extremity DVT. There is no clear consensus on optimal management of extensive extremity DVT in pediatric patients, especially in patients with IVC anomalies. We report a case of iliofemoral DVT in a 9-year-old boy with IVC atresia and presumed protein S deficiency that was treated successfully using pharmacomechanical thrombectomy and catheter-directed thrombolysis. He was maintained on long-term anticoagulation and remained symptom free at 6 months' follow-up.

  6. Phlegmasia Caerulea Dolens in a Patient With an Inferior Vena Cava Filter: Treatment of Massive Iliocaval Thrombosis Using Local Intravenous Catheter-Directed Thrombolysis

    SciTech Connect

    Cookson, Daniel; Caldwell, Stuart

    2012-10-15

    Phlegmasia caerulea dolens (PCD) is a potentially disastrous complication of inferior vena cava filter insertion, and its optimum management has not been clearly established. We present a case report of a patient with pulmonary embolism and acute adrenal haemorrhage who developed PCD secondary to massive iliocaval thrombosis after insertion of a Cook Celect removable filter. Local intravenous catheter-directed thrombolysis (CDT), followed by systemic anticoagulation, achieved limb salvage and virtual resolution of symptoms at 3 months without complications. CDT can be a successful primary treatment of filter-associated PCD and can be safe in selected patients with acute nontraumatic haemorrhage. Systemic anticoagulation may subsequently restore complete venous patency and may therefore be a useful approach to postthrombolysis management of residual iliocaval thrombus when filter removal is indicated.

  7. Leiomyosarcoma of the superior vena cava.

    PubMed

    de Chaumont, Arthus; Pierret, Charles; de Kerangal, Xavier; Le Moulec, Sylvestre; Laborde, François

    2014-08-01

    Leiomyosarcoma of the superior vena cava is a very rare tumor and only a few cases have been reported, with various techniques of vascular reconstruction. We describe a new case of leiomyosarcoma of the superior vena cava in a 61-year-old woman with extension to the brachiocephalic arterial trunk. Resection and vascular reconstruction were performed using, respectively, polytetrafluoroethylene and polyethylene terephtalate vascular grafts.

  8. Leiomyosarcoma of the superior vena cava.

    PubMed

    de Chaumont, Arthus; Pierret, Charles; de Kerangal, Xavier; Le Moulec, Sylvestre; Laborde, François

    2014-08-01

    Leiomyosarcoma of the superior vena cava is a very rare tumor and only a few cases have been reported, with various techniques of vascular reconstruction. We describe a new case of leiomyosarcoma of the superior vena cava in a 61-year-old woman with extension to the brachiocephalic arterial trunk. Resection and vascular reconstruction were performed using, respectively, polytetrafluoroethylene and polyethylene terephtalate vascular grafts. PMID:25087805

  9. Transhepatic approach to create stent fenestration in the extracardiac Fontan conduit in a child with dextrocardia and interrupted inferior vena cava with azygos continuation.

    PubMed

    Kobayashi, Daisuke; Turner, Daniel R; Forbes, Thomas J

    2013-04-01

    Plastic bronchitis is a rare life-threatening complication of Fontan operation. When medical treatment is ineffective in the setting of high systemic venous pressures, Fontan fenestration may be considered to decompress venous pressures and improve cardiac output by creation of the right-to-left shunting. However, transcatheter approach can be difficult in patients with complex venous anatomy. We report a 4-year-old girl born with hypoplastic left ventricle and heterotaxy syndrome, who developed plastic bronchitis following extracardiac Fontan procedure. Her venous anatomy was complex with dextrocardia and interrupted inferior vena cava with azygos continuation. Stent fenestration was successfully performed via transhepatic approach, which was selected based on the anatomical relationship (between extracardiac conduit, left atrium, and hepatic veins) delineated by pre-catheterization cardiac MRI. Simultaneous transesophageal echocardiography guided the intervention. Her plastic bronchitis improved significantly in 3 months but slowly progressed after the stent fenestration. At her 8-month follow-up, stent fenestration remains open and she is currently under heart transplantation evaluation due to persistent plastic bronchitis. Treatment of plastic bronchitis can be undertaken with Fontan fenestration, with pre-procedural MRI playing an essential role in patients with complex venous anatomy.

  10. Deep Venous Thrombosis of the Leg, Associated with Agenesis of the Infrarenal Inferior Vena Cava and Hypoplastic Left Kidney (KILT Syndrome) in a 14-Year-Old Child

    PubMed Central

    Bami, Sakshi; Vazquez, Yarelis; Chorny, Valeriy; Amodio, John

    2015-01-01

    Agenesis of the inferior vena cava (IVC) is a rare anomaly which can be identified as incidental finding or can be associated with iliofemoral vein thrombosis. IVC agenesis has a known association with renal anomalies which are mainly confined to the right kidney. We describe a case of a 14-year-old male who presented with left leg swelling and pain. Ultrasonography confirmed the presence of left leg deep vein thrombosis (DVT). No underlying hematologic risk factors were identified. A CT scan was obtained which demonstrated absent infrarenal IVC and extensive thrombosis in the left deep venous system and development of collateral venous flow into the azygous/hemiazygous system, with extension of thrombus into paraspinal collaterals. An additional finding in the patient was an atrophic left kidney and stenosis of an accessory left renal artery. Agenesis of the IVC should be considered in a young patient presenting with lower extremity DVT, especially in patients with no risk factors for thrombosis. As agenesis of the IVC cannot be corrected, one should be aware that there is a lifelong risk of lower extremity DVT. PMID:25685585

  11. Clinical and histopathological effects of presurgical treatment with sunitinib for renal cell carcinoma with inferior vena cava tumor thrombus at a single institution

    PubMed Central

    Ujike, Takeshi; Kawashima, Atsunari; Nagahara, Akira; Fujita, Kazutoshi; Miyagawa, Yasushi; Nonomura, Norio

    2016-01-01

    To evaluate the clinical and histopathological effects of presurgical treatment with sunitinib on inferior vena cava (IVC) tumor thrombus. Between 2010 and 2014, we treated seven patients with renal cell carcinoma and IVC tumor thrombus presurgically with sunitinib. We retrospectively evaluated primitive tumor size, the level of tumor thrombus according to Novick’s classification, its distance above the renal vein, thrombus diameter at its widest segment, and histopathological change after sunitinib treatment. Three patients were diagnosed histologically. Percutaneous biopsy of the renal mass before sunitinib treatment was performed in two patients. One patient was diagnosed after sunitinib treatment following nephrectomy. The primitive tumors shrank upon sunitinib therapy in four cases; however, although the caval thrombus was downstaged (from level II to I) in one patient, the level of caval thrombus did not change in five patients and increased in one patient (from level III to IV). We evaluated the histopathological effects in two patients. In one patient, the IVC tumor thrombus was mostly replaced with necrotic tissue, but its thrombus level was not downstaged. In the other patient, the IVC tumor thrombus was downstaged, but tumor thrombus was not replaced with necrotic tissue and viable tumor cells remained. Presurgical treatment with sunitinib for renal cell carcinoma with IVC tumor thrombus appears to have limited effect on IVC tumor thrombus, in contrast to its effects on primitive tumor shrinkage. In the absence of evidence of presurgical benefits from prospective studies, this treatment may not be systematically advisable. PMID:27557138

  12. Can Nephrologists Use Ultrasound to Evaluate the Inferior Vena Cava? A Cross-Sectional Study of the Agreement between a Nephrologist and a Cardiologist

    PubMed Central

    Muniz Pazeli, José; Fagundes Vidigal, Daniel; Cestari Grossi, Tarcísio; Silva Fernandes, Natália Maria; Colugnati, Fernando; Baumgratz de Paula, Rogério; Sanders-Pinheiro, Hélady

    2014-01-01

    Background/Aims The costs and the need for a specialist impair the implementation of ultrasonography for evaluating the inferior vena cava (IVC) to assess the volemic status in hemodialysis patients. We investigated whether a nephrologist with limited ultrasound training can accurately assess the IVC in patients undergoing hemodialysis. Methods A cardiologist and a nephrologist consecutively measured the indexed IVC expiratory diameter (VCDi) and the IVC collapsibility index (IVCCI) of 52 patients during hemodialysis sessions. In protocol I, the nephrologist used a regular ultrasound system (RUS) and the cardiologist used a cardiovascular ultrasound equipment; in protocol II, the machines were interchanged. Pearson and kappa coefficients and the interexaminer agreement by the Bland-Altman method were calculated. Results The VCDi measurements showed a strong correlation in both protocols (r = 0.88 and 0.84 in protocols I and II, respectively). The volemic classifications were excellent in protocol I (kappa = 0.82 and 0.93 by VCDi and IVCCI, respectively) and substantial in protocol II (kappa = 0.77 and 0.75 by VCDi and IVCCI, respectively). The interexaminer agreement on the VCDi measurements was very good in both protocols. Conclusions Ultrasound evaluation of the IVC can be performed by nephrologists using an RUS to assess the volemic status in hemodialysis patients. PMID:24926312

  13. Incidence of inferior vena cava thrombosis detected by transthoracic echocardiography in the immediate postoperative period after adult cardiac and general surgery.

    PubMed

    Saranteas, T; Kostopanagiotou, G; Tzoufi, M; Drachtidi, K; Knox, G M; Panou, F

    2013-11-01

    Venous thromboembolism is an important complication after general and cardiac surgery. Using transthoracic echocardiography, this study assessed the incidence of inferior vena cava (IVC) thrombosis among a total of 395 and 289 cardiac surgical and major surgical patients in the immediate postoperative period after cardiac and major surgery, respectively. All transthoracic echocardiography was performed by a specialist intensivist within 24 hours after surgery with special emphasis on using the subcostal view in the supine position to visualise the IVC. Of the 395 cardiac surgical patients studied, the IVC was successfully visualised using the subcostal view in 315 patients (79.8%) and eight of these patients (2.5%) had a partially obstructive thrombosis in the IVC. In 250 out of 289 (85%) general surgical patients, the IVC was also clearly visualised, but only one patient (0.4%) had an IVC thrombosis (2.5 vs 0.4%, P <0.05). In summary, visualisation of the IVC was feasible in most patients in the immediate postoperative period after both adult cardiac and major surgery. IVC thrombosis appeared to be more common after adult cardiac surgery than general surgery. A large prospective cohort study is needed to define the risk factors for IVC thrombus and whether early thromboprophylaxis can reduce the incidence of IVC thrombus after adult cardiac surgery.

  14. Primary Renal Rhabdomyosarcoma in an Adolescent With Tumor Thrombosis in the Inferior Vena Cava and Right Atrium: A Case Report and Review of the Literature.

    PubMed

    Lin, Wei-Ching; Chen, Jeon-Hor; Westphalen, Antonio; Chang, Han; Chiang, I-Ping; Chen, Cheng-Hong; Wu, Hsi-Chin; Lin, Chien-Heng

    2016-05-01

    Although the second peak of the age distribution of rhabdomyosarcoma (RMS) is at adolescence, renal RMS is extremely rare at this age group. This tumor is indistinguishable from other renal tumors based on clinical and imaging findings, and the diagnosis relies on histology and immunohistochemical staining. We report a unique case of adolescent renal RMS associated with tumor thrombus extending into the inferior vena cava (IVC) and right atrium.An 18-year-old female adolescent presented with shortness of breath and palpitations, associated with right flank discomfort, and hematuria. A pleomorphic-type renal RMS with Budd-Chiari syndrome and arrhythmia induced by IVC and RA thrombosis was diagnosed. Despite complete tumor resection, the patient developed multiple lung metastases a month after surgery. Chemotherapy was recommended, but the patient declined. She died within a year of the initial operation.Adolescent renal RMS is rare and associated with poor outcome. Early aggressive multimodal therapy seems to be appropriate, in particular, in the presence of tumor thrombosis. PMID:27227946

  15. Creation of an iOS and Android Mobile Application for Inferior Vena Cava (IVC) Filters: A Powerful Tool to Optimize Care of Patients with IVC Filters.

    PubMed

    Deso, Steven E; Idakoji, Ibrahim A; Muelly, Michael C; Kuo, William T

    2016-06-01

    Owing to a myriad of inferior vena cava (IVC) filter types and their potential complications, rapid and correct identification may be challenging when encountered on routine imaging. The authors aimed to develop an interactive mobile application that allows recognition of all IVC filters and related complications, to optimize the care of patients with indwelling IVC filters. The FDA Premarket Notification Database was queried from 1980 to 2014 to identify all IVC filter types in the United States. An electronic search was then performed on MEDLINE and the FDA MAUDE database to identify all reported complications associated with each device. High-resolution photos were taken of each filter type and corresponding computed tomographic and fluoroscopic images were obtained from an institutional review board-approved IVC filter registry. A wireframe and storyboard were created, and software was developed using HTML5/CSS compliant code. The software was deployed using PhoneGap (Adobe, San Jose, CA), and the prototype was tested and refined. Twenty-three IVC filter types were identified for inclusion. Safety data from FDA MAUDE and 72 relevant peer-reviewed studies were acquired, and complication rates for each filter type were highlighted in the application. Digital photos, fluoroscopic images, and CT DICOM files were seamlessly incorporated. All data were succinctly organized electronically, and the software was successfully deployed into Android (Google, Mountain View, CA) and iOS (Apple, Cupertino, CA) platforms. A powerful electronic mobile application was successfully created to allow rapid identification of all IVC filter types and related complications. This application may be used to optimize the care of patients with IVC filters.

  16. Creation of an iOS and Android Mobile Application for Inferior Vena Cava (IVC) Filters: A Powerful Tool to Optimize Care of Patients with IVC Filters.

    PubMed

    Deso, Steven E; Idakoji, Ibrahim A; Muelly, Michael C; Kuo, William T

    2016-06-01

    Owing to a myriad of inferior vena cava (IVC) filter types and their potential complications, rapid and correct identification may be challenging when encountered on routine imaging. The authors aimed to develop an interactive mobile application that allows recognition of all IVC filters and related complications, to optimize the care of patients with indwelling IVC filters. The FDA Premarket Notification Database was queried from 1980 to 2014 to identify all IVC filter types in the United States. An electronic search was then performed on MEDLINE and the FDA MAUDE database to identify all reported complications associated with each device. High-resolution photos were taken of each filter type and corresponding computed tomographic and fluoroscopic images were obtained from an institutional review board-approved IVC filter registry. A wireframe and storyboard were created, and software was developed using HTML5/CSS compliant code. The software was deployed using PhoneGap (Adobe, San Jose, CA), and the prototype was tested and refined. Twenty-three IVC filter types were identified for inclusion. Safety data from FDA MAUDE and 72 relevant peer-reviewed studies were acquired, and complication rates for each filter type were highlighted in the application. Digital photos, fluoroscopic images, and CT DICOM files were seamlessly incorporated. All data were succinctly organized electronically, and the software was successfully deployed into Android (Google, Mountain View, CA) and iOS (Apple, Cupertino, CA) platforms. A powerful electronic mobile application was successfully created to allow rapid identification of all IVC filter types and related complications. This application may be used to optimize the care of patients with IVC filters. PMID:27247483

  17. Respiratory variation in aortic flow peak velocity and inferior vena cava distensibility as indices of fluid responsiveness in anaesthetised and mechanically ventilated children

    PubMed Central

    Achar, Shreepathi Krishna; Sagar, Maddani Shanmukhappa; Shetty, Ranjan; Kini, Gurudas; Samanth, Jyothi; Nayak, Chaitra; Madhu, Vidya; Shetty, Thara

    2016-01-01

    Background and Aims: Dynamic parameters such as the respiratory variation in aortic flow peak velocity (ΔVpeak) and inferior vena cava distensibility index (dIVC) are accurate indices of fluid responsiveness in adults. Little is known about their utility in children. We studied the ability of these indices to predict fluid responsiveness in anaesthetised and mechanically ventilated children. Methods: This prospective study was conducted in 42 children aged between one to 14 years scheduled for elective surgery under general endotracheal anaesthesia. Mechanical ventilation was initiated with a tidal volume of 10 ml/kg. ΔVpeak, dIVC and stroke volume index (SVI) were measured before and after volume expansion (VE) with 10 ml/kg of crystalloid using transthoracic echocardiography. Patients were considered to be responders (R) and non-responders (NR) when SVI increased to either ≥15% or <15% after VE. ΔVpeak and dIVC were analysed between R and NR. Results: The best cut-off value for ΔVpeak as defined by the receiver operator characteristics (ROC) curve analysis was 12.2%, for which sensitivity, specificity, positive predictive value and negative predictive value were 100%, 94%, 96% and 100%, respectively, the area under the curve was 0.975. The best cut-off value for dIVC as defined by the ROC curve analysis was 23.5%, for which sensitivity, specificity, positive predictive value and negative predictive value were 91%, 89%, 91% and 89%, respectively, the area under the curve was 0.95. Conclusion: ΔVpeak and dIVC are reliable indices of fluid responsiveness in children. PMID:27013751

  18. Inferior vena cava filter insertion through the popliteal vein: enabling the percutaneous endovenous intervention of deep vein thrombosis with a single venous access approach in a single session

    PubMed Central

    Kim, Hyoung Ook; Kim, Jae Kyu; Park, Jin Gyoon; Yim, Nam Yeol; Kang, Yang Jun; Jung, Hye Doo

    2016-01-01

    PURPOSE We aimed to evaluate the efficiency of placing an inferior vena cava (IVC) filter through the same popliteal vein access site used for percutaneous endovenous intervention in patients with extensive lower extremity deep vein thrombosis. METHODS This retrospective study included 21 patients who underwent IVC filter insertion through the popliteal vein over a three-year period. Patient medical records were reviewed for the location of the deep vein thrombosis, result of filter removal, and total number of endovascular procedures needed for filter insertion and recanalization of the lower extremity venous system. Follow-up lower extremity computed tomography (CT) venography was also reviewed in each patient to assess the degree of filter tilt in the IVC. RESULTS All patients had extensive lower extremity deep vein thrombosis involving the iliac vein and/or femoral vein. Seventeen patients showed deep vein thrombosis of the calf veins. In all patients, IVC filter insertion and the recanalization procedure were performed during a single procedure through the single popliteal vein access site. In the 17 patients undergoing follow-up CT, the mean tilt angle of the filter was 7.14°±4.48° in the coronal plane and 8.77°±5.49° in the sagittal plane. Filter retrieval was successful in 16 of 17 patients (94.1%) in whom filter retrieval was attempted. CONCLUSION Transpopliteal IVC filter insertion is an efficient technique that results in low rates of significant filter tilt and enables a single session procedure using a single venous access site for filter insertion and percutaneous endovenous intervention. PMID:27559713

  19. Successful removal of a Gunther tulip vena cava filter with wall-embedded hook and migration during a retrieval attempt.

    PubMed

    Yamagami, Takuji; Yoshimatsu, Rika; Matsumoto, Tomohiro; Nishimura, Tsunehiko

    2013-01-01

    Retrieval of a Gunther tulip vena cava filter implanted in a patient with inferior vena cava and right common iliac vein thrombosis was attempted by the standard method. Because the filter was tilted, the hook became attached to the vena cava wall and could not be snared. During attempts at removal by an alternative method, the filter migrated toward the right atrium. However, it was finally successfully removed. PMID:23986855

  20. Modeling Flow Past a Tilted Vena Cava Filter

    SciTech Connect

    Singer, M A; Wang, S L

    2009-06-29

    Inferior vena cava filters are medical devices used to prevent pulmonary embolism (PE) from deep vein thrombosis. In particular, retrievable filters are well-suited for patients who are unresponsive to anticoagulation therapy and whose risk of PE decreased with time. The goal of this work is to use computational fluid dynamics to evaluate the flow past an unoccluded and partially occluded Celect inferior vena cava filter. In particular, the hemodynamic response to thrombus volume and filter tilt is examined, and the results are compared with flow conditions that are known to be thrombogenic. A computer model of the filter inside a model vena cava is constructed using high resolution digital photographs and methods of computer aided design. The models are parameterized using the Overture software framework, and a collection of overlapping grids is constructed to discretize the flow domain. The incompressible Navier-Stokes equations are solved, and the characteristics of the flow (i.e., velocity contours and wall shear stresses) are computed. The volume of stagnant and recirculating flow increases with thrombus volume. In addition, as the filter increases tilt, the cava wall adjacent to the tilted filter is subjected to low velocity flow that gives rise to regions of low wall shear stress. The results demonstrate the ease of IVC filter modeling with the Overture software framework. Flow conditions caused by the tilted Celect filter may elevate the risk of intrafilter thrombosis and facilitate vascular remodeling. This latter condition also increases the risk of penetration and potential incorporation of the hook of the filter into the vena caval wall, thereby complicating filter retrieval. Consequently, severe tilt at the time of filter deployment may warrant early clinical intervention.

  1. Long-term Outcomes of Percutaneous Venoplasty and Gianturco Stent Placement to Treat Obstruction of the Inferior Vena Cava Complicating Liver Transplantation

    SciTech Connect

    Lorenz, Jonathan M. Beek, Darren van; Funaki, Brian; Ha, Thuong G. Van; Zangan, Stephen; Navuluri, Rakesh; Leef, Jeffery A.

    2013-05-11

    PurposeEvaluation of long-term outcomes of venoplasty and Gianturco stents to treat inferior vena cava (IVC) obstruction after liver transplantation.MethodsWe retrospectively analyzed records from 33 consecutive adult patients referred with the intent to treat suspected IVC obstruction after liver transplantation. Treatment was performed for occlusion or stenosis with a gradient exceeding 3 mmHg. The primary treatment was venoplasty and, if refractory, Gianturco stent placement. Recurrence prompted repeat venoplasty or stent placement.ResultsOf the 33 patients, 25 (aged 46.9 ± 12.2 years) required treatment at a mean of 2.3 years (14 days to 20.3 years) after transplantation. For technically successful cases, primary treatment was venoplasty alone (14) or with stent placement (10). Technical success was 96 % (24 of 25) reflecting failure to cross one occlusion. Clinical success was 88 % (22 of 25) reflecting the technical failure and two that died of unrelated complications within 5 weeks. Cumulative primary patencies were 57.1 % at 6 months (n = 21) and 51.4 % at 1 (n = 10), 3 (n = 7), 5 (n = 6), and 7 (n = 5) years. Cumulative primary assisted patency was 95.2 % at 6 months (n = 21) and at 1 (n = 15), 3 (n = 9), 5 (n = 8), and 7 (n = 8) years. The 17 patients stented for refractory (n = 10) or recurrent (n = 7) stenosis had cumulative primary and primary assisted patencies of 86.0 and 100 %, respectively, from 6 months (n = 14) to 7 years (n = 3). No major complications occurred; one fractured stent was observed after 11.6 years.ConclusionFor IVC obstruction following liver transplantation, excellent long-term outcomes can be achieved by venoplasty and Gianturco stent placement.

  2. Lymphatic Pump Treatment Increases Thoracic Duct Lymph Flow in Conscious Dogs with Edema Due to Constriction of the Inferior Vena Cava

    PubMed Central

    Prajapati, Parna; Shah, Pankhil; King, Hollis H.; Williams, Arthur G.; Desai, Pratikkumar

    2010-01-01

    Abstract Background Osteopathic lymphatic pump treatments (LPT) are used to treat edema, but their direct effects on lymph flow have not been studied. In the current study, we examined the effects of LPT on lymph flow in the thoracic duct of instrumented conscious dogs in the presence of edema produced by constriction of the inferior vena cava (IVC). Methods and Results Six dogs were surgically instrumented with an ultrasonic flow transducer on the thoracic lymph duct and catheters in the descending thoracic aorta and in IVC. After postoperative recovery, lymph flow and hemodynamic variables were measured 1) pre-LPT, 2) during 4 min LPT, 3) post-LPT, in the absence and presence of edema produced by IVC constriction. This constriction increased abdominal girth from 60 ± 2.6 to 75 ± 2.9 cm. Before IVC constriction, LPT increased lymph flow (P < 0.05) from 1.9 ± 0.2 ml/min to a maximum of 4.7 ± 1.2 ml/min, whereas after IVC constriction, LPT increased lymph flow (P < 0.05) from 7.9 ± 2.2 to a maximum of 11.7 ± 2.2 ml/min. The incremental lymph flow mobilized by 4 min of LPT (ie, the flow that exceeded 4 min of baseline flow), was 10.6 ml after IVC constriction. This incremental flow was not significantly greater than that measured before IVC constriction. Conclusions Edema caused by IVC constriction markedly increased lymph flow in the thoracic duct. LPT increased thoracic duct lymph flow before and after IVC constriction. The lymph flow mobilized by 4 min of LPT in presence of edema was not significantly greater than that mobilized prior to edema. PMID:20863267

  3. Vena cava filter insertion and the general surgery armamentarium: a 13-year experience.

    PubMed

    Sing, Ronald F; Nguyen, Phuong H; Christmas, A Britton; Jacobs, David G; Heniford, B Todd

    2010-07-01

    The prevention of pulmonary emboli has a long surgical history. Through the development of percutaneous technologies, vena cava filters (VCFs) are now commonly inserted by interventional radiologists. This study reviews our experience with VCFs inserted by general surgeons. We retrospectively reviewed data from our VCF performance improvement database, which is a prospective collection of the VCF experience of the Department of General Surgery from February 1996 to May 2009. Demographics, procedural information, and complications were recorded. Eight hundred fifty-five VCFs were inserted in 853 patients. The mean age was 42.0 years (range, 14 to 90 years). One hundred ninety-seven VCFs were placed in the operating room, and 658 were placed in the intensive care unit. Twelve VCFs were intentionally inserted in a suprarenal position, and four were placed in the superior vena cava. Two patients received both superior vena cava and inferior vena cava filters. Complications included deep vein thrombosis at the insertion site (n=16), vena cava thrombosis (n=9), post-VCF pulmonary embolism (n=2), and a ventricle perforation requiring operative repair (n=1). No deaths were attributed to the presence of a VCF. Overall insertion success was 99.8 per cent. In two patients, an inferior VCF could not be placed as a result of inferior vena cava occlusion with no safe "landing zone" for deployment. The placement of VCFs is a vital skill in the general surgery armamentarium. Our experience demonstrates that general surgeons can safely insert VCFs with minimal perioperative complications.

  4. [Cardiac resynchronization through a persistent left superior vena cava].

    PubMed

    Moriña-Vázquez, P; Barba-Pichardo, R; Venegas Gamero, J; Herrera Carranza, M

    2006-12-01

    Cardiac resynchronization therapy is effective in the treatment of patients with severe heart failure and intraventricular dysynchrony. However, we are sometimes faced with the unexpected presence of a persistent left superior vena cava. We report the case of a patient with dilated cardiomyopathy and left ventricular dysynchrony in which we implanted a resynchronization pacemaker exclusively through a persistent left superior vena cava that did not communicate with the right vena cava. PMID:17194405

  5. 21 CFR 870.3260 - Vena cava clip.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Vena cava clip. 870.3260 Section 870.3260 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3260 Vena cava clip. (a) Identification. A...

  6. 21 CFR 870.3260 - Vena cava clip.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Vena cava clip. 870.3260 Section 870.3260 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES CARDIOVASCULAR DEVICES Cardiovascular Prosthetic Devices § 870.3260 Vena cava clip. (a) Identification. A...

  7. In Vitro Studies of Temporary Vena Cava Filters

    SciTech Connect

    Lorch, Heike; Zwaan, Martin; Kulke, Christian; Weiss, Hans-Dieter

    1998-03-15

    Purpose: To evaluate the clot trapping capacity of different temporary vena cava filters in a vena cava model. Methods: A vena cava flow model was built using PVC tubing, a hemodialysis membrane and a pulsatile pump. Blood was imitated by a Dextran 40 solution. Five different temporary vena cava filters and two prototypes were tested using human thrombi. The mechanism of clot capture was observed. Results: Decreasing rank order according to decreasing percentage of clots captured for the 21-mm diameter vena cava model was Cook (C) > Angiocor (A) > Cordis (CD) > Antheor (TF-6) > DIL for thrombi with a diameter of 3 mm and A > C > CD > TF-6 > DIL for 5-mm thrombi. In a cava with diameter of 28 mm, decreasing rank order was C > CD = A > TF-6 > DIL and C > CD = A > DIL > TF-6 for 3- and 5-mm thrombi, respectively. Two new prototypes, the TF-8 and TF-10 filters, achieved better results than the TF-6 filter and were in most conditions comparable to the A and CD filters. In most cases, thrombi were trapped between filter and cava wall. Conclusion: The vena cava flow model demonstrates significant differences in rates of clot capture (range 22%-98%) depending on cava diameter, thrombus size, and filter type.

  8. [Emphysematous cystitis with air bubbles in the vena cava].

    PubMed

    Yokokawa, Ryusei; Tsuka, Harutoshi; Muranaka, Koji

    2014-01-01

    A 76-year-old diabetic woman was referred to our hospital with an episode of high fever and sub-abdominal pain. Computed tomography (CT) of the pelvis revealed gas accumulation within the lumen and wall of the bladder and CT of the abdomen demonstrated bubbles in the inferior vena cava. She recovered by urinary drainage and antibiotic therapy. Urinary culture revealed Escherichia coli. CT after the therapy didn't demonstrate gas accumulation of the bladder and bubbles in the inferior vena cava. Emphysematous urinary tract infections (UTIs) have the high fatality rate, it seems to be a possibility that venous bubbles with emphysematous UTIs contribute to the high fatality rate such as air embolisms. It was suspected that bacterial injury of the bladder wall and high vesical pressure caused by urinary outlet obstruction such as neurogenic bladder lead gas translocation into the venous system. Six previous cases of emphysematous UTIs (three emphysematous cystitis cases and three emphysematous pyelonephritis cases) with venous bubbles have been reported to this day. Our case is seems to be the fourth case report that venous bubbles with emphysematous cystitis was demonstrated.

  9. Congenital Absence of Inferior Vena Cava in a Young Patient with Iliofemoral Deep Venous Thrombosis Treated with Ultrasound-accelerated Catheter-directed Thrombolysis: Case Report and Review of the Literature.

    PubMed

    Reslan, Ossama M; Raffetto, Joseph D; Addis, Michael; Sundick, Scott

    2015-11-01

    Absence of the inferior vena cava (AIVC) is a rare congenital anomaly and result from aberrant development during embryogenesis. Deep vein thrombosis (DVT) is a frequent finding in healthy young adults who are diagnosed with congenital AIVC. This condition is best diagnosed with color venous Doppler ultrasound and computed tomography angiography or magnetic resonance imaging, and managed using anticoagulation, mechanical catheter-directed thrombectomy, and thrombolysis. Catheter-directed thrombolysis (CDT) followed by systemic anticoagulation and use of compression stockings appears safe and effective in the treatment of patients who present with acute DVT and AIVC. We present a case report of DVT with underlying AIVC treated successfully with CDT and will review the relevant English literature.

  10. Inferior vena caval masses identified by echocardiography

    NASA Technical Reports Server (NTRS)

    Sun, J. P.; Asher, C. R.; Xu, Y.; Huang, V.; Griffin, B. P.; Stewart, W. J.; Novick, A. C.; Thomas, J. D.

    1999-01-01

    The most common cause of an inferior vena caval mass is renal cell carcinoma that extends through the lumen, occurring in 47 of 62 patients (85%). Detection of an inferior vena caval mass affects the surgical approach requiring cardiopulmonary bypass for resection when the mass extends to the heart.

  11. Congenital Absence of Superior Vena Cava with no Manifestation of Superior Vena Cava Syndrome

    PubMed Central

    Park, Chan Soon; Kim, Jeong Jae

    2016-01-01

    Total absence of superior vena cava (SVC) is a very rare anomaly, and the patient usually suffers from SVC syndrome or conduction disturbances. We report an asymptomatic 27 year-old male, with complete absence of SVC. Transthoracic echocardiography and computed tomography demonstrated the absence of SVC and other congenital cardiac anomalies, but the presence of prominent collateral vessels that allow a sufficient venous return.

  12. Left Atrial Drainage of a Persistent Left Superior Vena Cava.

    PubMed

    Yousaf, Muhammad; Malak, Sharp F

    2008-01-01

    Although the most common form of the persistent left superior vena cava anomaly is usually clinically silent and often discovered incidentally, the risk of developing cyanosis, heart failure, and embolic cerebrovascular events is high among cases where the anomaly causes a right to left shunt. A rare case of persistent left superior vena cava draining into the left atrium through the superior left pulmonary vein is presented with a discussion of the embryology, morphologic forms, and clinical significance of the persistent left superior vena cava.

  13. [Duplication of the superior vena cava and other malformations discovered at insertion of a port-a-cath].

    PubMed

    Hammerer, V; Jeung, M; Mennecier, B; Demian, M; Pauli, G; Quoix, E

    2005-09-01

    We report a clinical case of a persistent left superior vena cava discovered in a 50-year-old female patient when a port-a-cath was inserted. This already seldom malformation was associated with an arteria lusoria and polysplenia with left inferior vena cava with hemiazygos continuation, right-sided stomach, short pancreas, preduodenal portal vein and intestinal malrotation, but without any cardiac abnormalities.

  14. [Duplication of the superior vena cava and other malformations discovered at insertion of a port-a-cath].

    PubMed

    Hammerer, V; Jeung, M; Mennecier, B; Demian, M; Pauli, G; Quoix, E

    2005-09-01

    We report a clinical case of a persistent left superior vena cava discovered in a 50-year-old female patient when a port-a-cath was inserted. This already seldom malformation was associated with an arteria lusoria and polysplenia with left inferior vena cava with hemiazygos continuation, right-sided stomach, short pancreas, preduodenal portal vein and intestinal malrotation, but without any cardiac abnormalities. PMID:16208194

  15. Role of cardiac output and the autonomic nervous system in the antinatriuretic response to acute constriction of the thoracic superior vena cava.

    NASA Technical Reports Server (NTRS)

    Schrier, R. W.; Humphreys, M. H.; Ufferman, R. C.

    1971-01-01

    Study of the differential characteristics of hepatic congestion and decreased cardiac output in terms of potential afferent stimuli in the antinatriuretic effect of acute thoracic inferior vena cava (TIVC) constriction. An attempt is made to see if the autonomic nervous system is involved in the antinatriuretic effect of acute TIVC or thoracic superior vena cava constriction.

  16. Superior vena cava syndrome: A radiation oncologist's perspective.

    PubMed

    Talapatra, Kaustav; Panda, Soumadip; Goyle, Sandeep; Bhadra, Kallol; Mistry, Rajesh

    2016-01-01

    Superior vena cava syndrome is referred to as a constellation of symptoms and signs caused by obstruction of superior vena cava. It can occur due to both benign and malignant causes with the latter being the predominant. There is a paradigm shift in the approach to manage this condition. It is no longer considered a medical emergency and histological diagnosis is necessary before treatment. This article reviews the causes, symptoms, pathophysiology, and overall management policy which have changed over decades. PMID:27461602

  17. [Superior vena cava syndrome--surgical solution--case report].

    PubMed

    Galie, N; Vasile, R; Savu, C; Petreanu, C; Grigorie, V; Tabacu, E

    2010-01-01

    The patient of 52-year-old smoker was admitted in emergency with headaches, dyspnea, oedema and cyanosis of the cephalic extremity and of the superior members. This signs and symptoms suggest a superior vena cava sindrom. Thoracic CT scan shows the thrombosis of the superior vena cava and a tumor localized in the Bariety's Lodge of about 30/40 mm witch is around the right lateral wall of the traheea.This tumor is also tangent to the superior the superior vena cava. The patient was operated by total median sternotomy. By this approach we performed a complete excision of the mediastinal tumor mass. After that we effected a longitudinal cavotomy, we took out the endoluminal clot and we sutured the superior vena cava. The histological diagnosis of the mediastinal tumor was adenocarcinoma tubular-papillary moderately differentiated. The evolution post operative period was favorable the superior vena cava sindrom was a complet remission. The thoracic CT scan control after 9 months later didn't show a local relapse and blood flow was normally throw the superior vena cava.

  18. [Maze procedure in a case of dextrocardia with atrial septal defect and persistent left superior vena cava].

    PubMed

    Muraoka, Arata; Kawada, Masaaki; Misawa, Yoshio

    2014-08-01

    A 52-year-old man was diagnosed with dextrocardia at the age of 1 year and was asymptomatic until 1 year before admission. He was transferred to our hospital for management of atrial fibrillation. A transthoracic echocardiogram showed dextrocardia with atrial septal defect;moderate tricuspid valve regurgitation; and a large, persistent left superior vena cava. A cardiac catheterization study revealed that pulmonary flow/systemic flow (Qp/Qs) was 3.6 and that pulmonary vascular resistance was 2.5 Wood U·m². Intracardiac repair with tricuspid annuloplasty and a maze procedure was scheduled. When establishing cardiopulmonary bypass, venous drainage was initially obtained from the inferior vena cava and the left superior vena cava, and the small superior vena cava was then directly cannulated after opening the right atrium. The patient's postoperative course was uneventful, and serial electrocardiograms have demonstrated maintenance of normal sinus rhythm for 3.5 years after the operation.

  19. Design Optimization of Vena Cava Filters: An application to dual filtration devices

    SciTech Connect

    Singer, M A; Wang, S L; Diachin, D P

    2009-12-03

    Pulmonary embolism (PE) is a significant medical problem that results in over 300,000 fatalities per year. A common preventative treatment for PE is the insertion of a metallic filter into the inferior vena cava that traps thrombi before they reach the lungs. The goal of this work is to use methods of mathematical modeling and design optimization to determine the configuration of trapped thrombi that minimizes the hemodynamic disruption. The resulting configuration has implications for constructing an optimally designed vena cava filter. Computational fluid dynamics is coupled with a nonlinear optimization algorithm to determine the optimal configuration of trapped model thrombus in the inferior vena cava. The location and shape of the thrombus are parameterized, and an objective function, based on wall shear stresses, determines the worthiness of a given configuration. The methods are fully automated and demonstrate the capabilities of a design optimization framework that is broadly applicable. Changes to thrombus location and shape alter the velocity contours and wall shear stress profiles significantly. For vena cava filters that trap two thrombi simultaneously, the undesirable flow dynamics past one thrombus can be mitigated by leveraging the flow past the other thrombus. Streamlining the shape of thrombus trapped along the cava wall reduces the disruption to the flow, but increases the area exposed to abnormal wall shear stress. Computer-based design optimization is a useful tool for developing vena cava filters. Characterizing and parameterizing the design requirements and constraints is essential for constructing devices that address clinical complications. In addition, formulating a well-defined objective function that quantifies clinical risks and benefits is needed for designing devices that are clinically viable.

  20. [Malignant mediastinal lesions with invasion to the superior vena cava].

    PubMed

    Kitada, M; Kubo, Y; Hirata, S; Yatsuyanagi, E; Nosaka, T; Sugimoto, S; Moriyama, H; Koshigo, S; Muraki, S; Sasajima, T

    1995-11-01

    Four patients underwent resection of mediastinal malignant tumors with invasion to the superior vena cava. Two patients had invasive thymoma, one seminoma, and one metastatic mediastinal lymph nodes of unknown origin. Prior to resection of the tumor, an ePTFE graft was anastomosed between the innominate vein and the right atrium to maintain the venous drainage from the brain and the upper extremities. In two patients, the superior vena cava was reconstructed by patch angioplasty after the tumor with a part of the vena cava was safely resected. One patient died of acute respiratory failure, but the other three are alive and well without any evidence of graft obstruction. This safe and useful method in order to prevent cerebral congestion during and after resection of the tumor.

  1. Percutaneous Stent Placement as Treatment of Renal Vein Obstruction Due to Inferior Vena Caval Thrombosis

    SciTech Connect

    Stecker, Michael S. Casciani, Thomas; Kwo, Paul Y.

    2006-02-15

    A patient who had undergone his third orthotopic liver transplantation nearly 9 years prior to presentation developed worsening hepatic and renal function, as well as severe bilateral lower extremity edema. Magnetic resonance imaging demonstrated vena caval thrombosis from the suprahepatic venous anastomosis to the infrarenal inferior vena cava, obstructing the renal veins. This was treated by percutaneous placement of metallic stents from the renal veins to the right atrium. At 16 months clinical follow-up, the patient continues to do well.

  2. Efficacy of stereotactic body radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis/inferior vena cava tumor thrombosis: evaluation by comparison with conventional three-dimensional conformal radiotherapy

    PubMed Central

    Matsuo, Yoshiro; Yoshida, Kenji; Nishimura, Hideki; Ejima, Yasuo; Miyawaki, Daisuke; Uezono, Haruka; Ishihara, Takeaki; Mayahara, Hiroshi; Fukumoto, Takumi; Ku, Yonson; Yamaguchi, Masato; Sugimoto, Koji; Sasaki, Ryohei

    2016-01-01

    This study aimed to evaluate the efficacy of stereotactic body radiotherapy (SBRT) compared with three-dimensional conformal radiotherapy (3DCRT). Forty-three patients with portal vein tumor thrombosis (PVTT)/inferior vena cava tumor thrombosis (IVCTT) treated with SBRT (27 with CyberKnife (CK) and 16 with TrueBeam (TB)) from April 2013 to December 2014, and 54 treated with 3DCRT from June 2008 to March 2013 were evaluated. Dosimetric parameters, response to radiotherapy (RT) and survival outcomes were compared in total SBRT vs. 3DCRT, CK vs. 3DCRT and TB vs. 3DCRT, respectively. The median biologically effective dose 10 (BED10) values in total SBRT, CK, TB and 3DCRT were 73.4 Gy10, 75.0 Gy10, 60.5 Gy10 and 58.5 Gy10, respectively (P < 0.001 in total SBRT vs. 3DCRT, P < 0.001 in CK vs. 3DCRT, P = 0.004 in TB vs. 3DCRT). The tumor response rates were 67%, 70%, 62% and 46%, respectively (P = 0.04, P = 0.04, P = 0.25). The 1-year overall survival rates were 49.3%, 56.7%, 38.1% and 29.3%, respectively (P = 0.02, P = 0.02, P = 0.30), and the 1-year local progression rates were 20.4%, 21.9%, 18.8% and 43.6%, respectively (P = 0.01, P = 0.04, P = 0.10). The use of SBRT made it possible to achieve a higher BED10 compared with the use of 3DCRT. Improvements in local control and survival were achieved in the CK group and the total SBRT group. Our results suggest that SBRT may have the potential to be the standard RT technique for the treatment of PVTT/IVCTT. PMID:27053259

  3. Safety and Efficacy of the Gunther Tulip Retrievable Vena Cava Filter: Midterm Outcomes

    SciTech Connect

    Hoffer, Eric K. Mueller, Rebecca J.; Luciano, Marcus R.; Lee, Nicole N.; Michaels, Anne T.; Gemery, John M.

    2013-08-01

    PurposeTo evaluate of the medium-term integrity, efficacy, and complication rate associated with the Gunther Tulip vena cava filter.MethodsA retrospective study was performed of 369 consecutive patients who had infrarenal Gunther Tulip inferior vena cava filters placed over a 5-year period. The mean patient age was 61.8 years, and 59 % were men. Venous thromboembolic disease and a contraindication to or complication of anticoagulation were the indications for filter placement in 86 % of patients; 14 % were placed for prophylaxis in patients with a mean of 2.3 risk factors. Follow-up was obtained by review of medical and radiologic records.ResultsMean clinical follow-up was 780 days. New or recurrent pulmonary embolus occurred in 12 patients (3.3 %). New or recurrent deep-vein thrombosis occurred in 53 patients (14.4 %). There were no symptomatic fractures, migrations, or caval perforations. Imaging follow-up in 287 patients (77.8 %) at a mean of 731 days revealed a single (0.3 %) asymptomatic fracture, migration greater than 2 cm in 36 patients (12.5 %), and no case of embolization. Of 122 patients with CT scans, asymptomatic perforations were identified in 53 patients (43.4 %) at a mean 757 days.ConclusionThe Gunther Tulip filter was safe and effective at 2-year follow-up. Complication rates were similar to those reported for permanent inferior vena cava filters.

  4. Impact of miR-21, miR-126 and miR-221 as prognostic factors of clear cell renal cell carcinoma with tumor thrombus of the inferior vena cava.

    PubMed

    Vergho, Daniel Claudius; Kneitz, Susanne; Kalogirou, Charis; Burger, Maximilian; Krebs, Markus; Rosenwald, Andreas; Spahn, Martin; Löser, Andreas; Kocot, Arkadius; Riedmiller, Hubertus; Kneitz, Burkhard

    2014-01-01

    Clear cell renal cell carcinoma (ccRCC) characterized by a tumor thrombus (TT) extending into the inferior vena cava (IVC) generally indicates poor prognosis. Nevertheless, the risk for tumor recurrence after nephrectomy and thrombectomy varies. An applicable and accurate prediction system to select ccRCC patients with TT of the IVC (ccRCC/TT) at high risk after nephrectomy is urgently needed, but has not been established up to now. To our knowledge, a possible role of microRNAs (miRs) for the development of ccRCC/TT or their impact as prognostic markers in ccRCC/TT has not been explored yet. Therefore, we analyzed the expression of the previously described onco-miRs miR-200c, miR-210, miR-126, miR-221, let-7b, miR-21, miR-143 and miR-141 in a study collective of 74 ccRCC patients. Using the expression profiles of these eight miRs we developed classification systems that accurately differentiate ccRCC from non-cancerous renal tissue and ccRCC/TT from tumors without TT. In the subgroup of 37 ccRCC/TT cases we found that miR-21, miR-126, and miR-221 predicted cancer related death (CRD) accurately and independently from other clinico-pathological features. Furthermore, a combined risk score based on the expression of miR-21, miR-126 and miR-221 was developed and showed high sensitivity and specificity to predict cancer specific survival (CSS) in ccRCC/TT. Using the combined risk score we were able to classify ccRCC/TT patients correctly into high and low risk cases. The risk stratification by the combined risk score (CRS) will benefit from further cohort validation and might have potential for clinical application as a molecular prediction system to identify high- risk ccRCC/TT patients. PMID:25279769

  5. Impact of miR-21, miR-126 and miR-221 as Prognostic Factors of Clear Cell Renal Cell Carcinoma with Tumor Thrombus of the Inferior Vena Cava

    PubMed Central

    Vergho, Daniel Claudius; Kneitz, Susanne; Kalogirou, Charis; Burger, Maximilian; Krebs, Markus; Rosenwald, Andreas; Spahn, Martin; Löser, Andreas; Kocot, Arkadius; Riedmiller, Hubertus; Kneitz, Burkhard

    2014-01-01

    Clear cell renal cell carcinoma (ccRCC) characterized by a tumor thrombus (TT) extending into the inferior vena cava (IVC) generally indicates poor prognosis. Nevertheless, the risk for tumor recurrence after nephrectomy and thrombectomy varies. An applicable and accurate prediction system to select ccRCC patients with TT of the IVC (ccRCC/TT) at high risk after nephrectomy is urgently needed, but has not been established up to now. To our knowledge, a possible role of microRNAs (miRs) for the development of ccRCC/TT or their impact as prognostic markers in ccRCC/TT has not been explored yet. Therefore, we analyzed the expression of the previously described onco-miRs miR-200c, miR-210, miR-126, miR-221, let-7b, miR-21, miR-143 and miR-141 in a study collective of 74 ccRCC patients. Using the expression profiles of these eight miRs we developed classification systems that accurately differentiate ccRCC from non-cancerous renal tissue and ccRCC/TT from tumors without TT. In the subgroup of 37 ccRCC/TT cases we found that miR-21, miR-126, and miR-221 predicted cancer related death (CRD) accurately and independently from other clinico-pathological features. Furthermore, a combined risk score based on the expression of miR-21, miR-126 and miR-221 was developed and showed high sensitivity and specificity to predict cancer specific survival (CSS) in ccRCC/TT. Using the combined risk score we were able to classify ccRCC/TT patients correctly into high and low risk cases. The risk stratification by the combined risk score (CRS) will benefit from further cohort validation and might have potential for clinical application as a molecular prediction system to identify high- risk ccRCC/TT patients. PMID:25279769

  6. Predicting Fluid Responsiveness Using Bedside Ultrasound Measurements of the Inferior Vena Cava and Physician Gestalt in the Emergency Department of an Urban Public Hospital in Sub-Saharan Africa

    PubMed Central

    Haeffele, Cathryn; Mfinanga, Juma A.; Mwafongo, Victor G.; Reynolds, Teri A.

    2016-01-01

    Background Bedside inferior vena cava (IVC) ultrasound has been proposed as a non-invasive measure of volume status. We compared ultrasound measurements of the caval index (CI) and physician gestalt to predict blood pressure response in patients requiring intravenous fluid resuscitation. Methods This was a prospective study of adult emergency department patients requiring fluid resuscitation. A structured data sheet was used to record serial vital signs and the treating clinician’s impression of patient volume status and cause of hypotension. Bedside ultrasound CI measurements were performed at baseline and after each 500mL of fluid. Receiver operating characteristic (ROC) curve analysis was performed to characterize the relationship between CI and Physician gestalt, and the change in mean arterial pressure (MAP). Results We enrolled 364 patients, 52% male, mean age 36 years. Indications for fluid resuscitation were haemorrhage (54%), dehydration (30%), and sepsis (17%). Receiver operating characteristic curve analysis found optimal CI cut-off values of 45%, 52% and 53% to predict a MAP rise of 5, 8 and 10 mmHg per litre of fluid, respectively. The sensitivity and specificity of CI of 50% for predicting a 10mmHg increase in MAP per litre were 88% (95%CI 81–93%) and 73% (95%CI 67–79%), respectively, area under the curve (AUC) = 0.85 (0.81–0.89). The sensitivity and specificity of physician gestalt estimate of volume depletion severity were 68% (95%CI 60–75%) and 86% (95%CI 80–90%), respectively, AUC = 0.83 (95% CI: 0.79–0.87). Those with a baseline CI ≥ 50% (51% of patients) had a 2.8-fold greater fluid responsiveness than those with a baseline CI<50% (p<0.0001). Conclusion Ultrasound measurement of the CI can predict blood pressure response among patients requiring intravenous fluid resuscitation and may be useful in early identification of patients who will benefit most from volume resuscitation, and those who will likely require other

  7. Anesthetic management of superior vena cava syndrome due to anterior mediastinal mass

    PubMed Central

    Chaudhary, Kapil; Gupta, Anshu; Wadhawan, Sonia; Jain, Divya; Bhadoria, Poonam

    2012-01-01

    Anesthetic management of superior vena cava syndrome carries a possible risk of life-threatening complications such as cardiovascular collapse and complete airway obstruction during anesthesia. Superior vena cava syndrome results from the enlargement of a mediastinal mass and consequent compression of mediastinal structures resulting in impaired blood flow from superior vena cava to the right atrium and venous congestion of face and upper extremity. We report the successful anesthetic management of a 42-year-old man with superior vena cava syndrome posted for cervical lymph node biopsy. PMID:22557753

  8. Inferior Vena Cava Filter Placement and Removal

    MedlinePlus

    ... a specially trained interventional radiologist in an interventional radiology suite or occasionally in the operating room. This ... page Additional Information and Resources Society of Interventional Radiology (SIR) - Patient Section top of page This page ...

  9. Retrievable Vena Cava Filters in Major Trauma Patients: Prevalence of Thrombus Within the Filter

    SciTech Connect

    Mahrer, Arie; Zippel, Douglas; Garniek, Alexander; Golan, Gil; Bensaid, Paul; Simon, Daniel; Rimon, Uri

    2008-07-15

    The purpose of this study was to report the prevalence of thrombus within a retrievable vena cava filter inserted prophylactically in major trauma patients referred for filter extraction. Between November 2002 and August 2005, 80 retrievable inferior vena cava filters (68 Optease and 12 Gunther-Tulip) were inserted into critically injured trauma patients (mean injury severity score 33.5). The filters were inserted within 1 to 6 (mean 2) days of injury. Thirty-seven patients were referred for filter removal (32 with Optease and 5 with Gunther-Tulip). The indwelling time was 7 to 22 (mean 13) days. All patients underwent inferior vena cavography prior to filter removal. There were no insertion-related complications and all filters were successfully deployed. Forty-three (54%) of the 80 patients were not referred for filter removal, as these patients continued to have contraindications to anticoagulation. Thirty-seven patients (46%) were referred for filter removal. In eight of them (22%) a large thrombus was seen within the filters and they were left in place, all with the Optease device. The other 29 filters (36%) were removed uneventfully.We conclude that the relatively high prevalence of intrafilter thrombi with the Optease filter may be explained by either spontaneous thrombus formation or captured emboli.

  10. Superior vena cava reconstruction using bovine jugular vein conduit.

    PubMed

    Lü, Wei Dong; Yu, Feng Lei; Wu, Zhong Shi

    2007-11-01

    The glutaraldehyde-treated bovine jugular vein conduit (BJVC) is a xenograft conduit initially used for right ventricular outflow tract reconstruction and has never been used for reconstruction of superior vena cava (SVC). In September 2003, a patient with SVC obstruction underwent SVC reconstruction using BJVC. He has been alive for 42 months and free from signs and symptoms of SVC obstruction except that metastasis was found in the vertebrae. The radionuclide venography showed the graft tube was patent and only slight stenosis was found in the proximal anastomosis. The initial result supports BJVC as an acceptable alternative for SVC reconstruction. PMID:17768061

  11. [Vena cava agenesia presented as incarcerated groin hernia].

    PubMed

    Safir-Hansen, Kristina; Achiam, Michael Patrick

    2014-12-15

    The case describes a 45-year-old man with a rare finding of vena cava agenesia presented as incarcerated groin hernia. From childhood the patient had developed dilatation of subcutaneous veins with establishment of aneurismal dilatation in the lower right side of the abdomen and groin. The patient was submitted with severe abdominal pain in the lower right side. The case describes the difficulties of an initially incorrect radiological diagnosis of incarcerated groin hernia and the discrepancy of the clinical findings. The case stresses the importance of a thorough evaluation of each patient. PMID:25497657

  12. Ultrasonographic findings in a cow with ascites due to thrombosis of the caudal vena cava.

    PubMed

    Braun, U; Schefer, U; Gerber, D; Föhn, J

    1992-01-01

    This case report describes a three-year-old Swiss Braunvieh cow with ascites due to thrombosis of the caudal vena cava. Ultrasonography verified the ascites and revealed dilatation of the abdominal portion of the caudal vena cava (4.8 cm). It was presumed that the caudal vena cava was occluded by a thrombus or by perivenous compression cranial to the dilatation. Post mortem findings included: a massive accumulation of fluid in the abdominal cavity; a 15 cm long thrombus in the subphrenic region of the caudal vena cava; multiple pulmonary abscesses; severe thrombosis of the pulmonary vasculature; hepatic congestion; oedematous abomasal folds; and severe thrombophlebitis of the left jugular vein and both udder veins, due to poor intravenous injection technique. Ascites caused by thrombosis of the caudal vena cava is rare because collateral routes of venous return, including the udder veins, are usually established. It was therefore concluded that the ascites was attributable to bilateral thrombosis of the udder veins.

  13. Comparison of superior vena caval and inferior vena caval access using a radioisotope technique during normal perfusion and cardiopulmonary resuscitation

    SciTech Connect

    Dalsey, W.C.; Barsan, W.G.; Joyce, S.M.; Hedges, J.R.; Lukes, S.J.; Doan, L.A.

    1984-10-01

    Recent studies of thoracic pressure changes during external cardiopulmonary resuscitation (CPR) suggest that there may be a significant difference in the rate of delivery of intravenous drugs when they are administered through the extrathoracic inferior vena cava (IVC) rather than the intrathoracic superior vena cava (SVC). Comparison of delivery of a radionuclide given using superior and inferior vena caval access sites was made during normal blood flow and during CPR. Mean times from injection to peak emission count in each ventricle were determined. There were no significant differences between mean peak times for SVC or IVC routes during normal flow or CPR. When peak times were corrected for variations in cardiac output, there were no significant differences between IVC and SVC peak times during normal flow. During CPR, however, mean left ventricular peak time, when corrected for cardiac output, was significantly shorter (P less than .05) when the SVC route was used. The mean time for the counts to reach half the ventricular peak was statistically shorter (P less than .05) in both ventricles with the SVC route during the low flow of CPR. This suggests that during CPR, increased drug dispersion may occur when drugs are infused by the IVC route and thus may modify the anticipated effect of the drug bolus. These results suggest that during CPR, both the cardiac output and the choice of venous access are important variables for drug delivery.

  14. Thrombectomy and surgical reconstruction for extensive iliocaval thrombosis in a patient with agenesis of the retrohepatic vena cava and atresia of the left renal vein.

    PubMed

    La Spada, Michele; Stilo, Francesco; Carella, Giuseppe; Salomone, Ignazio; Benedetto, Filippo; De Caridi, Giovanni; Spinelli, Francesco

    2011-08-01

    In 80% of the patients presenting with deep-venous thrombosis (DVT), a risk factor can be identified. An absent or hypoplastic infrarenal vena cava is a rare risk factor for DVT in young adults. In these cases, the prevalence of congenital anomalies of the inferior vena cava (IVC) is estimated at 0.5% of the general population, up to 5% in young people. The association with coagulopathy increases the risk of DVT. We report a case of a young man who presented with a massive caval and iliofemoral-popliteal thrombosis in presence of the agenesis of retrohepatic inferior vena cava and atresia of the left renal vein. Open thrombectomy and caval reconstruction with a polytetrafluoroethylene graft were performed. Surgical option with vein reconstruction was preferred to prevent new episodes of thrombosis and the risk of acute renal failure.

  15. Early and Late Retrieval of the ALN Removable Vena Cava Filter: Results from a Multicenter Study

    SciTech Connect

    Pellerin, O.; Barral, F. G.; Lions, C.; Novelli, L.; Beregi, J. P.; Sapoval, M.

    2008-09-15

    Retrieval of removable inferior vena cava (IVC) filters in selected patients is widely practiced. The purpose of this multicenter study was to evaluate the feasibility and results of percutaneous removal of the ALN removable filter in a large patient cohort. Between November 2003 and June 2006, 123 consecutive patients were referred for percutaneous extraction of the ALN filter at three centers. The ALN filter is a removable filter that can be implanted through a femoral/jugular vein approach and extracted by the jugular vein approach. Filter removal was attempted after an implantation period of 93 {+-} 15 days (range, 6-722 days) through the right internal jugular vein approach using the dedicated extraction kit after control inferior vena cavography. Following filter removal, vena cavograms were obtained in all patients. Successful extraction was achieved in all but one case. Among these successful retrievals, additional manipulation using a femoral approach was needed when the apex of the filter was close to the IVC wall in two patients. No immediate IVC complications were observed according to the postimplantation cavography. Neither technical nor clinical differences between early and late filter retrieval were noticed. Our data confirm the safety of ALN filter retrieval up to 722 days after implantation. In infrequent cases, additional endovenous filter manipulation is needed to facilitate extraction.

  16. [Primary Cardiac Angiosarcoma with Superior Vena Cava Syndrome].

    PubMed

    Shimada, Naohiro; Shiomi, Daisuke; Kaki, Nobuaki; Kiyama, Hiroshi

    2016-05-01

    Primary cardiac angiosarcoma is rare and its prognosis very poor. A 34-year-old woman complained of facial edema and dyspnea. Echocardiography, chest computed tomography scan and chest magnetic resonance imaging showed a huge tumor arising in the right atrium. Surgical excision of the tumor was performed for the purpose of relieving superior vena cava syndrome and making diagnosis of the tumor. The right atrial wall, including the tumor, was resected and reconstructed with Gore Tex patch under cardiopulmonary bypass. The tumor was diagnosed as angiosarcoma. Doxorubicin hydrochloride/ifosfamide were used to treat postoperative cardiac recurrence and lung metastasis. These drugs were effective to a certain degree, but she died of brain metastasis of the tumor in the 14th postoperative month. PMID:27220927

  17. Type A aortic dissection presenting as superior vena cava syndrome.

    PubMed

    Raja, Faisal S; Islam, Ali; Khan, Mustafa; Abbasi, Iram

    2013-01-01

    A 51-year-old man presented with a 5-day history of progressive facial swelling, sensation of head fullness, increasing shortness of breath and paroxysmal nocturnal dyspnea. He denied chest pain, syncope or presyncope. Past medical history included mechanical aortic valve replacement 7 years prior and atrial fibrillation treated with warfarin. A clinical diagnosis of acute superior vena cava (SVC) syndrome was made. Portable chest radiograph showed a widened superior mediastinum. Computed tomography scan of the thorax demonstrated a large type A aortic dissection almost completely effacing the SVC. Acute type A aortic dissection (AD) is an emergency requiring prompt diagnosis and treatment. Patients typically present with acute onset of chest and/or back pain, classically described as "ripping" or "tearing." SVC syndrome is rarely, if ever, mentioned as a presentation, as it is usually due to more chronic conditions. This case illustrates a rare incidence of type A AD actually presenting as SVC syndrome.

  18. [Suprarenal leiomyoma of the vena cava. A rare differential adrenal gland tumor diagnosis].

    PubMed

    Friedrich, M G; Witte, A; Hautmann, S H; Saeger, W

    2002-11-01

    Leiomyomas are benign tumors that can arise in the smooth muscle and can appear practically everywhere; hence, they must be taken into consideration as a rare possibility in the differential diagnosis of numerous tumors. While leiomyomas of the peripheral vessels are a relatively common finding, they are rarely found in the central vessels. Only a few cases of leiomyomas in the vena cava are known. In contrast to malignant leiomyosarcomas, leiomyomas usually grow towards the lumen. We report on the rare case of a leiomyoma in the inferior vena cava that appeared in the image to be located in the adrenal gland. Therefore, transperitoneal extirpation of the site was undertaken. It was only during surgery that a tumor emanating from the vessel wall became apparent. Thus, after an initial laparoscopic approach it became necessary to change to open resection of the tumor with cavotomy and resection of the vessel wall. The histopathological work-up revealed a benign leiomyoma and further imaging diagnostics gave no indication for the presence of metastases.

  19. Bilateral agenesis of the superior vena cava associated with congenital hydrothorax.

    PubMed

    Römer, S; Opgen-Rhein, B; Chaoui, R; Scheer, I; Czernik, C; Obladen, M

    2006-11-01

    Agenesis of the superior vena cava is a rare anomaly that is generally asymptomatic in the neonate. We report a male neonate with bilateral (total) agenesis of the superior vena cava with obstructed thoracic duct and subsequent congenital hydrothorax, anomalies that were detected by prenatal ultrasound at 25 weeks' gestation. The cardiac anomaly was confirmed by postnatal magnetic resonance angiography. The chylothorax disappeared with conservative therapy.

  20. Multidetector row computed tomography and ultrasound characteristics of caudal vena cava duplication in dogs.

    PubMed

    Bertolini, Giovanna; Diana, Alessia; Cipone, Mario; Drigo, Michele; Caldin, Marco

    2014-01-01

    Caudal vena cava duplication has been rarely reported in small animals. The purpose of this retrospective study was to describe characteristics of duplicated caudal vena cava in a large group of dogs. Computed tomography (CT) and ultrasound databases from two hospitals were searched for canine reports having the diagnosis "double caudal vena cava." One observer reviewed CT images for 71 dogs and two observers reviewed ultrasound images for 21 dogs. In all CT cases, the duplication comprised two vessels that were bilaterally symmetrical and approximately the same calibre (similar to Type I complete duplication in humans). In all ultrasound cases, the duplicated caudal vena cava appeared as a distinct vessel running on the left side of the abdominal segment of the descending aorta and extending from the left common iliac vein to the left renal vein. The prevalence of caudal vena cava duplication was 0.46% for canine ultrasound studies and 2.08% for canine CT studies performed at these hospitals. Median body weight for affected dogs was significantly lower than that of unaffected dogs (P < 0.0001). Breeds with increased risk for duplicated caudal vena cava were Yorkshire Terrier (odds ratio [OR] = 6.41), Poodle (OR = 7.46), West Highland White Terrier (OR = 6.33), and Maltese (OR = 3.87). Presence of a duplicated caudal vena cava was significantly associated with presence of extrahepatic portosystemic shunt(s) (P < 0.004). While uncommon in dogs, caudal vena cava duplication should be differentiated from other vascular anomalies when planning surgeries and for avoiding misdiagnoses.

  1. Failure properties of vena cava tissue due to deep penetration during filter insertion.

    PubMed

    Hernández, Q; Peña, E

    2016-08-01

    In this work, we use an in-vitro mechanical test to explore the resistance of biaxially stretched vena cava tissue against deep perforation and a methodology which integrates experimental and numerical modeling to identify constitutive fracture properties of the vena cava. Six sheep vena cava were harvested just after killing, and cyclic uniaxial tension tests in longitudinal and circumferential directions and biaxial deep penetration tests were performed. After that, we use a nonlinear finite element model to simulate in vitro penetration of the cava tissue in order to fit the fracture properties under penetration of the vena cava by defining a cohesive fracture zone. An iterative process was developed in order to fit the fracture properties of the vena cava using the previously obtained experimental results. The proposed solutions were obtained with fracture energy of 0.22 or 0.33 N/mm. In comparison with the experimental data, the simulation using [Formula: see text], [Formula: see text], and [Formula: see text] parameters ([Formula: see text]) is in good agreement with results from penetration experiments of cava tissue. It is noticeable that the parameter estimation process of the fracture behavior is more accurate than the estimation process of the elastic behavior for the toe region of the curve.

  2. Superior Vena Cava Syndrome. From the Bronchus to the Vessel

    PubMed Central

    Schmidt, B.; Borges, A. C.; Doerffel, W.; Baumann, G.; Romaniuk, P.

    1997-01-01

    This paper addresses the diagnosis and management of superior vena cava syndrome (SVCS) due to malignant intrathoracic tumours. Diagnosis of SVCS is usually established by bedside examination. Chest X-ray and computed tomography may be helpful, but the cavography remains the “gold-standard”. Other imaging techniques (MRI, nuclear flow studies) are more of scientific interest. Bronchoscopy helps to evaluate the risk of pulmonary complications and endoscopic procedures often lead to histological findings. In the treatment of malignant SVCS surgery, radiotherapy, and chemotherapy have been successfully used. The placement of a vascular stent might be an additional or alternative possibility. There are no conclusive indication criteria and no conclusive regimen concerning post-stenting anticoagulation. From all reported results and published papers we draw the conclusion that the immediate effects of stent implantation and the long-term results of tumour-specific therapy are complementary to one another. The stent dilates the local venous stenosis while tumour-specific therapy has a general effect on the vascular and respiratory situation in a multi-therapy concept. PMID:18493457

  3. Evaluation of Retrievability of the Gunther Tulip Vena Cava Filter

    SciTech Connect

    Yamagami, Takuji Kato, Takeharu; Hirota, Tatsuya; Yoshimatsu, Rika; Matsumoto, Tomohiro; Nishimura, Tsunehiko

    2007-04-15

    Purpose. To evaluate the feasibility and safety of withdrawal of a Gunther tulip retrievable vena cava filter (GTF). Methods. Between June 2001 and December 2005, at our institution 86 GTFs were implanted for temporary caval filtration in 59 patients (37 women, 22 men; mean age 59.3 years, range 18-87 years). For GTFs retrieved thereafter, we retrospectively reviewed the following parameters: rate of success in retrieval, degree of trapped thrombus in the filter, and complications during retrieval. Results. Worsening of or new development of pulmonary embolism after filter implantation did not occur in any patient. Of the 86 GTFs implanted, retrieval of 80 was attempted. Among those 80 filters, 77 (96%) were successfully retrieved (with the standard method, n = 72; with the modified method, n = 5) without any complication. The period of implantation of the retrieved filters was 13.4 {+-} 4.2 days. In the 5 filters that were filled to a height of {>=} 1/4 with trapped thrombus, retrieval was performed after attempts were made to decrease trapped thrombi. In addition, a temporary filter or another GTF was temporarily placed at the cephalad level of the GTF during this removal procedure. Conclusion. GTFs can be retrieved in the majority of cases. Even when encountering situations in which the filter could not be removed using the standard method, withdrawal was possible in a high frequency of cases through various trials using modified methods.

  4. Radical resection of the superior vena cava using the Contegra bovine jugular vein conduit.

    PubMed

    Belcher, Elizabeth; Dusmet, Michael; Petrou, Mario

    2010-02-01

    Radical resection of the superior vena cava poses a challenge for the cardiothoracic surgeon. The Contegra graft (Medtronic Inc, Minneapolis, MN), a biologic conduit comprising the valved segment of the bovine jugular vein, is established as a right ventricular to pulmonary artery conduit for right ventricular outflow tract repair in the pediatric population. We describe the use of the Contegra graft to facilitate radical resection and reconstruction of the superior vena cava in 2 patients, with demonstrable patency of grafts at 12 months and 7 months postoperatively. PMID:20103366

  5. Intracranial hemorrhage due to intracranial hypertension caused by the superior vena cava syndrome.

    PubMed

    Bartek, Jiri; Abedi-Valugerdi, Golbarg; Liska, Jan; Nyström, Harriet; Andresen, Morten; Mathiesen, Tiit

    2013-07-01

    We report a patient with intracranial hemorrhage secondary to venous hypertension as a result of a giant aortic pseudoaneurysm that compressed the superior vena cava and caused obstruction of the venous return from the brain. To our knowledge, this is the first patient reported to have an intracranial hemorrhage secondary to a superior vena cava syndrome. The condition appears to be caused by a reversible transient rise in intracranial pressure, as a result of compression of the venous return from the brain. Treatment consisted of surgery for the aortic pseudoaneurysm, which led to normalization of the intracranial pressure and resorption of the intracranial hemorrhage.

  6. Surgical repair of coronary sinus orifice atresia with persistent left superior vena cava in heterotaxia.

    PubMed

    Takabayashi, Shin; Shimpo, Hideto; Yokoyama, Kazuto

    2007-05-01

    A 6-month-old boy was diagnosed with coronary sinus orifice atresia, double-outlet right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and moderate common atrioventricular valve regurgitation associated with heterotaxy syndrome. Cardiac venous flow drained through a persistent left superior vena cava. We decided to perform coronary sinus orifice unroofing through the right atrium under a guide using a bougie. The persistent left superior vena cava was divided. Bidirectional Glenn anastomosis and edge-to-edge common atrioventricular valve repair were concomitantly performed. After a 1-year follow-up period, the patient is alive and well without any ischemic event.

  7. [Superior vena cava syndrome after pacemaker implantation. Increased risk with DDD-systems? Case report].

    PubMed

    Minale, C; Splittgerber, F H; Niehage, D

    1992-04-01

    Superior vena cava syndrome due to transvenous pacing leads is a rare event. Local infection as well as multiple leads are important predisposing factors. The case of a patient with superior caval syndrome after multiple complicated permanent pacemaker insertions is presented. Medical treatment was unsuccessful. At operation a fibrous narrowing of the vena cava superior was found. The two leads (DDD-pacemaker) were left in place. A Goretex patch was used for enlargement of the anterior wall of the vein. Postoperatively, the patient remained free of symptoms and the vein was patent angiographically. In case of failure of medical management surgical correction should be attempted without delay. PMID:1604927

  8. Imaging of the vena cava in the intensive care unit prior to vena cava filter insertion: carbon dioxide as an alternative to iodinated contrast.

    PubMed

    Schmelzer, Thomas M; Christmas, A Britton; Jacobs, David G; Heniford, B Todd; Sing, Ronald F

    2008-02-01

    This study evaluates the safety and effectiveness of carbon dioxide (CO2) as a contrast agent in patients in the intensive care unit undergoing vena cava filter (VCF) insertion. We prospectively evaluated patients in the intensive care unit undergoing bedside VCF insertion using CO2 cavagraphy. Blood pressure, pulse rate, mixed venous oxygen saturation, and intracranial pressure were monitored before, during, and after the CO2 injection. Fifty patients in the intensive care unit (mean age 48.2 +/- 16.5 years) were included in the study. Five patients had decreases in blood pressure, which resolved without intervention. Two patients required iodinated contrast as a result of inadequate CO2 imaging. All patients had successful insertion of VCF. The use of CO2 as a contrast agent is a safe and highly effective alternative for vena cava imaging and can be considered the first-line contrast agent for all critically ill patients requiring VCF placement.

  9. Cardiac Metastasis from Invasive Thymoma Via the Superior Vena Cava: Cardiac MRI Findings

    SciTech Connect

    Dursun, Memduh Sarvar, Sadik; Cekrezi, Bledi; Kaba, Erkan; Bakir, Baris; Toker, Alper

    2008-07-15

    Cardiac tumors are rare, and metastatic deposits are more common than primary cardiac tumors. We present cardiac magnetic resonance imaging (MRI) findings of a 50-year-old woman with invasive thymoma. Cardiac MRI revealed a heterogeneous, lobulated anterior mediastinal mass invading the superior vena cava and extending to the right atrium. In cine images there was no invasion to the right atrial wall.

  10. Cranial vena cava syndrome secondary to cryptococcal mediastinal granuloma in a cat

    PubMed Central

    Letendre, Jo-Annie; Boysen, Søren

    2015-01-01

    The successful management of cranial vena cava syndrome with suspected secondary chylothorax due to mediastinal cryptococcal granuloma in a 4-year-old male domestic shorthair cat is described. Treatment included long-term antifungal medication, short-term corticosteroids, intermittent thoracocentesis, rutin, octreotide, and enalapril. PMID:25829555

  11. Thrombosis of the cranial vena cava in a cow with bronchopneumonia and traumatic reticuloperitonitis

    PubMed Central

    Gerspach, Christian; Wirz, Mirjam; Schweizer-Knubben, Gabriela; Braun, Ueli

    2011-01-01

    This paper reports the clinical findings, surgical and medical management, and necropsy of a 6-year-old cow with thrombosis of the cranial vena cava and thrombo-embolic pneumonia following traumatic reticuloperitonitis. The clinical diagnosis was confirmed by necropsy. PMID:22547845

  12. Superior vena cava clamping for brachiocephalic vein cannulation during heart surgery.

    PubMed

    Kuralay, Erkan

    2009-08-01

    A new central venous catheterization during open heart surgery is seldom required. Clamping of superior vena cava (SVC) causes adequate brachiocephalic vein distension which facilitates vein puncture. In our experience, approximately 20 s is enough for adequate brachiocephalic vein distension. I usually prefer subclavian vein puncture by supraclavicular approach. By this approach, average superior vein clamping time is about 45 s. PMID:19339273

  13. Long-Term Safety and Effectiveness of the 'OptEase' Vena Cava Filter

    SciTech Connect

    Kalva, Sanjeeva P.; Marentis, Theodore C.; Yeddula, Kalpana; Somarouthu, Bhanusupriya; Wicky, Stephan; Stecker, Michael S.

    2011-04-15

    Purpose: To assess the long-term safety and effectiveness of the OptEase inferior vena cava (IVC) filter. Materials and Methods: In this Institutional Review Board-approved, retrospective study, we reviewed data of 71 patients who received an OptEase filter at our institution from 2002 to 2007. Thirty-nine (55%) patients had symptoms of venous thromboembolism before filter placement. The indications for filter included contraindication to anticoagulation in 31 (44%) patients, prophylaxis against pulmonary embolism (PE) in 29 (41%) patients, and failure of anticoagulation in 11 (15%) patients. Procedure-related complications, such as symptomatic post-filter PE, deep venous thrombosis (DVT), IVC occlusion, and incidental imaging-evident filter-related complications, were recorded. Safety was assessed by the occurrence of filter-related complications during placement and follow-up. Effectiveness was assessed by the occurrence of post-filter PE. Results: Sixty-five (92%) filters were placed under fluoroscopy, and 6 (8%) were placed using intravascular ultrasound guidance. Seventy (99%) filters were placed successfully. Seven (10%) filters were placed in the suprarenal cava. Retrieval was attempted in 14 (20%) patients, and 12 filters were successfully retrieved. Clinical follow-up was available for 20 {+-} 21 months. Symptoms of postfilter PE and DVT occurred in 15% (n = 11) and 10% (n = 7) patients, respectively. None of these patients had computed tomography (CT)-proven PE, and only one had ultrasound-proven new DVT. One patient had symptomatic IVC occlusion. Follow-up abdominal CT in 20 patients showed thrombus in the filter in two of them. There were no instances of filter migration, filter tilt, or caval wall penetration. Conclusion: The OptEase filter appears to have an acceptable long-term safety profile. The filter was effective against PE.

  14. Persistent Left Superior Vena Cava: A Rare Case with Clinical Significance

    PubMed Central

    Kumar, Raj; Yadav, Sankalp; Verma, Deepak

    2016-01-01

    Persistent Left Superior Vena Cava (PLSVC) is a rare congenital vascular anomaly (incidence of 0.3-0.5% of the general population) which being mostly asymptomatic in its presentation, is usually detected incidentally. There are many practical clinical implications associated with it including arrhythmias. We report a rare case of PLSVC with absent Right Superior Vena Cava (RSVC) (isolated PLSVC), in a 55-year-old lady who had complete heart block followed by sepsis and was diagnosed to have this condition during the permanent cardiac pacemaker implantation and central venous catheter insertion showing an abnormal path of the catheter/pacing leads. The authors also give an insight into its clinical relevance. PMID:27437282

  15. Radiation-induced leiomyosarcoma of the great vessels presenting as superior vena cava syndrome

    SciTech Connect

    Weiss, K.S.; Zidar, B.L.; Wang, S.; Magovern, G.J. Sr.; Raju, R.N.; Lupetin, A.R.; Shackney, S.E.; Simon, S.R.; Singh, M.; Pugh, R.P.

    1987-09-15

    A patient with a pleomorphic intravascular leiomyosarcoma of the great vessels of the neck and mediastinum presented clinically with a superior vena cava syndrome. A latent period of 29 years elapsed between receiving orthovoltage radiation to the neck and right side of chest to treat recurrent ganglioneuroblastoma, and the appearance of a leiomyosarcoma and subsequent recurrences. The patient underwent partial resection of the tumor, received adjunct chemotherapy, and was shown to be free of disease by clinical tests and by magnetic resonance imaging (MRI) 17 months after completion of chemotherapy. The criteria for the diagnosis of radiation-induced sarcomas are reviewed in relation to the present case. The critical role of magnetic resonance imaging in both the diagnosis and continued follow-up of the patient is described. This would appear to be the first reported case of radiation-induced intravascular leiomyosarcoma of the great vessels of the neck and mediastinum presenting as a superior vena cava syndrome.

  16. Radiofrequency Guide Wire Recanalization of Venous Occlusions in Patients with Malignant Superior Vena Cava Syndrome

    SciTech Connect

    Davis, Robert M.; David, Elizabeth; Pugash, Robyn A.; Annamalai, Ganesan

    2012-06-15

    Fibrotic central venous occlusions in patients with thoracic malignancy and prior radiotherapy can be impassable with standard catheters and wires, including the trailing or stiff end of a hydrophilic wire. We report two patients with superior vena cava syndrome in whom we successfully utilized a radiofrequency guide wire (PowerWire, Baylis Medical, Montreal, Quebec, Canada) to perforate through the occlusion and recanalize the occluded segment to alleviate symptoms.

  17. Acute superior vena cava syndrome after rupture of Kommerell's diverticulum: a case report.

    PubMed

    Suarez, Alison E; Slivka, Rachael

    2013-03-01

    Kommerell's diverticulum, a rare congenital aortic anomaly, is dilatation at the region in which an aberrant subclavian artery branches from either a left-sided or right-sided thoracic aorta. We report a rare case of acute superior vena cava syndrome that developed in a young healthy male patient who presented to the emergency department in imminent respiratory arrest after rupture of this diverticulum.

  18. Technical Error During Deployment Leads to Vena Cava Filter Migration and Massive Pulmonary Embolism

    SciTech Connect

    Fotiadis, Nikolas I. Sabharwal, Tarun; Dourado, Renato; Fikrat, Shabbo; Adam, Andreas

    2008-07-15

    The Guenther Tulip vena cava filter is a safe, effective, well-established device for pulmonary embolism prophylaxis. We report a patient in whom there was migration of the filter to the right atrium, 2 weeks after insertion, caused by a technical error during deployment. An attempt to retrieve the filter percutaneously failed, necessitating removal at open-heart surgery. The potential causes of migration are described and the lessons learned from this unusual case are outlined.

  19. Medical literature, vena cava filters and evidence of efficacy. A descriptive review.

    PubMed

    Girard, Philippe; Meyer, Guy; Parent, Florence; Mismetti, Patrick

    2014-04-01

    Up to 15% of all patients with venous thromboembolism (VTE) receive an inferior vena cava filter, and prophylactic placements are increasing. To determine whether current use of filters is based on robust evidence, a global review of the recent (2001-2012) literature on filters was undertaken. The MEDLINE database was searched for articles related to filters appearing during the period 2001-2012, updating a prior search of literature from 1975-2001. All retrieved articles were analysed, classified into predetermined categories and compared to the prior analysis; randomised and large (>100 patients with a filter) comparative non-randomised clinical studies were read in full. The 651 articles, vs 568 in the period 1975-2000, consisted mainly of retrospective series (37.8%), case reports (31.7%), reviews (14.7%, vs 6.7%, p<0.001), animal and/or in vitro studies (7.5%, vs 12.9%, p=0.002), and prospective series or trials (4.9%, vs 7.4%, p=0.07). Of 4 new randomised trials (RCT), none were designed to test the efficacy of the device; to date, only one RCT has attempted to ascertain efficacy, occurring during the period 1975-2000. Eleven large non-randomised studies compared clinical outcomes of patients with and without filters, in VTE patients (n=5) or prophylactic indications (n=6); two studies found statistically significant relationships between filter use and lower mortality rates, though none could demonstrate a causal relationship. Hence, the plethoric literature on filters parallels growing experience with these devices, but still fails to provide reliable evidence that filter use improves relevant clinical outcomes. No indication for filter placement is based on appropriate scientific evidence.

  20. Living donor liver transplantation with replacement of vena cava for Echinococcus alveolaris: A case report☆

    PubMed Central

    Mamedov, Ruslan; Novruzov, Namig; Baskiran, Adil; Yetisir, Fahri; Unal, Bulent; Aydın, Cemalettın; Bayramov, Nuru; Kayaalp, Cuneyt; Yilmaz, Sezai

    2014-01-01

    INTRODUCTION There is no medical treatment for alveolar echinococceal disease (AED) of liver till now. Curative surgical resection is optimal treatment but in most advanced cases curative resection can’t be done. Liver transplantation is accepted treatment option for advanced AED. AED in some case invade surrounding tissue especially inferior vena cava (IVC). Advanced AED with invasion to IVC can be treated with deceased liver transplantation. Although living donor liver transplantation is very difficult to perform in patients with advanced AED with resected IVC, it come into consideration, since there is very few cadaveric liver. PRESENTATION OF CASE Here we present a case with advanced stage of AED of liver which cause portal hypertension and cholestasis. AED invaded surrounding tissue, right diaphragm, both lobes of liver and retrohepatic part of IVC. Invasion of IVC forced us to make resection of IVC and reconstruction with cryopreserved venous graft to reestablish blood flow. After that a living donor liver transplantation was done. DISCUSSION Curative surgery is the first-choice option in all operable patients with AED of liver. Advanced stage of AED like chronic jaundice, liver abscess, sepsis, repeated attacks of cholangitis, portal hypertension, and Budd-Chiari syndrome may be an indication for liver transplantation. In some advanced stage AED during transplantation replacement of retrohepatic part of IVC could be done with artificial vascular graft, cadaveric aortic and caval vein graft. CONCLUSION Although living donor liver transplantation with replacement of IVC is a very difficult operation, it should be considered in the management of advanced AED of liver with IVC invasion because of the rarity of deceased liver. PMID:24584043

  1. In Vivo Evaluation of a Retrievable Vena Cava Filter-The Dibie-Musset Filter: Experimental Results

    SciTech Connect

    Dibie, Alain; Musset, Dominique; Heissler, Marc; Fournet, Jean-Christophe; Palau, Robert; Laborde, Francois

    1998-03-15

    Purpose: To evaluate, in an animal model, the efficacy and safety of a 7 Fr percutaneous vena cava filter for temporary or permanent use. Methods: The Dibie-Musset (DM) filter is a wire preformed into a double-spiral shape with a spring effect. The experiment was performed in 15 adult sheep and consisted of the insertion of 45 filters, clot trapping tests, and filter retrieval. Follow-up in all sheep consisted of radiologic (abdominal radiograph, inferior vena cavogram, abdominal computed tomography), macroscopic, and microscopic examinations between days 8 and 386 after filter placement. Results: Of the 45 filters implanted in 15 sheep, 29 were retrieved between day 0 and day 15. Filtration efficiency was 100% for clots 4 x 4 x 20 mm. No long-term (1 year) side-effects were detectable. Microscopic examination of the vein wall showed only a dense intimal fibrosis without signs of acute inflammation at 1 year. Conclusion: These results support the efficiency and safety of the DM filter in an animal model.

  2. Management of superior vena cava obstruction syndrome due to thrombosis of a Contegra conduit used to re-establish the innominate vein-to-right atrium continuity.

    PubMed

    Xu, Gang; Alexiou, Christos; Tofeig, Magdi; Spyt, Tomasz J

    2007-08-01

    Following intraoperative superior vena cava injury, venous drainage of the head, neck and upper extremities can be re-established with bovine jugular vein (Contegra) conduits. Inadequate anticoagulation, however, may lead to conduit thrombosis and superior vena cava obstruction syndrome. This can be successfully treated with percutaneous dilatation and stenting of the failed conduit. PMID:17669924

  3. Azygos Tip Placement for Hemodialysis Catheters in Patients with Superior Vena Cava Occlusion

    SciTech Connect

    Wong, Jeffrey J.; Kinney, Thomas B.

    2006-02-15

    Chronic central venous access is necessary for numerous life-saving therapies. Repeated access is complicated by thrombosis and occlusion of the major veins, such as the superior vena cava (SVC), which then require novel vascular approaches if therapy is to be continued. We present two cases of catheterization of the azygos system in the presence of an SVC obstruction. We conclude that the azygos vein may be used for long-term vascular access when other conduits are unavailable and that imaging studies such as magnetic resonance venography, contrast-enhanced computed tomography or conventional venography can be employed prior to the procedure to aid with planning and prevent unforeseen complications.

  4. [Catheter in the superior vena cava for hemodialysis as a last resort in superior hemithorax].

    PubMed

    Restrepo Valencia, C A; Buritica Barragán, C M; Arango, A

    2010-01-01

    We report four patients with chronic kidney disease undergoing haemodialysis therapy, which had exhausted conventional venous access (internal jugular, subclavian) and non-conventional access (axillary, innominate) in the upper hemithorax for haemodialysis. This was primarily due to thrombosis of these veins caused by previous catheterisation. These patients did not qualify for peritoneal dialysis. Using the technique recommended by Archundia et al., 4 indwelling catheters were implanted directly in the superior vena cava in each of the patients with subsequent subcutaneous tunneling. The catheters operated correctly and are currently permeable after being used for an average of 19 months.

  5. Invasive Thymoma Protruding into the Superior Vena Cava through the Thymic Vein

    PubMed Central

    Yoshimura, Takashi; Matsubara, Yoshito; Yasuhara, Yumiko; Terada, Yasuji

    2015-01-01

    We report a rare case of protrusion of an invasive thymoma with intraluminal growth through the thymic vein into the superior vena cava (SVC) without direct invasion of the vessel walls. The tumor and left brachiocephalic vein were resected, and the tumor in the SVC was removed with temporal bypass of the right brachiocephalic vein and right auricle. Histopathological finding showed that the thymoma had protruded via a thymic vein. During resection of a thymoma, a detailed examination of thymic vein is necessary to ensure that no tumor tissue remains in the vessels. PMID:26299398

  6. Life-threatening Cerebral Edema Caused by Acute Occlusion of a Superior Vena Cava Stent

    SciTech Connect

    Sofue, Keitaro Takeuchi, Yoshito Arai, Yasuaki; Sugimura, Kazuro

    2013-02-15

    A71-year-old man with advanced lung cancer developed a life-threatening cerebral edema caused by the acute occlusion of a superior vena cava (SVC) stent and was successfully treated by an additional stent placement. Although stent occlusion is a common early complication, no life-threatening situations have been reported until now. Our experience highlights the fact that acute stent occlusion can potentially lead to the complete venous shutdown of the SVC, resulting in life-threatening cerebral edema, after SVC stent placement. Immediate diagnosis and countermeasures are required.

  7. Giant Right Coronary Artery Aneurysm Associated with a Fistula Draining into the Superior Vena Cava

    PubMed Central

    Dolapoglu, Ahmet

    2016-01-01

    Giant coronary artery aneurysm associated with a coronary–cameral fistula is an uncommon condition. Such aneurysms are usually associated with other cardiac diseases, such as coronary atherosclerosis, and therefore might augment myocardial ischemia in adults. The main indications for surgical intervention are severe coexisting coronary artery disease, evidence of embolization, and aneurysmal enlargement or rupture. We describe a large right coronary artery aneurysm and a coronary–cameral fistula that drained into the superior vena cava. The surgical repair was successful. PMID:27547153

  8. Superior Vena Cava Stent Migration into the Pulmonary Artery Causing Fatal Pulmonary Infarction

    SciTech Connect

    Anand, Girija Lewanski, Conrad R.; Cowman, Steven A.; Jackson, James E.

    2011-02-15

    Migration of superior vena cava (SVC) stents is a well-recognised complication of their deployment, and numerous strategies exist for their retrieval. To our knowledge, only three cases of migration of an SVC stent to the pulmonary vasculature have previously been reported. None of these patients developed complications that resulted in death. We report a case of SVC stent migration to the pulmonary vasculature with delayed pulmonary artery thrombosis and death from pulmonary infarction. We conclude that early retrieval of migrated stents should be performed to decrease the risk of serious complications.

  9. Permanent Pacemaker-Induced Superior Vena Cava Syndrome: Successful Treatment by Endovascular Stent

    SciTech Connect

    Lanciego, Carlos Rodriguez, Mario; Rodriguez, Adela; Carbonell, Miguel A.; Garcia, Lorenzo Garcia

    2003-11-15

    The use of metallic stents in the management of benign and malignant superior vena cava syndrome (SVCS) is well documented. Symptomatic stenosis or occlusion of the SVC is a rare complication of a transvenous permanent pacemaker implant. Suggested treatments have included anticoagulation therapy, thrombolysis, balloon angioplasty and surgery. More recently, endovascular stenting has evolved as an attractive alternative but the data available in the literature are limited. We describe a case in which venous stenting with a Wallstent endoprosthesis was used successfully. The patient remains symptom free and with normal pacemaker function 36 months later.

  10. Extrinsic compression of superior vena cava: an analysis of 41 patients

    SciTech Connect

    Kanji, A.M.; Chao, J.H.; Liebner, E.J.; Lobo, P.; Thakrar, H.V.

    1980-02-01

    A retrospective analysis was made of 41 patients with extrinsic compression of the superior vena cava who were treated at the University of Illinois Hospital, Mercy Hospital and Columbus Hospital between 1967 and 1977. Small cell carcinoma was the predominant histological variety. The mode of presentation (acute versus subacute) was found to be an important prognostic factor: 47% of patients with acute presentation responded to treatment compared to 79% of patients with subacute onset. Chemotherapy given concomitantly with radiotherapy did not produce better results than radiotherapy alone.

  11. Successful use of wearable cardioverter defibrillator in a patient with dextrocardia and persistent left superior vena cava.

    PubMed

    Wan, Chingping; Oren, Jess W; Szymkiewicz, Steven J

    2013-09-01

    Congenital disorders, such as dextrocardia and persistent left superior vena cava, are rare. However, their presence is often associated with other cardiac anomalies, and may lead to lethal ventricular tachyarrhythmias, which result in sudden cardiac death. Treating patients with these disorders can present a challenge to clinicians, as it may cause technical difficulties during interventional procedures, and more often, altered defibrillation techniques in a setting of prehospital sudden cardiac arrest. This report describes the first case of successful defibrillation therapy delivered by the wearable cardioverter defibrillator to a patient with dextrocardia and persistent left superior vena cava during a ventricular tachycardia arrest.

  12. Hypoxia caused by persistent left superior vena cava connecting to the left atrium a rare clinical entity.

    PubMed

    Freeman, Andrew M; Fenster, Brett E; Weinberger, Howard D; Buckner, J Kern; Lynch, David

    2012-01-01

    We relate the case of a 40-year-old man with a history of premature birth and dextroposition of the heart who presented for an evaluation of persistent hypoxia. An unrevealing pulmonary evaluation and agitated-saline echocardiogram led to cardiac magnetic resonance imaging. This revealed a very unusual finding: a persistent left superior vena cava with insertion into the left atrium and a small connecting vein between the right and left superior venae cavae. The implications, embryology, and pathogenesis of this rare condition are discussed.

  13. Placement of a Retrievable Guenther Tulip Filter in the Superior Vena Cava for Upper Extremity Deep Venous Thrombosis

    SciTech Connect

    Nadkarni, Sanjay; Macdonald, Sumaira; Cleveland, Trevor J.; Gaines, Peter A.

    2002-12-15

    A retrievable Guenther Tulip caval filter(William Cook, Europe) was successfully placed and retrieved in the superior vena cava for upper extremity deep venous thrombosis in a 56-year-old woman. Bilateral subclavian and internal jugular venous thromboses thought secondary to placement of multiple central venous catheters were present. There have been reports of the use of permanent Greenfield filters and a single case report of a temporary filter in the superior vena cava. As far as we are aware this is the first reported placement and successful retrieval of a filter in these circumstances.

  14. 'Recovery{sup TM}' Vena Cava Filter: Experience in 96 Patients

    SciTech Connect

    Kalva, Sanjeeva P. Athanasoulis, Christos A.; Fan, C.-M.; Curvelo, Marcio; Geller, Stuart C.; Greenfield, Alan J.; Waltman, Arthur C.; Wicky, Stephan

    2006-08-15

    The purpose of the study was to assess the clinical safety and efficacy of the 'Recovery{sup TM}' (Bard) inferior vena cava (IVC) filter. We retrospectively evaluated the clinical and imaging data of patients who had a 'Recovery{sup TM}' IVC filter placed between January 2003 and December 2004 in our institution. The clinical presentation, indications, and procedure-related complications during placement and retrieval were evaluated. Follow-up computed tomography (CT) examinations of the abdomen and chest were evaluated for filter-related complications and pulmonary embolism (PE), respectively. 'Recovery' filters were placed in 96 patients (72 males and 24 females; age range: 16-87 years; mean: 46 years). Twenty-four patients presented with PE, 13 with deep vein thrombosis (DVT) and 2 with both PE and DVT. The remaining 57 patients had no symptoms of thromboembolism. Indications for filter placement included contraindication to anticoagulation (n = 27), complication of anticoagulation (n = 3), failure of anticoagulation (n = 5), and prophylaxis (n = 61). The device was successfully deployed in the infrarenal (n = 95) or suprarenal (n = 1) IVC through a femoral vein approach. Retrieval was attempted in 11 patients after a mean period of 117 days (range: 24-426). The filter was successfully removed in nine patients (82%). Failure of retrieval was due to technical difficulty (n = 1) and the presence of thrombus in the filter (n = 1). One of the nine patients who had the filter removed developed IVC thrombus after retrieval and another had an intimal tear of the IVC. Follow-up abdominal CT (n = 40) at a mean of 80 days (range: 1-513) showed penetration of the IVC by the filter arms in 11, of which 3 had fracture of filter components. In one patient, a broken arm migrated into the pancreas. Asymmetric deployment of the filter legs was seen in 12 patients and thrombus within the filter in 2 patients. No filter migration or caval occlusion was encountered. Follow-up chest

  15. Preparation and experimental research into retrievable rapamycin- and heparin-coated vena cava filters: a pilot study.

    PubMed

    Zhao, Hui; Zhang, Fuxian; Liang, Gangzhu; Ye, Lin; Zhang, Huan; Niu, Luyuan; Cheng, Long; Zhang, Mingyi

    2016-04-01

    The use of retrievable vena cava filters (RVCFs) was once commonplace, but filter retrieval was often very difficult. Most unsuccessful retrieval was due to intimal hyperplasia of the inferior vena cava and in-filter thrombosis. This pilot study aimed to design a drug-eluting RVCF. The hypothesis was that coated drugs could be released continuously to inhibit vena intimal hyperplasia and thrombosis, and thus improve the retrieval rates of RVCFs. Various concentrations of polycaprolactone (PCL)/chloroform solution were made from a mixture of Rapamycin and Heparin according to the quality of PCL. The drug was coated onto the surface of the filters by a process of dipping. In vitro tests were performed to check stability and in vitro drug release. Animals receiving filter implantation were divided into 4 groups, the experimental intervention group (EI), experimental laparotomy group (EL), control intervention group (CI), and control laparotomy group (CL). Filters were retrieved by laparotomy in the EL and CL groups, and by interventional operation in the EI and CI groups at 10, 20 and 30 days after implantation. Pathological endothelia biopsies were performed with wood grain-eosin (HE) staining and immunohistochemical examination, with the proliferating cell nuclear antigen (PCNA) index, and the results were compared between the experimental and control groups. The weight of thrombus within the filters was also measured by scale and compared. The coating concentration that succeeded in completely covering the surface was 0.2 g/ml. There was better coverage by SEM at this concentration, and the coated drugs had no obvious loss after filter release. The drug release curves showed that the amount of Heparin released was more than 50 % at day 1; Rapamycin released little in the first few days, beginning in earnest at 20 to 30 days. The filters were easy to retrieve at 10 days for both groups, while neither could be retrieved at 30 days. However, at 20 days the filter in

  16. Measurement of streaming potentials of mammalian blood vessels, aorta and vena cava, in vivo.

    PubMed

    Sawyer, P N; Himmelfarb, E; Lustrin, I; Ziskind, H

    1966-09-01

    Attempts to measure streaming potentials in large rabbit blood vessels in vivo have been carried out. Streaming potentials, V(89), were measured by the introduction of microelectrodes through the wall of the blood vessel at separations greater than 1 cm. The outputs from these electrodes fed through calomel cells were amplified and recorded directly by using an Electronics for Medicine photorecorder (White Plains, N. Y.). "Effective streaming currents" were determined by running the output through a low impedence galvanometer while simultaneously measuring the resistance of the circuit V(8) were, therefore, calculated from two measurements and compared. Flow through vessels studied was measured using two different electromagnetic flowmeters. The results indicate that V(8) present in both aorta and vena cava are of the order of 5 to 10 mv. By using the Helmholtz-Smoluchowski equation into which flow was reintegrated, the numbers yield zeta potentials approximating 0.1 to 0.4 v in both aorta and vena cava. This number approaches the apparent upper limit for zeta (actually "interfacial potentials") potentials in biological systems. The measured "i.f." potential is considered as the interreaction of several physical and metabolic factors operating at the blood intimal interface. The polarity of the potential suggests that the interface is negative with respect to the blood flowing through the vessel. Interfacial potential and related V(8) are discussed in terms of their possible importance as a mechanism for maintaining vascular homeostasis in the living animal. PMID:5970567

  17. Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy

    SciTech Connect

    Fagedet, Dorothee; Thony, Frederic; Timsit, Jean-Francois; Rodiere, Mathieu; Monnin-Bares, Valerie; Ferretti, Gilbert R.; Vesin, Aurelien; Moro-Sibilot, Denis

    2013-02-15

    To demonstrate the effectiveness of endovascular treatment (EVT) with self-expandable bare stents for malignant superior vena cava syndrome (SVCS) and to analyze predictive factors of EVT efficacy. Retrospective review of the 164 patients with malignant SVCS treated with EVT in our hospital from August 1992 to December 2007 and followed until February 2009. Endovascular treatment includes angioplasty before and after stent placement. We used self-expandable bare stents. We studied results of this treatment and looked for predictive factors of clinical efficacy, recurrence, and complications by statistical analysis. Endovascular treatment was clinically successful in 95% of cases, with an acceptable rate of early mortality (2.4%). Thrombosis of the superior vena cava was the only independent factor for EVT failure. The use of stents over 16 mm in diameter was a predictive factor for complications (P = 0.008). Twenty-one complications (12.8%) occurred during the follow-up period. Relapse occurred in 36 patients (21.9%), with effective restenting in 75% of cases. Recurrence of SVCS was significantly increased in cases of occlusion (P = 0.01), initial associated thrombosis (P = 0.006), or use of steel stents (P = 0.004). Long-term anticoagulant therapy did not influence the risk of recurrence or complications. In malignancy, EVT with self-expandable bare stents is an effective SVCS therapy. These results prompt us to propose treatment with stents earlier in the clinical course of patients with SVCS and to avoid dilatation greater than 16 mm.

  18. Bilateral Breast Enlargement: An Unusual Presentation of Superior Vena Cava Obstruction in a Hemodialysis Patient with Fibrosing Mediastinitis

    SciTech Connect

    Goo, Dong Erk Kim, Yong Jae; Choi, Deuk Lin; Kwon, Kui Hyang; Yang, Seung Boo

    2011-02-15

    A 67-year-old woman with end-stage renal disease presented with profound edema of both breasts. The presence of a patent hemodialysis basilic transposition fistula and superior vena cava obstruction (SVC), due to fibrosing mediastinitis, was demonstrated by the use of fistulography. Endovascular treatment with a balloon and stent caused immediate resolution of the breast edema.

  19. Dramatic response of follicular thyroid carcinoma with superior vena cava syndrome and tracheal obstruction to external-beam radiotherapy

    SciTech Connect

    Wilford, M.R.; Chertow, B.S.; Lepanto, P.B.; Leidy, J.W. Jr. )

    1991-06-01

    We report a patient with follicular thyroid carcinoma progressing to superior vena cava (SVC) syndrome and tracheal obstruction despite multiple doses of radioactive iodine therapy but subsequently responding dramatically to external-beam radiotherapy (RT). Although RT is not considered to be the treatment of choice for follicular carcinoma, RT in our patient produced unequivocal improvement of SVC syndrome and tracheal obstruction.

  20. Surgical treatment of an invasive thymoma extending into the superior vena cava and right atrium

    PubMed Central

    2014-01-01

    Although invasive thymoma commonly infiltrates neighbouring mediastinal structures, its extension into the superior vena cava (SVC) and consequent SVC occlusion are rare. In such cases, the urgent removal of the thymoma and radical resection of the infiltrated SVC representreasonable options, since induction therapy is time-consuming and useless for symptom resolution. A case of invasive thymoma extending into the SVC and right atrium (RA) with SVC syndrome is reported. The patient underwent a combined resection of the invasive tumor and SVC under cardiopulmonary bypass (CPB), and the SVC and bilateral brachiocephalic vein (BCV) were reconstructed with an autologous pericardial ‘Y’ conduit. After 40 months of follow-up, the patient showed a patent graft and no tumor recurrence. PMID:24400724

  1. Primary Pulmonary Ewing’s Sarcoma: Rare Cause of Superior Vena Cava Syndrome in Children

    PubMed Central

    Atwal, Swapndeep Singh; Garga, Umesh Chandra

    2014-01-01

    Ewing’s sarcoma is a common malignant bone tumour presenting in children and young adults. Rarely extra- skeletal soft tissues and visceral organs can also be the site of origin of Ewing’s sarcoma. Primary pulmonary Ewing’s sarcoma is an extremely rare malignancy which occurs in the paediatric population. We report an unusual case of primary pulmonary Ewing’s sarcoma in a nine year old girl who presented with features of superior vena cava syndrome in the emergency department. The diagnosis was confirmed pathologically both by light microscopy and immunohistochemistry. The patient was put on chemotherapy and surgery was planned but the patient expired within three days of starting chemotherapy. PMID:25302247

  2. Giant saccular superior vena cava aneurysm-a rare and difficult clinical case.

    PubMed

    Janczak, Dariusz; Skiba, Jacek; Gemel, Marek; Mak, Marek; Ziomek, Agnieszka; Malinowski, Maciej; Dorobisz, Tadeusz; Lesniak, Michal; Janczak, Dawid; Chabowski, Mariusz

    2016-03-01

    A superior vena cava (SVC) aneurysm is an extremely rare case of vascular malformation in the chest cavity. This is a report of a case of a 57-year-old woman with a saccular SVC aneurysm which was 8 cm wide. The chest computed tomography (CT) scan confirmed a giant 75 mm × 79 mm × 81 mm mass containing the contrast medium from SVC, constricting the right lung parenchyma, narrowing the right innominate vein, in contact with the anterolateral chest cavity wall, and adjoining the superior mediastinum. Under general anesthesia and employing the median sternotomy approach, using a cardiopulmonary bypass (CPB), the venous aneurysm was successfully resected. The postoperative period was uneventful. Radical surgical resection using a sternotomy and a CPB is recommended. PMID:27076981

  3. Giant saccular superior vena cava aneurysm—a rare and difficult clinical case

    PubMed Central

    Janczak, Dariusz; Skiba, Jacek; Gemel, Marek; Mak, Marek; Ziomek, Agnieszka; Malinowski, Maciej; Dorobisz, Tadeusz; Lesniak, Michal; Janczak, Dawid

    2016-01-01

    A superior vena cava (SVC) aneurysm is an extremely rare case of vascular malformation in the chest cavity. This is a report of a case of a 57-year-old woman with a saccular SVC aneurysm which was 8 cm wide. The chest computed tomography (CT) scan confirmed a giant 75 mm × 79 mm × 81 mm mass containing the contrast medium from SVC, constricting the right lung parenchyma, narrowing the right innominate vein, in contact with the anterolateral chest cavity wall, and adjoining the superior mediastinum. Under general anesthesia and employing the median sternotomy approach, using a cardiopulmonary bypass (CPB), the venous aneurysm was successfully resected. The postoperative period was uneventful. Radical surgical resection using a sternotomy and a CPB is recommended. PMID:27076981

  4. Trimodality Therapy for an Advanced Thymic Carcinoma With Both Aorta and Vena Cava Invasion.

    PubMed

    Momozane, Tohru; Inoue, Masayoshi; Shintani, Yasushi; Funaki, Soichiro; Kawamura, Tomohiro; Minami, Masato; Shirakawa, Yukitoshi; Kuratani, Toru; Sawa, Yoshiki; Okumura, Meinoshin

    2016-08-01

    A case of locally advanced thymic carcinoma that was successfully resected with the great vessels after chemoradiation therapy is reported. A 57-year-old man with Masaoka stage III thymic carcinoma received two cycles of cisplatin/docetaxel and 60 Gy irradiation. The response was stable disease with 19% size reduction, and a radical resection with the ascending aorta and superior vena cava with the patient under circulatory arrest with the use of cardiopulmonary bypass was performed. The postoperative course was uneventful, and the patient has been free of disease for 28 months. Trimodality therapy with use of a cardiovascular surgical procedure might be a valuable option in locally advanced thymic carcinoma. PMID:27449450

  5. [Syndrome of vena cava superior in the injured persons with traumatic instability of a sternocostal skeleton as a consequence of polytrauma].

    PubMed

    Sheĭko, V D; Panasenko, S I

    2013-06-01

    There were analyzed 8 clinical observations of treatment of syndrome of vena cava superior in the injured persons in traumatic instability of a sternocostal skeleton. Peculiarities of course of traumatic process, concerning the trauma severity objective prove, were established.

  6. Macro-reentrant atrial tachycardia conducting through a left superior vena cava after catheter ablation in a patient with paroxysmal atrial fibrillation.

    PubMed

    Kurotobi, Toshiya; Kino, Naoto; Tonomura, Daisuke; Shimada, Yoshihisa

    2015-01-01

    A left superior vena cava can be a cause of cardiac rhythm or conduction abnormalities, and can also be the arrhythmogenic source of atrial fibrillation (AF) with connections to the coronary sinus and left atrium. In the present study, we report a case with a macro re-entrant atrial tachycardia that coursed through the left superior vena cava after a previous AF ablation, which successfully ablated paroxysmal AF.

  7. Persistent left superior vena cava, absence of the innominate vein, and upper sinus venosus defect : a rare anomaly detected using bubbles.

    PubMed

    Akpinar, I; Sayin, M R; Karabag, T; Dogan, S M; Sen, S T; Gudul, N E; Aydin, M

    2013-05-01

    Superior vena cava anomalies are rare malformations that are typically seen with other congenital cardiac defects. Although a persistent left superior vena cava is the most common anomaly of the systemic venous return in the thorax, its combination with an upper sinus venosus defect and absence of the innominate vein is extremely rare. Here, we report a patient diagnosed with these anomalies based on a bubble study and confirmed with magnetic resonance imaging.

  8. Gunther Tulip Retrievable Inferior Vena Caval Filters: Indications, Efficacy, Retrieval, and Complications

    SciTech Connect

    Looby, S.; Given, M.F.; Geoghegan, T.; McErlean, A.; Lee, M.J.

    2007-02-15

    Purpose. We evaluated the Gunther Tulip (GT) retrievable inferior vena cava (IVC) filter with regard to indications, filtration efficacy, complications, retrieval window, and use of anticoagulation. Method. A retrospective study was performed of 147 patients (64 men, 83 women; mean age 58.8 years) who underwent retrievable GT filter insertion between 2001 and 2005. The indications for placement included a diagnosis of pulmonary embolism or deep venous thrombosis with a contraindication to anticoagulation (n = 68), pulmonary embolism or deep venous thrombosis while on anticoagulation (n = 49), prophylactic filter placement for high-risk surgical patients with a past history of pulmonary embolism or deep venous thrombosis (n = 20), and a high risk of pulmonary embolism or deep venous thrombosis (n = 10). Forty-nine of the 147 patients did not receive anticoagulation (33.7%) while 96 of 147 patients did, 82 of these receiving warfarin (56.5%), 11 receiving low-molecular weight heparins (7.58%), and 3 receiving antiplatelet agents alone (2.06%). Results. Filter placement was successful in 147 patients (100%). Two patients had two filters inserted. Of the 147 patients, filter deployment was on a permanent basis in 102 and with an intention to retrieve in 45 patients. There were 36 (80%) successful retrievals and 9 (20%) failed retrievals. The mean time to retrieval was 33.6 days. The reasons for failed retrieval included filter struts tightly adherent to the IVC wall (5/9), extreme filter tilt (2/9), and extensive filter thrombus (2/9). Complications included pneumothorax (n = 4), failure of filter expansion (n = 1), and breakthrough pulmonary embolism (n = 1). No IVC thrombotic episodes were recorded. Discussion. The Gunther Tulip retrievable filter can be used as a permanent or a retrievable filter. It is safe and efficacious. GT filters can be safely retrieved at a mean time interval of 33.6 days. The newly developed Celect filter may extend the retrieval interval.

  9. [On the venous system in the retroperitoneal region (a contribution to the persistence of the primitive vena cava system) (author's transl)].

    PubMed

    Besier, H; Stofft, E

    1977-01-01

    A vasal anomaly in the region of the Vena cava inferior is being described in the corpse of a 25-year-old man. 1. In the course of development the V. subcardinalis has not been joined to the Pars hepatica of the V. cava inferior, which originates from the V. hepatis revehens communis. In our case the Anastomosis intersubcardinalis remains and is subjected to a slight retroaortal displacement to the left. 2. Among the Vv. sacrocardinales the V. sacrocardinalis sinistra, which ought to involute after the sixth embryonal week, has been retained together with the Anastomosis intersacrocardinalis. 3. The Vv. supracardinales are connected with the intersubcardinal anastomosis and the intersupracardinal transversal anastomosis has been retained. 4. The Vv. caudales end in the Anastomosis sacrocardinalis at a point before the Sacrum and the Anastomosis intercaudalis has been retained, too. 5. The caudal section of the right lower cardinal vein in its prerenal part is retained with an anastomosis to the right subcardinal vein. 6. The portal blood of the liver is directly distributed to the atrium dextrum after it has passed through three Vv. hepaticae. The Lig. venosum is intrahepatic and is joined to the Vv. hepaticae. 7. The primitive bilateral-symmetric veinous system of the caudal half of the body continues to exist almost completely. PMID:603065

  10. OptEase and TrapEase Vena Cava Filters: A Single-Center Experience in 258 Patients

    SciTech Connect

    Onat, Levent Ganiyusufoglu, Ali Kursat; Mutlu, Ayhan; Sirvanci, Mustafa; Duran, Cihan; Ulusoy, Onur Levent; Hamzaoglu, Azmi

    2009-09-15

    We aimed to evaluate the efficacy and safety of the OptEase and TrapEase (both from Cordis, Roden, Netherlands) vena cava filters in the prevention of pulmonary embolism (PE). Between May 2004 and December 2008, OptEase (permanent/retrievable; n = 228) or TrapEase (permanent; n = 30) vena cava filters were placed in 258 patients (160 female and 98 male; mean age 62 years [range 22 to 97]). Indications were as follows: prophylaxis for PE (n = 239), contraindication for anticoagulation in the presence of PE or DVT (n = 10), and development of PE or DVT despite anticoagulation (n = 9). Medical records were retrospectively reviewed for indications, clinical results, and procedure-related complications during placement and retrieval. Clinical PE did not develop in any of the patients. However, radiologic signs of segmental PE were seen in 6 of 66 patients with follow-up imaging data. Migration or fracture of the filter or cava perforation was not seen in any of the patients. Except for a single case of asymptomatic total cava thrombosis, no thrombotic occlusion was observed. One hundred forty-one patients were scheduled to undergo filter removal; however, 17 of them were not suitable for such based on venography evaluation. Removal was attempted in 124 patients and was successful in 115 of these (mean duration of retention 11 days [range 4 to 23]). Nine filters could not be removed. Permanent/retrievable vena cava filters are safe and effective devices for PE prophylaxis and for the management of venous thromboembolism by providing the option to be left in place.

  11. Impact of intra-abdominal pressure on retrohepatic vena cava shape and flow in mechanically ventilated pigs.

    PubMed

    Bendjelid, Karim; Viale, Jean-Paul; Duperret, Serge; Colling, Joëlle; Piriou, Vincent; Merlani, Paolo; Jacques, Didier

    2012-04-01

    Conflicting results have been found regarding correlations between right atrial pressure (RAP) and inferior vena cava (IVC) diameter in mechanically ventilated patients. This finding could be related to an increase in intra-abdominal pressure (IAP). This study was designed to clarify whether variations in IVC flow rate caused by positive pressure ventilation are associated with changes in the retrohepatic IVC cross-section (ΔIVC) during major changes in volume status and IAP. Nine pigs were anesthetized, mechanically ventilated and equipped. IAP was set at 0, 15 and 30 mmHg during two conditions, i.e. normovolemia and hypovolemia, generated by blood removal to obtain a mean arterial pressure value lower than 60 mmHg. At each IAP increment, cardiac output, IVC flow and surface area were respectively assessed by flowmeters and transesophageal echocardiography. At normal IAP, even in presence of respiratory changes in IVC flows, no ΔIVC were observed during the two conditions. At high IAP, neither ΔIVC nor modulations of IVC flow were observed whatever the volemic status. The majority of animals with an IVC area of less than 0.65 cm(2) showed evidence of IAP greater than RAP values. Negative RAP-IAP pressure gradients were found to occur with an IVC area of less than 0.65 cm(2), suggesting that IVC dimensions determined using standard ultrasound techniques may indicate the direction of the RAP-IAP gradient. The clinical relevance of the present findings is that volume status should not be estimated from retrohepatic IVC dimensions in cases of high IAP. PMID:22418601

  12. Superior Vena Cava Syndrome due to Thrombosis: A Rare Paraneoplastic Presentation of Bronchogenic Carcinoma.

    PubMed

    Santra, Avradip; Nandi, Saumen; Mondal, Saibal; Chakraborty, Subhankar

    2016-07-01

    Superior vena cava (SVC) syndrome is not an uncommon occurrence in patients with malignancy and it is often described as a medical emergency. In majority of the cases, SVC syndrome occurs due to mechanical obstruction of the SVC by extraluminal compression with primary intrathoracic malignancies. However, intraluminal obstruction due to thrombosis can also produce symptoms and signs of SVC syndrome. Clot-related SVC obstruction is mostly associated with indwelling central venous catheter and pacemaker leads, although such thrombosis can occur spontaneously in a background of a hypercoagulable state, e.g., malignancy. Here, an unusual case of sudden onset SVC syndrome has been reported, which on initial radiologic evaluation was found to have a lung nodule without any significant mediastinal mass or adenopathy compressing SVC. Subsequent investigation with Doppler ultrasonography of the neck showed thrombosis in the right internal jugular, right subclavian and right brachiocephalic vein, which was responsible for SVC syndrome. Histopathological evaluation of lung nodule confirmed presence of an adenocarcinoma. Therefore, venous thromboembolism as a paraneoplastic syndrome should be kept in mind while evaluating a case of SVC obstruction in a cancer patient. Management of the underlying disease is of prime importance in such cases and anticoagulation is the mainstay of therapy. Ability to identify paraneoplastic syndrome may have a significant effect on clinical outcome, ranging from early diagnosis to improved quality of life of the patient. PMID:27365560

  13. Superior Vena Cava Obstruction in Hemodialysis Patients: Symptoms, Clinical Presentation and Outcomes Compared to Other Etiologies.

    PubMed

    Siegel, Yoel; Kuker, Russ

    2016-08-01

    The incidence of superior vena cava (SVC) obstruction associated with non-malignant diseases is on the rise, and a large percentage of these patients are on hemodialysis (HD). The objective was to characterize the presentation, symptoms and outcomes of HD patients with SVC obstruction identified on computerized tomography (CT) compared to patients with other etiologies such as neoplasm. A search was performed through the PACS system using key words to identify patients with SVC obstruction. The CT scans and charts were reviewed for degree of obstruction, signs, symptoms and outcomes. Thirty-six patients were included in the study. Thirteen were on HD and of these, five had symptoms associated with SVC obstruction and one had concordant findings on physical exam. In comparison, thirteen patients with a chest neoplasm had symptoms and four had concordant findings on physical exam. On follow up, 31% of the HD patients died and of these 60% were symptomatic and died within 2 years. 29% of lung cancer patients died within 16 months. The majority of the HD patients had complete SVC obstruction (85%) as opposed to those with a chest neoplasm who mostly had partial SVC occlusion (67%). In conclusion, patients on HD with SVC obstruction are less often symptomatic than those with a neoplasm. However, these HD patients had a death rate similar to the patients with cancer. This risk seems to increase in those who are symptomatic. Diagnosis of SVC obstruction by CT in HD patients may help identify those with less favorable prognosis.

  14. Superior Vena Cava Syndrome due to Thrombosis: A Rare Paraneoplastic Presentation of Bronchogenic Carcinoma

    PubMed Central

    Santra, Avradip; Nandi, Saumen; Mondal, Saibal; Chakraborty, Subhankar

    2016-01-01

    Superior vena cava (SVC) syndrome is not an uncommon occurrence in patients with malignancy and it is often described as a medical emergency. In majority of the cases, SVC syndrome occurs due to mechanical obstruction of the SVC by extraluminal compression with primary intrathoracic malignancies. However, intraluminal obstruction due to thrombosis can also produce symptoms and signs of SVC syndrome. Clot-related SVC obstruction is mostly associated with indwelling central venous catheter and pacemaker leads, although such thrombosis can occur spontaneously in a background of a hypercoagulable state, e.g., malignancy. Here, an unusual case of sudden onset SVC syndrome has been reported, which on initial radiologic evaluation was found to have a lung nodule without any significant mediastinal mass or adenopathy compressing SVC. Subsequent investigation with Doppler ultrasonography of the neck showed thrombosis in the right internal jugular, right subclavian and right brachiocephalic vein, which was responsible for SVC syndrome. Histopathological evaluation of lung nodule confirmed presence of an adenocarcinoma. Therefore, venous thromboembolism as a paraneoplastic syndrome should be kept in mind while evaluating a case of SVC obstruction in a cancer patient. Management of the underlying disease is of prime importance in such cases and anticoagulation is the mainstay of therapy. Ability to identify paraneoplastic syndrome may have a significant effect on clinical outcome, ranging from early diagnosis to improved quality of life of the patient. PMID:27365560

  15. Resection of the sidewall of superior vena cava using video-assisted thoracic surgery mechanical suture technique

    PubMed Central

    Xu, Xin; Qiu, Yuan; Pan, Hui; Mo, Lili; Chen, Hanzhang

    2016-01-01

    Lung cancer invading the superior vena cava (SVC) is a locally advanced condition, for which poor prognosis is expected with conservative treatment alone. Surgical resection of the lesion can rapidly relieve the symptoms and significantly improve survival for some patients. Replacement, repair and partial resection of SVC via thoracotomy were generally accepted and used in the past. As the rapid development of minimally invasive techniques and devices, partial resection and repair of SVC are feasible via video-assisted thoracic surgery (VATS). However, few studies have reported the VATS surgical techniques. In this study, we reported the crucial techniques of partial resection of SVC via VATS. PMID:27076960

  16. Intra-atrial rerouting and maze procedure for an adult patient in cor triatriatum, persistent left superior vena cava, and atrial fibrillation.

    PubMed

    Sughimoto, Koichi; Matsuo, Kozo; Ohba, Masanao

    2012-06-01

    A combination of cor triatriatum and persistent left superior vena cava without communication to the coronary sinus is uncommon. A 62-year-old male with this diagnosis in conjunction with atrial fibrillation underwent successful intracardiac repair done with a unique method. After a maze procedure and enlargement of the route from the pulmonary veins to the mitral valve, a GoreTex graft was used to reroute the left superior vena cava into the right atrium and to close two thirds of the circumference of the patient's atrial septal defect; the rest of the defect was closed with another GoreTex patch.

  17. ICD Leads Extraction and Clearing of Access Way in a Patient With Superior Vena Cava Syndrome: Building A Tunnel.

    PubMed

    Kiuchi, Márcio Galindo; Andrade, Ricardo Luiz Lima; da Silva, Gustavo Ramalho; Souto, Hanry Barros; Chen, Shaojie; Villacorta Junior, Humberto

    2015-09-01

    Central vein disease is defined as at least 50% narrowing up to total occlusion of central veins of the thorax including superior vena cava, brachiocephalic, subclavian, and internal jugular vein. Thrombosis due to intravascular leads occurs in approximately 30% to 45% of patients early or late after implantation of a pacemaker by transvenous access.In this case, we report a male patient, 65-years old, hypertensive, type 2 diabetic, with atherosclerotic disease, coronary artery disease, underwent coronary artery bypass surgery in the past 10 years, having already experienced an acute myocardial infarction, bearer automatic implantable cardioverter defibrillator for 8 years after an episode of aborted sudden death due to ischemic cardiomyopathy, presenting left superior vena cava syndrome. The use of clopidogrel and rivaroxaban for over a year had no benefit on symptoms improvement.After atrial and ventricular leads extraction, a new shock lead was positioned in the right ventricle using active fixation and a new atrial lead was positioned in the right atrium, passing inside of the stents. Two days after the procedure the patient was asymptomatic and was discharged. PMID:26402803

  18. Treatment of a coronary artery to superior vena cava fistula resulting from early closure of a Possis Perma-Flow graft.

    PubMed

    Graham, M M; Kells, C M; Sullivan, J; O'Neill, B J

    1999-06-01

    The Perma-Flow graft used in bypass surgery achieves more complete revascularization when paucity of native conduits exists. We report a coronary artery to superior vena cava fistula as a complication of this graft, leading to severe right heart failure. The fistula was successfully occluded percutaneously, improving the patient's clinical situation.

  19. Demonstration of collateral pathways in superior vena cava syndrome by means of radionuclide venography

    SciTech Connect

    Kida, T.

    1985-03-01

    Radionuclide venography was used to study lesions producing obstruction in the superior vena caval system. This procedure is a simple and safe diagnostic method; it offers precise information regarding the site and degree of venous obstruction and the extent of the collaterals. It is useful not only in diagnosis, but also in radiotherapy planning and follow-up evaluation.

  20. Coronary sinus orifice atresia and persistent left superior vena cava. A report of two cases, one associated with atypical coronary artery thrombosis.

    PubMed Central

    Gerlis, L M; Gibbs, J L; Williams, G J; Thomas, G D

    1984-01-01

    Fourteen previously reported cases of atresia of the coronary sinus ostium, in which the coronary venous flow entered the right atrium by a persistent left superior vena cava, the innominate vein, and the right superior vena cava, are reviewed and two new cases reported. The first new case was in a 43 year old woman with atypical chest pains in whom investigations for suspected ischaemic heart disease, including coronary arteriography, yielded normal results. She died suddenly from massive myocardial infarction due to extensive old thrombotic occlusion of a major coronary artery without any appreciable underlying disease of the vessel wall. Exercise testing is considered to be advisable in symptomatic patients with normal coronary angiograms and attention to the venous phase might be informative. The second new case occurred in a child with an atrial septal defect and complete transposition of the great arteries, who died aged 1 month. Images PMID:6508965

  1. Entrapment of J-tip guidewires by Venatech and stainless-steel Greenfield vena cava filters during central venous catheter placement: percutaneous management in four patients.

    PubMed

    Andrews, R T; Geschwind, J F; Savader, S J; Venbrux, A C

    1998-01-01

    We present four patients in whom bedside placement of a central venous catheter was complicated by entrapment of a J-tip guidewire by a previously placed vena cava (VC) filter. Two Venatech filters were fragmented and displaced into the superior VC or brachiocephalic vein during attempted withdrawal of the entrapped wire. Two stainless-steel Greenfield filters remained in place and intact. Fluoroscopically guided extraction of both wires entrapped by Greenfield filters was successfully performed in the angiography suite.

  2. Prosthetic graft interposition of the brachiocephalic veins or superior vena cava combined with resection of malignant tumours: graft patency and risk factors for graft occlusion

    PubMed Central

    Lee, Geun Dong; Choi, Se Hoon; Kim, Yong-Hee; Kim, Dong Kwan; Park, Seung-Il

    2016-01-01

    Background We aimed to assess graft patency in patients undergoing prosthetic graft interposition of the brachiocephalic veins (BCVs) or the superior vena cava (SVC) combined with resection of malignant tumours. Methods A retrospective analysis was conducted on 16 patients who underwent prosthetic graft interposition of the BCVs or the SVC between 1998 and 2012. Results Among a total of 20 grafts in 16 patients (unilateral graft interposition in 12, bilateral graft interposition in 4), 8 grafts were occluded in 8 patients. Overall graft patency rate was 64.6%, 42.4% at the 2- and 5-year follow-up. Graft patency rate of the left BCV was significantly lower than that of the right BCV or the SVC (2-year patency, 38.1% vs. 81.8%, P=0.024). In univariate analysis, the superior anastomosis site [left BCV vs. right BCV; hazard ratio (HR) =2.312; 95% confidence interval (CI), 1.015–5.265; P=0.046], the inferior anastomosis site (right atrial appendage vs. SVC; HR =2.409; 95% CI, 1.124–5.161; P=0.024), and interruption of warfarin (HR =5.015; 95% CI, 1.106–22.734; P=0.037) were significant risk factors for graft occlusion. Graft occlusive symptoms were identified in 4 patients who underwent unilateral graft interposition. Conclusions Prosthetic graft interposition between the left BCV and the right atrial appendage resulted in a significant rate of graft occlusion. Prosthetic graft interposition of the bilateral BCVs and long-term warfarin therapy may be necessary to prevent graft occlusive symptoms. PMID:26904213

  3. Percutaneous transluminal angioplasty in a patient with chronic cerebrospinal venous insufficiency and persistent left superior vena cava.

    PubMed

    Lupattelli, T; Benassi, F; Righi, E; Bavera, P; Bellagamba, G

    2014-04-01

    Chronic cerebrospinal venous insufficiency (CCSVI) is a syndrome characterized by stenoses of the internal jugular veins (IJVs) and/or azygos veins and formation of collateral venous channels. A case of a 57-year-old patient with CCSVI in whom the venous outflow from the left IJV to the right atrium occurred through a venous anomaly, the persistent left superior vena cava (PLSVC), is reported. PLSVC is caused by persistence of the left anterior cardinal vein that drains blood from the limb effluent from the left and the left side of head and neck into coronary sinus (Type a), or in the left atrium (Type b). PLSVC can be associated either with innominate vein hypoplasia or other congenital heart abnormalities. Because of evidence of left innominate vein hypoplasia, angioplasty was not performed using the ordinary route but passing with the balloon directly through the PLSVC up to the left IJV. Finally, angioplasty was carried out in a standard manner in the right IJV as well as in the azygous vein. Confirmation angiogram revealed complete reopening of all treated vessels with no evidence of peri- and postoperative complications. The patient was discharged home the following day in good general conditions. PLSVC is a rare congenital vein anomaly but in case of concomitant innominate vein hypoplasia may prove to be a valuable alternative to treat patients with IJV diseases.

  4. Catheter-directed Thrombolysis in Acute Superior Vena Cava Syndrome Caused by Central Venous Catheters.

    PubMed

    Cui, Jie; Kawai, Tasuo; Irani, Zubin

    2015-01-01

    Indwelling central venous catheters have been reported to increase the risk of superior venous cava (SVC) syndrome. This case report describes the development of acute SVC syndrome in a 28-year-old woman with end-stage renal disease implanted with a left-side hemodialysis reliable outflow graft and a right-side double lumen hemodialysis catheter via internal jugular veins. Her symptoms were not alleviated after catheter removal and systemic anticoagulation therapy. She was eventually treated with catheter-directed thrombolysis and a predischarge computer tomographic venogram on postthrombolytic procedure day 7 showed patent central veins and patient remained asymptomatic. This case demonstrates that catheter-directed thrombolysis can be safely employed to treat refractory catheter-induced acute SVC syndrome in end-stage renal disease patients.

  5. Günther Tulip inferior vena cava filter retrieval using a bidirectional loop-snare technique.

    PubMed

    Ross, Jordan; Allison, Stephen; Vaidya, Sandeep; Monroe, Eric

    2016-01-01

    Many advanced techniques have been reported in the literature for difficult Günther Tulip filter removal. This report describes a bidirectional loop-snare technique in the setting of a fibrin scar formation around the filter leg anchors. The bidirectional loop-snare technique allows for maximal axial tension and alignment for stripping fibrin scar from the filter legs, a commonly encountered complication of prolonged dwell times.

  6. Varicose veins: look before you strip - the occluded inferior vena cava and other lurking pathologies.

    PubMed

    Mokoena, Taole

    2014-05-15

    Lower limb varicose veins are a common complication of bipedal human movement and deep-vein thrombosis. However, they may have unusual causes, e.g. forming as collaterals around an obstruction or resulting from vascular malformations. Surgery in these cases can be inappropriate or harmful. Five cases of lower limb varicose veins in which there was underlying pathology highlight the fact that cursory examination of patients with varicose veins and inappropriate special investigations can miss rare but significant underlying pathology. Patients should be examined systematically, and varicose veins in unusual situations should alert the clinician. Inappropriate surgery can be harmful.

  7. Günther Tulip inferior vena cava filter retrieval using a bidirectional loop-snare technique

    PubMed Central

    Ross, Jordan; Allison, Stephen; Vaidya, Sandeep; Monroe, Eric

    2016-01-01

    Many advanced techniques have been reported in the literature for difficult Günther Tulip filter removal. This report describes a bidirectional loop-snare technique in the setting of a fibrin scar formation around the filter leg anchors. The bidirectional loop-snare technique allows for maximal axial tension and alignment for stripping fibrin scar from the filter legs, a commonly encountered complication of prolonged dwell times. PMID:27338675

  8. Results of a multicenter study of the retrievable Tulip vena cava filter: Early clinical experience

    SciTech Connect

    Neuerburg, Joerg M.; Guenther, Rolf W.; Vorwerk, Dierk; Dondelinger, Robert F.; Jaeger, Horst; Lackner, Klaus J.; Schild, Hans H.; Plant, Graham R.; Joffre, Francis G.; Schneider, Pierre A.; Janssen, Johan H. A.

    1997-01-15

    Purpose. To evaluate clinically a new, retrievable vena caval filter in a multicenter study. Methods. The Tulip filter is a stainless steel half-basket that is suitable for antegrade or retrograde insertion via an 8.5 Fr introducer sheath. The filter can be retrieved via the jugular approach using an 11 Fr coaxial retrieval system. Forty-eight filters were implanted via the femoral approach and 38 via the jugular approach in 83 patients. Follow-up examinations (plain films, colorcoded duplex sonography) were performed up to 3 years after filter insertion (mean 136 days) in 75 patients. Twenty-seven patients were screened by colorcoded duplex sonography for insertion site thrombosis. Results. An appropriate filter position was achieved in all cases. Insertion problems occurred in 3 cases; these were not due to the filter design but to an imperfect prototype insertion mechanism that has now been modified (n=2) or a manipulation error (n=1). In 2 of these cases the filters were replaced percutaneously; 1 patient required venotomy for filter removal. No further complications due to filter insertion occurred. Two filters were used as temporary devices and were successfully removed after 6 and 11 days, respectively. There was 1 fatal recurrent pulmonary embolism (PE) and 2 non-fatal PE, 5 complete and 3 partial caval occlusions, and 3 caudal migrations of the filter. Insertion site venous thrombosis was not seen in the 27 patients monitored for this complication. Conclusion. Precise placement of the Tulip filter is feasible by either access route and the device appears mechanically stable. Further observations are needed to confirm that safe filter removal is practical up to 10 days after its insertion.

  9. Transient sinus node dysfunction following sinus node artery occlusion due to radiofrequency catheter ablation of the septal superior vena cava-right atrium junction.

    PubMed

    Kitamura, Takeshi; Fukamizu, Seiji; Arai, Ken; Hojo, Rintaro; Aoyama, Yuya; Komiyama, Kota; Sakurada, Harumizu; Hiraoka, Masayasu

    2016-01-01

    We performed catheter ablation to septal superior vena cava (SVC)-right atrium (RA) junction rapid firing in a 57-year-old man with paroxysmal atrial fibrillation. He later experienced transient sinus node dysfunction resulting from injury to the sinus node artery (SNA), which branched only from the proximal region of the left circumflex artery. The direction of the SNA should be considered during catheter ablation at the septal SVC-RA junction, especially if the sinus node is supplied by only one SNA from the right coronary artery or the left circumflex artery.

  10. Brain Abscess Associated with Isolated Left Superior Vena Cava Draining into the Left Atrium in the Absence of Coronary Sinus and Atrial Septal Defect

    SciTech Connect

    Erol, Ilknur Cetin, I. Ilker; Alehan, Fuesun; Varan, Birguel; Ozkan, Sueleyman; Agildere, A. Muhtesem; Tokel, Kursad

    2006-06-15

    A previously healthy 12-year-old girl presented with severe headache for 2 weeks. On physical examination, there was finger clubbing without apparent cyanosis. Neurological examination revealed only papiledema without focal neurologic signs. Cerebral magnetic resonance imaging showed the characteristic features of brain abscess in the left frontal lobe. Cardiologic workup to exclude a right-to-left shunt showed an abnormality of the systemic venous drainage: presence of isolated left superior vena cava draining into the left atrium in the absence of coronary sinus and atrial septal defect. This anomaly is rare, because only a few other cases have been reported.

  11. Hemopericardium After Superior Vena Cava Stenting for Malignant SVC Obstruction: The Importance of Contrast-Enhanced CT in the Assessment of Postprocedural Collapse

    SciTech Connect

    Brant, Jonathan; Peebles, Charles; Kalra, Paul; Odurny, Allan

    2001-09-15

    We report the complication of hemopericardium following superior vena cava (SVC) stenting with an uncovered Wallstent in a patient with malignant SVC obstruction. The patient collapsed acutely 15 min following stent placement with hypoxemia and hypotension. A CT scan demonstrated a hemopericardium which was successfully treated with a pericardial drain. The possible complications of SVC stenting, including hemopericardium, pulmonary embolism, mediastinal hematoma, and pulmonary edema from increased venous return resulting from improved hemodynamics, ensure a wide differential diagnosis in the post procedural collapsed patient and this case emphasizes the important role of contrast-enhanced CT in the peri-resuscitation assessment of these patients.

  12. Left-sided high-flow arteriovenous hemodialysis fistula combined with a persistent left superior vena cava causing coronary sinus dilatation.

    PubMed

    Wolf, Michael; Scott, Benjamin

    2013-01-01

    We present an interesting case illustrating the possible hemodynamic consequences when a left-sided arteriovenous hemodialysis fistula is combined with the congenital anomaly of a persistent left superior vena cava (PLSVC). Our case illustrates the importance of an echocardiographic examination with attention to the coronary sinus (CS) caliber-raising suspicion of a PLSVC-in the assessment for the hemodialysis access in end-stage renal disease patients. The causes and symptoms of CS dilatation, as well as the literature on PLSVC, are also discussed in detail.

  13. A case of residual inferior sinus venosus defect after ineffective surgical closure

    PubMed Central

    Uga, Sayuri; Hidaka, Takayuki; Takasaki, Taiichi; Kihara, Yasuki

    2014-01-01

    A 38-year-old woman presented with cyanosis and heart failure 34 years after patch closure of an atrial septal defect and partial anomalous pulmonary venous connection. CT and cardiac catheterisation showed a residual defect that caused right-to-left shunting. The patch almost blocked the inferior vena cava from the right atrium, resulting in uncommon drainage of the inferior vena cava into the left atrium. Other anomalies included the coronary-to-pulmonary artery fistula and duplicate inferior vena cava with dilated azygos venous system. A second surgery was performed, and we confirmed an inferior sinus venosus defect, which is rare and can be misdiagnosed. The ineffective patch closure had caused a haemodynamic status that rarely occurs. We describe the diagnostic process and emphasise the importance of correctly understanding the entity. PMID:25281248

  14. Modulation of some estrogen-responsive genes in the vena cava of ovariectomised Wistar rats by griffonianone C, an isoflavone derived from Millettia griffoniana Baill. (Fabaceae).

    PubMed

    Ketcha Wanda, Germain Jean Magloire; Kretzschmar, Georg; Njamen, Dieudonné; Tagatsing Fotsing, Maurice; Yankep, Emmanuel; Vollmer, Günter

    2010-12-01

    In the present study, we investigated whether griffonianone C (Griff C), extracted from root bark of Millettia griffoniana, changes the expression of several estrogen-responsive genes in the vena cava of ovariectomised rats. For this purpose, we subcutaneously administered Griff C (2, 10, or 20mg/kg/d BW), 17β-estradiol (E2: 10μg/kg/d BW) as positive control, and a vehicle control respectively for three days. Relative expression levels of estrogen receptor α (ERα), progesterone receptor (PR), cyclooxygenase2 (Cox-2), vascular endothelial growth factor (VEGF), VEGF-receptor 2, angiotensin converting enzyme (ACE), endothelial NO synthase (eNOS), proliferating cell nuclear antigen (PCNA) and Ki67 mRNA extracted from the vena cava of these rats were quantified by real-time PCR. Results showed that Griff C up-regulated the expression of PR, ACE, ERα, VEGF, VEGFR2 and Ki67. However, the results of Cox-2, PCNA, and eNOS expression did not reach significance in the E2 and Griff C treated samples. These results show that griffonianone C regulated a few of the analysed genes in a similar fashion than estradiol; however, others showed a different pattern. This suggests that some of the biological effects attributed to M. griffoniana are mediated via ER pathway others may be mediated via other pathways. PMID:20732395

  15. Coexistence of Obstructive Sleep Apnea and Superior Vena Cava Syndromes Due to Substernal Goitre in a Patient With Respiratory Failure: A Case Report

    PubMed Central

    Tunc, Mehtap; Sazak, Hilal; Karlilar, Bulent; Ulus, Fatma; Tastepe, Irfan

    2015-01-01

    Introduction: Substernal goiter may rarely cause superior vena cava syndrome (SVCS) owing to venous compression, and cause acute respiratory failure due to tracheal compression. Obstructive sleep apnea syndrome (OSAS) may rarely occur when there is a narrowing of upper airway by edema and vascular congestion resulting from SVCS. Case Presentation: We presented the clinical course and treatment of acute respiratory failure (ARF) developed in a patient with SVCS and OSAS due to substernal goiter. After treatment of ARF with invasive mechanical ventilation, weaning and total thyroidectomy were successfully performed through collar incision and median sternotomy without complications. Conclusions: Our case showed that if the respiratory failure occurred due to substernal goiter and SVCS, we would need to investigate the coexistence of OSAS and SVCS. PMID:26082848

  16. The Optional VenaTech{sup Trade-Mark-Sign} Convertible{sup Trade-Mark-Sign} Vena Cava Filter: Experimental Study in Sheep

    SciTech Connect

    Le Blanche, Alain F.; Ricco, Jean-Baptiste; Bonneau, Michel; Reynaud, Philippe

    2012-10-15

    Purpose: Retrieval of optional caval filters may be impaired by filter tilting, migration, fracture, or embedding in the IVC wall. The goal of this experimental study was to evaluate a new optional filter, convertible by unlocking and removing the filter head. Methods: Forty-nine Pre-Alp sheep (average weight, 55 kg) were anesthetized. IVC was catheterized via the right femoral vein (n = 46) or via the internal jugular vein (n = 3) with a 12.9-F sheath. VenaTech{sup Trade-Mark-Sign} Convertible{sup Trade-Mark-Sign} IVC filters were inserted as either permanent filters (n = 14) or as filters to be converted. Conversion was immediately after deployment (n = 19) or delayed after 1, 3, or 6 months (n = 20). Filter delivery, deployment, and conversion with measurement of migration and tilting were evaluated by cavography. Incorporation of the filter's stabilizers and arms in the IVC wall was assessed by gross anatomy. Results: Delivery system insertion, filter release, and immediate conversion were successful in all cases. Delayed conversion was completed in all but one sheep, due to insufficient snare tension. Complimentary balloon-catheter inflation was required in 12 of 20 delayed conversions to achieve filter opening. In all 49 sheep, no thrombosis, migration, or significant tilting occurred. Within 4 weeks of conversion, the filter's stabilizers and arms were incorporated into the IVC wall. Upon removal, the filter head was free of intimal growth. Conclusions: The VenaTech{sup Trade-Mark-Sign} Convertible{sup Trade-Mark-Sign} optional IVC filter was successfully implanted in all sheep with no migration or tilting. Conversion at various dates by filter head removal was feasible in all but one case.

  17. [Remote results of implantation of cava filters: analysis of errors and complications].

    PubMed

    Zatevakhin, I I; Shipovsky, V N; Barzaeva, M A

    2015-01-01

    The authors carried out comparative assessment of efficacy of cava filters (CF) for prevention of pulmonary artery thromboembolism in patients presenting with iliofemoral thrombosis with flotation of thrombi, as well as analysed complications in the remote postimplantation period. A total of 266 patients were examined within the terms from 1 month to 10 years after CF implantation. Depending on the type of the implanted device, all patients were subdivided into 3 groups: group 1 (n=65) consisted of patients with one-level CF, group 2 (n=112) comprised those with "sandglass" and "shuttle" type two-level cava filters, and group 3 (n=89) was composed of patients with the implanted CF "TrapEase" and "OptEase". In the remote period relapsed PATE was revealed in 5.2% of cases. Embolism in the CF was noted in 9.3% of cases, with the incidence rate of this complication not depending on the type of the implanted device. However, total occlusion of the inferior vena cava after embolism was observed 2 times more often in patients of the 2nd and 3rd group. In the first group recanalization of the intrafilter space occurred in one third of cases. Chronic occlusion of the inferior vena cava was revealed in 13.9% of cases, most frequently in group 2. Total occlusion of the inferior vena cava with the development of inferior vena cava syndrome was diagnosed in 24.1% of patients with thrombotic lesion below the level of renal veins confluence. This complication was associated with both characteristics of CF and technical errors of implantation, and was also encountered more frequently in group 2. PMID:26035565

  18. Near-Infrared Spectroscopy Monitoring, Superior Vena Cava Flow, and Neurodevelopmental Outcome at 2 years in a Cohort of Very Low-Birth-Weight Infants.

    PubMed

    Cerbo, Rosa Maria; Orcesi, Simona; Scudeller, Luigia; Borellini, Martina; Croci, Carolina; Ravelli, Claudia; Masa, Giulia; Paolillo, Piermichele; Manzoni, Paolo; Balottin, Umberto; Stronati, Mauro

    2016-09-01

    Objective We aimed at assessing the association between superior vena cava flow (SVCf), regional (cerebral) tissue oxygen saturation (rSO2), and cerebral fractional oxygen extraction (CFOE) during the first 48 hours of life and 2-years neurodevelopmental outcome of very low-birth-weight infants (VLBW). Methods We prospectively studied 60 VLBW infants admitted to our neonatal intensive care unit; rSO2 was continuously monitored with near-infrared spectroscopy during the first 48 hours of life, SVCf was measured at 4 to 6, 12, 24, and 48 hours, and CFOE was calculated. Neurodevelopmental outcome was assessed at 24 months corrected age. Results The mean gestational age at birth was 27.9 weeks (standard deviation: 2.4); 8 infants died in the first 3 months of life, 6 were lost to follow-up, 46 survived and were followed up. At 24 months, 6 (13%) and 7 (15.2%) infants developed minor and major sequelae, respectively. Infants who died had higher CFOE (p < 0.001) and lower SVCf (p < 0.001) than infants surviving with sequelae. In turn, these had higher SVCf between 24 and 48 hours than those without sequelae (p < 0.001). Conclusion SVCf, rSO2, and CFOE patterns in the first days of life suggest cerebral hyperperfusion, related to loss of autoregulation and/or use of inotropic drugs, as a potential mechanism of cerebral injury. PMID:27603543

  19. Defibrillation lead placement using a transthoracic transatrial approach in a case without transvenous access due to lack of the right superior vena cava.

    PubMed

    Otsuka, Yosuke; Okamura, Hideo; Sato, Syunsuke; Nakajima, Ikutaro; Ishibashi, Kohei; Miyamoto, Kouji; Noda, Takashi; Aiba, Takeshi; Kamakura, Shiro; Kobayashi, Junjiro; Yasuda, Satoshi; Ogawa, Hisao; Kusano, Kengo

    2015-06-01

    A 65-year-old woman with a history of syncope was diagnosed with hypertrophic cardiomyopathy. She had previously undergone mastectomy of the left breast owing to breast cancer. Holter electrocardiogram (ECG) and monitor ECG revealed sick sinus syndrome (Type II) and non-sustained ventricular tachycardia. Sustained ventricular tachycardia and ventricular fibrillation were induced in an electrophysiological study. Although the patient was eligible for treatment with a dual chamber implantable cardioverter defibrillator (ICD), venography revealed lack of the right superior vena cava (R-SVC). Lead placement from the left subclavian vein would have increased the risk of lymphedema owing to the patient׳s mastectomy history. Consequently, the defibrillation lead was placed in the right ventricle by direct puncture of the right auricle through the tricuspid valve. The atrial lead was sutured to the atrial wall, and the postoperative course was unremarkable. Defibrillation lead placement using a transthoracic transatrial approach can be an alternative method in cases where a transvenous approach for lead placement is not feasible.

  20. Endovascular Repair of a Perforation of the Vena Caval Wall Caused by the Retrieval of a Gunther Tulip Filter After Long-Term Implantation

    SciTech Connect

    Morishita, Hiroyuki; Yamagami, Takuji; Matsumoto, Tomohiro; Takeuchi, Yoshito; Sato, Osamu; Nishimura, Tsunehiko

    2011-02-15

    Symptomatic penetration of the inferior vena cava (IVC) wall reportedly occurs in 0.3% of patients in whom a filter has been implanted, and it causes injury to the adjacent structures (Bogue et al. in Pediatr Radiol 39(10):1110-1113, 1; Brzezinski et al. in Burns 32(5):640-643, 2). We succeeded in the endovascular repair of perforation of the IVC wall occurring during the retrieval of a penetrated Gunther tulip vena cava filter (Cook, Bjaeverskov, Denmark) after long-term implantation.

  1. Follow-up Results of 71 Patients Undergoing Metallic Stent Placement for the Treatment of a Malignant Obstruction of the Superior Vena Cava

    SciTech Connect

    Nagata, Takeshi Makutani, Shiro; Uchida, Hideo; Kichikawa, Kimihiko; Maeda, Munehiro; Yoshioka, Tetsuya; Anai, Hiroshi; Sakaguchi, Hiroshi; Yoshimura, Hitoshi

    2007-09-15

    Purpose. To retrospectively clarify the utility of metallic stent placement for the treatment of the malignant obstruction of the superior vena cava (SVC) in 71 patients with VC syndrome (SVCS) on the basis of long-term follow-up data. Materials and Methods. Seventy-one patients underwent stent placement and were followed until death. The applicability of the spiral Z-stent (S-Z-stent) mainly used the initial and follow-up results, stent placement for bilateral BCV obstruction and the value of concurrent anticancer therapy were studied. Results. The technical success rate was 100%, the initial clinical success rate was 87% (62/71), the primary clinical patency rate was 88% (57/65), and the secondary clinical patency rate was 95% (62/65). The obstruction rate of the stent was 12% (8/65), and an additional stent was useful for relief of recurrent SVCS. Survival of 57 patients in whom there was no recurrence of SVCS until death ranged from 1 week to 29 months (mean, 5.4 months and the S-Z-stent appeared to be suitable for the treatment of the malignant obstruction of SVC. Unilateral stent placement was effective for relief of SVCS with bilateral BCV obstruction. Patients who received concurrent anticancer therapy survived 2 months longer than those who did not. Conclusion. Stent placement is an effective treatment for SVCS. Further, the utility of S-Z-stent for SVCS, an additional stent for recurrence, unilateral stent for patients with bilateral BCV obstruction, and anticancer therapy after stent placement were verified.

  2. Accuracy of Inferior Vena Cava Ultrasound for Predicting Dehydration in Children with Acute Diarrhea in Resource-Limited Settings

    PubMed Central

    Modi, Payal; Glavis-Bloom, Justin; Nasrin, Sabiha; Guy, Allysia; Rege, Soham; Noble, Vicki E.; Alam, Nur H.; Levine, Adam C.

    2016-01-01

    Introduction Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy. Objective To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children. Methods A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having “some dehydration” with weight change 3–9% or “severe dehydration” with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity. Results 850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor. Conclusions Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting. PMID:26766306

  3. Reno-portal anastomosis as an approach to pediatric kidney transplantation in the setting of inferior vena cava thrombosis.

    PubMed

    Cauley, R P; Potanos, K; Fullington, N; Lillehei, C; Vakili, K; Kim, H B

    2013-05-01

    In pediatric renal transplantation in the setting of IVC thrombosis, the retrohepatic IVC or gonadal veins are often used for outflow. However, if use of systemic venous outflow is unsuccessful, options become limited. We report the use of the portal vein for venous outflow in kidney retransplantation in the setting of IVC thrombosis. The patient is a 19-month-old male who developed end-stage renal failure at seven months of age secondary to hypotension after spontaneous rupture of an accessory renal vein. The IVC was occluded during emergent laparotomy, and the patient developed extensive IVC thrombosis. The first two transplant attempts used the retrohepatic IVC for venous outflow. Despite good initial flow, in both instances the renal vein thrombosed on post-operative day 1. In an unsuccessful salvage attempt of the second transplant, a reno-portal anastomosis was performed. With few options for vascular access, a third transplant was attempted. The reno-portal stump from the second transplant was used for outflow. The patient recovered well from his third transplant (creatinine 0.6 mg/dL 35 months post-surgery), demonstrating that the portal vein can be used for outflow in cases of extensive IVC thrombosis.

  4. Double-lumen catheter in the right jugular vein induces two sub-endothelial abscesses in an unusual place, the transition between the superior vena cava and the right atrium: a case report

    PubMed Central

    2014-01-01

    Endocarditis is a type of infection that is common in internal medicine wards and in haemodialysis clinics. The location that is most affected are the heart valves. Herein, we report a case of an uncommon abscess, a sub-endothelial abscess between the transition of the superior vena cava and the right atrium. There were several emboli to the lung and foot, and the agent was related to Staphylococcus aureus and a double-lumen catheter. Usually, this type of abscess is located in valves, either the tricuspid valve if related to catheters or injection drug use or the mitral valve if related to other causes. An exhaustive review was made, but we found no information about the location of this abscess and the rarity of the event motivating the report of infection. PMID:25110520

  5. An unusual constellation of congenital malformations in a single patient including partial anomalous pulmonary venous return, persistent left superior vena cava, aberrant pulmonary fissure, anomalous aortic arch, tracheal diverticulum and annular pancreas

    PubMed Central

    Lapa, T; Vedelago, J; Kim, H; Patrick, E

    2014-01-01

    We report a case of a male patient with a constellation of rare congenital anomalies consisting of: partial anomalous pulmonary venous return (PAPVR), persistent left superior vena cava, ‘bovine arch’ aortic branching, tracheal diverticulum, aberrant lung fissure anatomy and an annular pancreas. He had presented with a history of worsening dyspnoea. To the best of our knowledge, this is the first reported case of a single patient with such a vast constellation of anomalies. The radiological evaluations, epidemiology, embryology and clinical features of the anomalies are discussed. It is important for radiologists to be aware of each of these anomalies as distinct entities; detection of a single anomaly should alert to the possibility that further anatomic aberrancies may be present. PMID:25362184

  6. An unusual constellation of congenital malformations in a single patient including partial anomalous pulmonary venous return, persistent left superior vena cava, aberrant pulmonary fissure, anomalous aortic arch, tracheal diverticulum and annular pancreas.

    PubMed

    Lapa, T; Vedelago, J; Kim, H; Patrick, E

    2014-10-31

    We report a case of a male patient with a constellation of rare congenital anomalies consisting of: partial anomalous pulmonary venous return (PAPVR), persistent left superior vena cava, 'bovine arch' aortic branching, tracheal diverticulum, aberrant lung fissure anatomy and an annular pancreas. He had presented with a history of worsening dyspnoea. To the best of our knowledge, this is the first reported case of a single patient with such a vast constellation of anomalies. The radiological evaluations, epidemiology, embryology and clinical features of the anomalies are discussed. It is important for radiologists to be aware of each of these anomalies as distinct entities; detection of a single anomaly should alert to the possibility that further anatomic aberrancies may be present.

  7. First Magnetic Resonance Imaging-Guided Aortic Stenting and Cava Filter Placement Using a Polyetheretherketone-Based Magnetic Resonance Imaging-Compatible Guidewire in Swine: Proof of Concept

    SciTech Connect

    Kos, Sebastian; Huegli, Rolf; Hofmann, Eugen; Quick, Harald H.; Kuehl, Hilmar; Aker, Stephanie; Kaiser, Gernot M.; Borm, Paul J. A.; Jacob, Augustinus L.; Bilecen, Deniz

    2009-05-15

    The purpose of this study was to demonstrate feasibility of percutaneous transluminal aortic stenting and cava filter placement under magnetic resonance imaging (MRI) guidance exclusively using a polyetheretherketone (PEEK)-based MRI-compatible guidewire. Percutaneous transluminal aortic stenting and cava filter placement were performed in 3 domestic swine. Procedures were performed under MRI-guidance in an open-bore 1.5-T scanner. The applied 0.035-inch guidewire has a PEEK core reinforced by fibres, floppy tip, hydrophilic coating, and paramagnetic markings for passive visualization. Through an 11F sheath, the guidewire was advanced into the abdominal (swine 1) or thoracic aorta (swine 2), and the stents were deployed. The guidewire was advanced into the inferior vena cava (swine 3), and the cava filter was deployed. Postmortem autopsy was performed. Procedural success, guidewire visibility, pushability, and stent support were qualitatively assessed by consensus. Procedure times were documented. Guidewire guidance into the abdominal and thoracic aortas and the inferior vena cava was successful. Stent deployments were successful in the abdominal (swine 1) and thoracic (swine 2) segments of the descending aorta. Cava filter positioning and deployment was successful. Autopsy documented good stent and filter positioning. Guidewire visibility through applied markers was rated acceptable for aortic stenting and good for venous filter placement. Steerability, pushability, and device support were good. The PEEK-based guidewire allows either percutaneous MRI-guided aortic stenting in the thoracic and abdominal segments of the descending aorta and filter placement in the inferior vena cava with acceptable to good device visibility and offers good steerability, pushability, and device support.

  8. Out of Sight, out of Mind? An Audit Which Proposes a Follow-Up and Management Pathway for Inferior Vena Cava Filters.

    PubMed

    Logan, Caitriona; O'Connell, Niamh; Kavanagh, John; McEniff, Niall; Ryan, Mark; Guiney, Michael; Seery, Orla; O'Donnell, James; Ryan, Kevin; White, Barry

    2016-01-01

    Insertion of an IVC filter can be a safe and effective way to avoid PE in thrombosis patients who cannot be anticoagulated. If temporary filters are not promptly removed they can become difficult to remove, causing avoidable complications and often requiring lifelong warfarin. In this study, two sequential audits of retrieval of temporary IVC filters were conducted before and after the implementation of a coordinated management strategy for IVC filter follow-up. 33 filter placements were examined over a 15-month period (Group A). Following implementation of the strategy a comparable 15-month period in which 33 IVC filters were placed was audited (Group B). Following implementation, failed retrievals dropped from 15% to 9%. The number successfully retrieved did not change at 45%. The number made permanent from the outset following expert discussion increased from 12% to 39%. The number of filters with no attempted retrieval and no consultation about retrieval decreased from 27% to 9% (these patients were lost to follow-up with multiple contact attempts made). In Group B 100% of placed IVC filters were followed up appropriately. The proposed model is an easily implemented plan to avoid patient morbidity caused by temporary IVC filters made unintentionally permanent by loss to follow-up.

  9. Percutaneous endovascular creation of an inferior vena cava in a patient with caval agenesis, Budd-Chiari syndrome, and iliofemorocaval thrombosis.

    PubMed

    Haskal, Ziv J; Potosky, Darryn R; Twaddell, William S

    2014-01-01

    A 29-year-old woman with acute iliofemorocaval thrombosis was discovered to have suprarenal caval agenesis with azygous continuation, hepatic congestion, and fibrosis as a result of chronic Budd-Chiari syndrome. Three staged procedures were performed: pharmacomechanical thrombolysis of acute thromboses, transfemoral liver biopsy and hemodynamic assessment, and percutaneous endovascular creation of a "neocava" lined with endografts. Symptomatic improvement and patency were maintained at 12-week follow-up. PMID:24365505

  10. Out of Sight, out of Mind? An Audit Which Proposes a Follow-Up and Management Pathway for Inferior Vena Cava Filters

    PubMed Central

    Logan, Caitriona; O'Connell, Niamh; Kavanagh, John; McEniff, Niall; Ryan, Mark; Guiney, Michael; Seery, Orla; O'Donnell, James; Ryan, Kevin; White, Barry

    2016-01-01

    Insertion of an IVC filter can be a safe and effective way to avoid PE in thrombosis patients who cannot be anticoagulated. If temporary filters are not promptly removed they can become difficult to remove, causing avoidable complications and often requiring lifelong warfarin. In this study, two sequential audits of retrieval of temporary IVC filters were conducted before and after the implementation of a coordinated management strategy for IVC filter follow-up. 33 filter placements were examined over a 15-month period (Group A). Following implementation of the strategy a comparable 15-month period in which 33 IVC filters were placed was audited (Group B). Following implementation, failed retrievals dropped from 15% to 9%. The number successfully retrieved did not change at 45%. The number made permanent from the outset following expert discussion increased from 12% to 39%. The number of filters with no attempted retrieval and no consultation about retrieval decreased from 27% to 9% (these patients were lost to follow-up with multiple contact attempts made). In Group B 100% of placed IVC filters were followed up appropriately. The proposed model is an easily implemented plan to avoid patient morbidity caused by temporary IVC filters made unintentionally permanent by loss to follow-up. PMID:27110399

  11. Pilot study evaluating the safety of a combined central venous catheter and inferior vena cava filter in critically ill patients at high risk of pulmonary embolism.

    PubMed

    Cadavid, Carlos A; Gil, Bladimir; Restrepo, Alvaro; Alvarez, Sergio; Echeverry, Santiago; Angel, Luis F; Tapson, Victor; Kaufman, John

    2013-04-01

    The objectives of this pilot trial were to assess the safety of a new device for pulmonary embolism (PE) prophylaxis. The device, the Angel Catheter, was placed in eight patients who were in the intensive care unit and were at high risk of PE. The device was inserted at the bedside without fluoroscopic guidance via a femoral venous approach. All eight devices were inserted and subsequently retrieved without complications (follow-up, 33-36 d). One filter trapped a large clot.

  12. Cardiopulmonary bypass (CPB) has no significant impact on survival in patients undergoing nephrectomy and level III-IV inferior vena cava thrombectomy; a multi-institutional analysis

    PubMed Central

    Dall'Era, Marc A.; Durbin-Johnson, Blythe; Carballido, Joaquín A.; Chandrasekar, Thenappan; Chromecki, Thomas; Ciancio, Gaetano; Daneshmand, Siamak; Gontero, Paolo; Gonzalez, Javier; Haferkamp, Axel; Hohenfellner, Markus; Huang, William C.; Espinós, Estefania Linares; Mandel, Philipp; Martinez-Salamanca, Juan I.; Master, Viraj A.; McKiernan, James M.; Montorsi, Francesco; Novara, Giacomo; Pahernik, Sascha; Palou, Juan; Pruthi, Raj S.; Rodriguez-Faba, Oscar; Russo, Paul; Scherr, Douglas S.; Shariat, Shahrokh F.; Spahn, Martin; Terrone, Carlo; Vergho, Daniel; Wallen, Eric M.; Xylinas, Evanguelos; Zigeuner, Richard; Libertino, John A.; Evans, Christopher P.

    2016-01-01

    Purpose The impact of cardiopulmonary bypass (CPB) usage in level III-IV tumor thrombectomy on surgical and oncologic outcomes is unknown. We sought to determine the impact of cardiopulmonary bypass (CPB) on overall and cancer specific survival, as well as surgical complication rates, and immediate outcomes in patients undergoing nephrectomy and level III-IV tumor thrombectomy with or without CPB. Patients and Methods We retrospectively analyzed 362 patients with RCC and with level III or IV tumor thrombus from 1992 to 2012 in 22 US and European centers. Cox proportional hazards models were used to compare overall and cancer-specific survival between patients with and without CPB. Perioperative mortality and complications rates were assessed using logistic regression analyses. Results The median overall survival was 24.6 months in non-CPB patients and 26.6 months in CPB patients. Overall survival and cancer-specific survival (CSS) did not differ significantly in both groups, neither in univariate analysis nor when adjusting for known risk factors. In multivariate analysis, no significant differences were seen in hospital LOS, Clavien 1-4 complication rate, intraoperative or 30 day mortality, and CSS between both groups. Limitations include the retrospective nature of the study. Conclusions In our multi-institutional analysis, the use of cardiopulmonary bypass did not significantly impact cancer specific survival or overall survival in patients undergoing nephrectomy and level III or IV tumor thrombectomy. Neither approach was independently associated with increased mortality in the multivariate analysis. Higher surgical complications were not independently associated with the use of CPB. PMID:25797392

  13. Inferior sinus venosus defects: anatomic features and echocardiographic correlates.

    PubMed

    Plymale, Jennifer; Kolinski, Kellen; Frommelt, Peter; Bartz, Peter; Tweddell, James; Earing, Michael G

    2013-02-01

    Inferior sinus venosus defects (SVDs) are rare imperfections located in the inferior portion of the atrial septum, leading to an overriding inferior vena cava (IVC) and an interatrial connection. These defects have increased risk of anomalous pulmonary venous return (PAPVR) and often are confused with secundum atrial septal defects (ASDs) with inferior extension. The authors sought to review their experience with inferior SVDs and to establish at their institution an echocardiographic definition that differentiates inferior SVDs from secundum ASDs with inferior extension. The study identified 161 patients 1.5 to 32 years of age who had undergone repair of a secundum ASD with inferior extension or inferior SVD over the preceding 10 years. All surgical notes, preoperative transthoracic echocardiograms (TTEs), and preoperative transesophageal echocardiograms (TEEs) were reviewed. Based on the surgical notes, 147 patients were classified as having a secundum ASD (147/161, 91 %) and 14 patients (9 %) as having an inferior SVD. The study identified PAPVR in 7 % (1/14) of the patients with inferior SVDs and 3.5 % (5/14) of the patients with secundum ASDs. Surgical diagnosis and preoperative TTE correlated for 143 (89 %) of the 161 patients. Using a strict anatomic and echocardiographic definition with a blinded observer, the majority of the defects (14/18, 78 %) were reclassified correctly after review of their TTE images, and 100 % of the defects were correctly reclassified after TEE image review. Accurate diagnosis of inferior SVDs remains challenging. The data from this study demonstrate that use of a strict anatomic and echocardiographic definition (a defect that originates in the mouth of the IVC and continues into the inferoposterior border of the left atrium, leaving no residual atrial septal tissue at the inferior margin) allows for accurate differentiation between secundum ASDs with inferior extension and inferior SVDs. This differentiation is extremely important

  14. Posttransplant Complex Inferior Venacava Balloon Dilatation After Hepatic Vein Stenting

    SciTech Connect

    Kohli, Vikas; Wadhawan, Manav; Gupta, Subhash; Roy, Vipul

    2010-02-15

    Orthotopic and living related liver transplantation is an established mode of treatment of end-stage liver disease. One of the major causes of postoperative complications is vascular anastomotic stenosis. One such set of such complications relates to hepatic vein, inferior vena cava (IVC), or portal vein stenosis, with a reported incidence of 1-3%. The incidence of vascular complications is reported to be higher in living donor versus cadaveric liver transplants. We encountered a patient with hepatic venous outflow tract obstruction, where the hepatic vein had been previously stented, but the patient continued to have symptoms due to additional IVC obstruction. The patient required double-balloon dilatation of the IVC simultaneously from the internal jugular vein and IVC.

  15. Isolated inferior mesenteric portal hypertension with giant inferior mesenteric vein and anomalous inferior mesenteric vein insertion

    PubMed Central

    Prasad, G. Raghavendra; Billa, Srikar; Bhandari, Pavaneel; Hussain, Aijaz

    2013-01-01

    Extrahepatic portal hypertension is not an uncommon disease in childhood, but isolated inferior mesenteric portal varices and lower gastrointestinal (GI) bleed have not been reported till date. A 4-year-old girl presented with lower GI bleed. Surgical exploration revealed extrahepatic portal vein obstruction with giant inferior mesenteric vein and colonic varices. Inferior mesenteric vein was joining the superior mesenteric vein. The child was treated successfully with inferior mesenteric – inferior vena caval anastomosis. The child was relieved of GI bleed during the follow-up. PMID:23798814

  16. Origin of a common trunk for the inferior phrenic arteries from the right renal artery: a new anatomic vascular variant with clinical implications.

    PubMed

    Topaz, On; Topaz, Allyne; Polkampally, Pritam R; Damiano, Thomas; King, Christopher A

    2010-01-01

    The inferior phrenic arteries constitute a pair of important vessels, supplying multiple organs including the diaphragm, adrenal glands, esophagus, stomach, liver, inferior vena cava, and retroperitoneum. The vast majority (80-90%) of inferior phrenic arteries originate as separate vessels with near equal frequency from either the abdominal aorta or the celiac trunk. Infrequently, the right and left inferior phrenic arteries can arise in the form of a common trunk from the aorta or from the celiac trunk. We herein present three patients with a new anatomic vascular variant: a common trunk of the inferior phrenic arteries arising from the right renal artery. In one case, the left inferior phrenic branch of the common trunk provided collaterals connecting with a supra-diaphragmatic branch of the left internal mammary artery and in another with the lateral wall of the pericardium. Angiographic identification of a common trunk for the inferior phrenic arteries arising from the right renal artery is important for proper diagnosis and clinical management. The presence of this unique vascular variant can impact revascularization of the renal arteries.

  17. Optease Vena Cava Filter Optimal Indwelling Time and Retrievability

    SciTech Connect

    Rimon, Uri Bensaid, Paul Golan, Gil Garniek, Alexander Khaitovich, Boris; Dotan, Zohar; Konen, Eli

    2011-06-15

    The purpose of this study was to assess the indwelling time and retrievability of the Optease IVC filter. Between 2002 and 2009, a total of 811 Optease filters were inserted: 382 for prophylaxis in multitrauma patients and 429 for patients with venous thromboembolic (VTE) disease. In 139 patients [97 men and 42 women; mean age, 36 (range, 17-82) years], filter retrieval was attempted. They were divided into two groups to compare change in retrieval policy during the years: group A, 60 patients with filter retrievals performed before December 31 2006; and group B, 79 patients with filter retrievals from January 2007 to October 2009. A total of 128 filters were successfully removed (57 in group A, and 71 in group B). The mean filter indwelling time in the study group was 25 (range, 3-122) days. In group A the mean indwelling time was 18 (range, 7-55) days and in group B 31 days (range, 8-122). There were 11 retrieval failures: 4 for inability to engage the filter hook and 7 for inability to sheathe the filter due to intimal overgrowth. The mean indwelling time of group A retrieval failures was 16 (range, 15-18) days and in group B 54 (range, 17-122) days. Mean fluoroscopy time for successful retrieval was 3.5 (range, 1-16.6) min and for retrieval failures 25.2 (range, 7.2-62) min. Attempts to retrieve the Optease filter can be performed up to 60 days, but more failures will be encountered with this approach.

  18. [Superior Cava Venous syndrome as presentation of neoplasic disease].

    PubMed

    Pérez Maure, M; Subils, G; Peresin Paz, R; Cazaux, A; Cambursano, V H; Cortés, J R

    2013-01-01

    Superior Cava Venous Syndrome (SVCS) encompasses a constellation of signs and symptoms resulting from partial or complete obstruction of blood flow through the superior vena cava (SVC) to the right atrium. Thrombosis can be caused by intrinsic (primary) or extrinsic compression (with or without secondary thrombosis). The causes of SVCS can be grouped according to their etiology in non-neoplastic and neoplastic. The causes malignant correspond to 65-90% of them, thrombosis and nonmalignant conditions are another causes. The presentation may be acute, clinically characterized by dyspnea and a characteristic triad (facial, neck and arms edema, cyanosis and collateral circulation). Early detection improves prognosis and is based on clinical data and imaging studies. We describe 8 cases where the SVCS was the first manifestation of neoplastic diseases. Patients were predominantly of middle-aged, male, without association with consumption of tobacco and lymphoma was most frequent diagnosis.

  19. A man with dilated superficial abdominal veins: A clinical presentation of non-Hodgkin lymphoma

    PubMed Central

    Changal, Khalid Hamid; Altaf, Sheikh Shoaib; Raina, Adnan

    2016-01-01

    Background: The clinical presentation of non-Hodgkin lymphoma (NHL) varies tremendously depending upon the type of lymphoma and the areas of involvement. NHL can rarely present as an abdominal mass compressing the inferior vena cava. The clinical presentation due to obstruction of inferior vena cava has often been called the inferior vena cava syndrome (IVCS). It can present acutely or chronically. Case Presentation: A 35-year-old male presented with 3 months history of fever, anorexia, weight loss and abdominal discomfort. His abdominal examination showed dilated superficial veins with blood flowing rostrally. CECT abdomen revealed multiple enlarged some necrotic, retroperitoneal lymph nodes. The inferior vena cava was noted to be compressed by the lymph nodes. The lymph node biopsy revealed non- Hodgkin lymphoma, precursor B cell. Conclusion: An abdominal mass compressing the inferior vena cava is a rare but possible cause for appearance of dilated superficial abdominal veins and should be looked for. PMID:27757210

  20. Embolization of Large Gastric Varices Using Vena Cava Filter and Coils

    SciTech Connect

    Ford, Jason M.; Shah, Himanshu Stecker, Michael S.; Namyslowski, Jan

    2004-08-15

    A 40-year-old male with alcoholic cirrhosis and portal hypertension presented with acute variceal hemorrhage. Abdominal CT scan and endoscopy revealed large gastric varices. The patient underwent a TIPS procedure. Portal venography demonstrated persistent filling of the large gastric varices with associated high-flow spontaneous splenorenal shunt. Because of the large size of the varices, a Simon-Nitinol filter was used in conjunction with multiple embolization coils to enable successful occlusion of the varices.

  1. Bilateral inferior turbinate osteoma

    PubMed Central

    Sahemey, R.; Warfield, A.T.; Ahmed, S.

    2016-01-01

    Osteomas are the most common benign osteoclastic tumours of the paranasal sinuses. However, nasal cavity and turbinate osteomas are extremely rare. Only nine middle turbinate, three inferior turbinate and one inferior turbinate osteoma cases have been reported to date. The present case report describes the management and follow-up of symptomatic bilateral inferior turbinate osteoma. A 60-year-old female presented with symptoms of bilateral nasal obstruction and right-sided epiphora. Radiological investigation found hypertrophic bony changes involving both inferior turbinates. The patient was managed successfully by endoscopic inferior turbinectomies in order to achieve a patent airway, with no further recurrence of tumour after 3 months postoperatively. To the best of our knowledge, this is the first reported case of bilateral inferior turbinate osteoma. We describe a safe and minimally invasive method of tumour resection, which has a better cosmetic outcome compared with other approaches. PMID:27534890

  2. Bilateral inferior turbinate osteoma.

    PubMed

    Sahemey, R; Warfield, A T; Ahmed, S

    2016-01-01

    Osteomas are the most common benign osteoclastic tumours of the paranasal sinuses. However, nasal cavity and turbinate osteomas are extremely rare. Only nine middle turbinate, three inferior turbinate and one inferior turbinate osteoma cases have been reported to date. The present case report describes the management and follow-up of symptomatic bilateral inferior turbinate osteoma.A 60-year-old female presented with symptoms of bilateral nasal obstruction and right-sided epiphora. Radiological investigation found hypertrophic bony changes involving both inferior turbinates. The patient was managed successfully by endoscopic inferior turbinectomies in order to achieve a patent airway, with no further recurrence of tumour after 3 months postoperatively.To the best of our knowledge, this is the first reported case of bilateral inferior turbinate osteoma. We describe a safe and minimally invasive method of tumour resection, which has a better cosmetic outcome compared with other approaches. PMID:27534890

  3. [Perioperative management of a patient with bilateral renal cell cancer and large vena caval tumor thrombosis].

    PubMed

    Yokoyama, T; Nishiyama, T; Hanaoka, K

    1996-09-01

    Von Hippel-Lindau disease is a kind of rare autosomal dominant hereditary disease characterized with many kinds of tumor or cystic lesion. In this 30 year old woman, vena caval tumor thrombi from retroperitoneal malignancies caused by renal cell cancer extended into the right atrium. She was scheduled to undergo bilateral radical nephrectomy and removal of vena caval thrombi under continuous hemodiafiltration (CHDF) and extracorporeal circulation. CHDF and Biomedics Pump were on stand-by during the operation. Radical left nephrectomy was performed. In the right kidney, however only the tumor could be removed and other part of the right kidney remained untouched. Therefore, CHDF was not used because urine volume and electrolyte balance were maintained with furosemide administration. The change of blood pressure caused by inferior vena caval clamping at just below the renal vein was not so great that the operation was performed without extracorporeal circulation. Total blood loss was 12,000 ml and careful management of water balance was necessary. She did not need any hemodialysis after the surgery. PMID:8905954

  4. The azygos system as a rare alternative for chronic indwelling catheters placement.

    PubMed

    Moise, Mireille A; Hadro, Neal; El-Arousy, Hazem; Alvarez-Tostado, Javier A

    2009-09-01

    Chronic indwelling catheters are plagued with a high rate of complications, including infection, central venous occlusion, or thrombosis. When direct access to the superior or inferior vena cava is not possible, venography may identify alternatives that might be viable with current endovascular techniques. This case report describes the successful placement of a tunneled catheter for total parenteral nutrition in the azygos arch through a small collateral vein from the left jugular vein in a patient with no other alternatives because of superior vena cava occlusion and inferior vena cava thrombophlebitis.

  5. Superior vena caval pressure elevation causes pleural effusion formation in sheep.

    PubMed

    Allen, S J; Laine, G A; Drake, R E; Gabel, J C

    1988-09-01

    The effect of superior vena caval pressure (SVCP) elevation on the formation of pleural effusions (PE) was studied in sheep. Through a right thoracotomy, a Silastic cuff was placed around the superior vena cava. Catheters for monitoring SVCP and pulmonary artery pressure (PAP) were also placed. After a 1- to 3-wk recovery period, we measured the SVCP, PAP, cardiac output, and plasma protein concentration (Cp). We then elevated the SVCP to various levels from base line [5.3 +/- 2.6 (SD) mmHg] to 33 mmHg. The cardiac output, PAP, and Cp were remeasured 1-2 h and 24 h after SVCP elevation. At the end of the 24-h period, the animals were killed. The PE volume and pleural fluid protein concentration (Cpl) were measured, and the Cpl/Cp was calculated. PE generally did not occur until the SVCP was elevated above 15 mmHg. To study the effect of the thoracotomy on the subsequent pleural effusion, we studied six additional sheep in which we did not perform a thoracotomy. In these animals, the SVCP was elevated to between 5 and 28 mmHg for 24 h by use of a 16-Fr balloon catheter placed via a left external jugular vein and a right carotid-external jugular shunt. We found that the PE volume, for a given SVCP elevation, was similar to that present in sheep that received a thoracotomy. For all sheep the volume of PE was related to SVCP by the equation PE (ml) = 0.24e0.26SVCP, r = 0.85. In the sheep without a thoracotomy, Cpl/Cp rose with increasing volume of PE. Our data demonstrate that elevation of SVCP greater than 15 mmHg for 24 h results in the formation of PE. The rise in Cpl/Cp with PE volume suggests that filtration through the pleural vessels is not the major contributor to PE formation. PMID:3414816

  6. Diagnostic value of computerized tomography venography in detecting stenosis and occlusion of subclavian vein and superior vena in chronic renal failure patients

    PubMed Central

    Bakhshoude, Banafsheh; Ravari, Hassan; Kazemzadeh, Gholam Hosein; Rad, Masoud Pezeshki

    2016-01-01

    Introduction Currently, venography is the standard diagnostic method to examine veins before implementing access, which is invasive in nature. Computerized tomography venography (CTV) can simultaneously indicate deep and superficial venous systems in the upper extremity and their relation to the surrounding anatomical structures; however, its diagnostic value in the detection of central venous disease has yet to be defined. The aim of this study was to determine the diagnostic value of CT venography compared to venography in the diagnosis of stenosis and the occlusion of subclavian veins and the superior vena in renal failure patients. Methods This cross-sectional study was conducted from January to September 2015 on patients with chronic renal failure undergoing upper extremity venography at the Radiology Department of Imam Reza Hospital in Mashhad, Iran. We excluded patients with catheters in their jugular and subclavian vein routes, venous hypertension with reverse-function fistula, or sensitivity to contrast agents. Several factors, including age, gender, catheterization record in jugular and subclavian veins, and fistula record in the upper extremity, as well as clinical symptoms consisting of edema, dermatitis, and ulcers in these organs, were recorded in the corresponding form. Then, the patients consecutively underwent indirect venography and CT venography and traces of stenosis (more than 50%) or complete occlusion in the subclavian vein and superior vena were recorded. The data were analyzed using SPSS software by the chi-squared test, and sensitivity, specificity, and positive and negative predictive values were calculated by means of MedCalc Online, version 16.2. Results The study was conducted on 40 patients (26 males and 14 females) with a mean age of 46.7 ± 10.4 years. In this study, 58 subclavian veins, as well as 32 superior vena cava, were studied. The results showed that the diagnostic value of CTV in the detection of subclavian stenosis had a

  7. Primary Synovial Sarcoma of the Kidney with Inferior Vena Caval Thrombus.

    PubMed

    Chandrasekaran, Deepak; Narayanaswamy, Kathiresan; Sundersingh, Shirley; Senniappan, Karthikeyan; Raja, Anand

    2016-09-01

    Synovial sarcomas occurs primarily in the soft tissues, mostly in para-articular regions of the extremities. These tumors have been described in other unusual locations like the pleura, lungs, mediastinum, and kidneys. Primary synovial sarcoma of the kidney is a recently described entity; to date, a total of approximately 35 cases have been reported. Only three cases of primary synovial sarcoma of kidney with IVC thrombus have been reported so far. Here we present the case of a 44 year old gentleman, with primary synovial sarcoma of the left kidney with caval thrombus. PMID:27651698

  8. Inferior alveolar nerve repositioning.

    PubMed

    Louis, P J

    2001-09-01

    Nerve repositioning is a viable alternative for patients with an atrophic edentulous posterior mandible. Patients, however, should be informed of the potential risks of neurosensory disturbance. Documentation of the patient's baseline neurosensory function should be performed with a two-point discrimination test or directional brush stroke test preoperatively and postoperatively. Recovery of nerve function should be expected in 3 to 6 months. The potential for mandibular fracture when combining nerve repositioning with implant placement also should be discussed with the patient. This can be avoided by minimizing the amount of buccal cortical plate removal during localization of the nerve and maintaining the integrity of the inferior cortex of the mandible. Additionally, avoid overseating the implant, thus avoiding stress along the inferior border of the mandible. The procedure does allow for the placement of longer implants, which should improve implant longevity. Patients undergoing this procedure have expressed overall satisfaction with the results. Nerve repositioning also can be used to preserve the inferior alveolar nerve during resection of benign tumors or cysts of the mandible. This procedure allows the surgeon to maintain nerve function in situations in which the nerve would otherwise have to be resected. PMID:11665379

  9. Incarcerated inferior lumbar (Petit's) hernia.

    PubMed

    Astarcioğlu, H; Sökmen, S; Atila, K; Karademir, S

    2003-09-01

    Petit's hernia is an uncommon abdominal wall defect in the inferior lumbar triangle. Colonic incarceration through the inferior lumbar triangle, which causes mechanical obstructive symptoms, necessitates particular diagnostic and management strategy. We present a rare case of inferior lumbar hernia, leading to mechanical bowel obstruction, successfully treated with prosthetic mesh reinforcement repair.

  10. Use of the Frog Heart Preparation to Teach Students about the Spontaneous Mechanical Activity of the Vena Cava

    ERIC Educational Resources Information Center

    Hill, Brent J. F.; Goodman, Ian; Moran, William M.

    2011-01-01

    Most undergraduate physiology texts describe veins simply as reservoirs for blood and conduits for return of blood to the heart. This article describes a laboratory exercise that can be performed by students to demonstrate that veins are much more than reservoirs and conduits for blood flow: they possess a dynamic rhythmic contraction. In this…

  11. Surgically assisted trans-hepatic anterior approach for central venous catheter placement: safety and efficacy.

    PubMed

    Diamanti, Antonella; Rollo, Massimo; Monti, Lidia; Candusso, Manila; de Ville de Goyet, Jean

    2012-12-01

    We describe a child dependent on parenteral nutrition who developed loss of all conventional central venous catheter insertion sites coupled with very unusual collateralization due to extensive thrombosis of both the superior and inferior vena cava, including the azygos vein. We successfully achieved trans-hepatic anterior access to the infra-diaphragmatic vena cava. Since the success rate for this technique is low due to catheter dislodgement, the procedure was surgically assisted for increased safety and efficacy.

  12. Endocaval suture of aortocaval fistula.

    PubMed

    Illuminati, G; Calió, F G; Bertagni, A; Caratozzolo, M; Vietri, F

    1997-05-01

    A case of aortocaval fistula complicating a ruptured infrarenal aortic aneurysm is reported. As the length of the defect and the thickness of the aortic wall made repair from within the aorta unsafe, the defect was repaired from within the vena cava. The details of the technique are reported. It can be a useful alternative to inferior vena cava ligation, when standard repair of aortocaval fistulae from within the aorta is risky or difficult to attempt.

  13. Cross-sectional echocardiographic diagnosis of systemic venous return.

    PubMed Central

    Huhta, J C; Smallhorn, J F; Macartney, F J; Anderson, R H; de Leval, M

    1982-01-01

    To determine the sensitivity and specificity of cross-sectional echocardiography in diagnosing anomalous systemic venous return we used the technique in 800 consecutive children with congenital heart disease and whom the diagnosis was ultimately confirmed by angiography. Cross-sectional echocardiography was performed without prior knowledge of the diagnosis in all but 11 patients, who were recalled because of a known abnormality of atrial situs. The sensitivity of cross-sectional echocardiographic detection of various structures was as follows: right superior vena cava 792/792 (100%); left superior vena cava 46/48 (96%); bilateral superior vena cava 38/40 (95%); bridging innominate vein with bilateral superior vena cava 13/18 (72%); connection of superior caval segment to heart (coronary sinus or either atrium) (100%); absence of suprarenal inferior vena cava 23/23 (100%); azygos continuation of the inferior vena cava 31/33 (91%); downstream connection of azygos continuation, once seen, 21/21 (100%); partial anomalous hepatic venous connection (one hepatic vein not connected to the inferior vena cava) 1/1 (100%); total anomalous hepatic venous connection (invariably associated with left isomerism) 23/23 (100%). The specificity of each above diagnoses was 100% except in one infant with exomphalos in whom absence of the suprarenal inferior vena cava was incorrectly diagnosed. Thus cross-sectional echocardiography is an extremely specific and highly sensitive method of recognizing anomalous systemic venous return. It is therefore of great value of planning both cardiac catheterisation and cannulation for open heart surgery. Images PMID:6751361

  14. The North Atlantic Oscillation affects the quality of Cava (Spanish sparkling wine).

    PubMed

    Real, Raimundo; Báez, José Carlos

    2013-05-01

    This study explores the possible effects of the North Atlantic Oscillation (NAO) on the quality of Spanish Cava. We found a significant negative relationship between the mean NAO for the months of March through August of each year between 1970 and 2008 and the probability of obtaining a top quality Cava. The NAO is associated with temperature and rainfall variations in the Cava region, which affect vine physiological processes during grape maturity. The probability of obtaining a top quality Cava was highest when the mean value of the NAO was negative, which causes the mean temperature in the Cava area to decrease, with positive consequences on Cava quality. Although the overall discrimination capacity and explanatory power of the model were low, 80% of clearly favorable years were classified correctly as corresponding to top quality Cava, and 70% of clearly unfavorable years were classified correctly as non top quality Cava.

  15. [UNMODIFIED DIAMETER V. PORTA. IN 79-YEAR-OLD PATIENT WITH CONGESTIVE HEART FAILURE AND SEVERE PULMONARY HYPERTENSION IN THE SETTING OF COMPLEX CONGENITAL HEART DISEASE--PATENT FORAMEN OVALE AT THE CONFLUENCE OF THE LEFT PULMONARY VEINS INTO THE V. CAVA SUPERIOR AND MIXED (HCV) LIVER CIRRHOSIS].

    PubMed

    Alexandrova, A A; Kolos, I P; Dupik, N V; Lazebnik, L B

    2015-01-01

    The clinical observation and analysis of the reasons for late diagnosis of congenital heart disease is presented. A feature of this observation is diagnosed complex congenital heart defect with shunting of blood in elderly woman with the second disease--chronic viral hepatitis C and cirrhosis of the liver. Long-term compensation circulation and lack of pulmonary fibrosis in our patient with patent foramen ovale was due to the presence of a second malformation--confluence of the left pulmonary veins in vena cava superior that apparently contributed to the constant lung tissue haemooxygenation.

  16. Effect of Dieckol, a Component of Ecklonia cava, on the Promotion of Hair Growth

    PubMed Central

    Kang, Jung-Il; Kim, Sang-Cheol; Kim, Min-Kyoung; Boo, Hye-Jin; Jeon, You-Jin; Koh, Young-Sang; Yoo, Eun-Sook; Kang, Sung-Myung; Kang, Hee-Kyoung

    2012-01-01

    This study was conducted to evaluate the effect of Ecklonia cava, a marine alga native to Jeju Island in Korea, on the promotion of hair growth. When vibrissa follicles were cultured in the presence of E. cava enzymatic extract (which contains more than 35% of dieckol) for 21 days, E. cava enzymatic extract increased hair-fiber length. In addition, after topical application of the 0.5% E. cava enzymatic extract onto the back of C57BL/6 mice, anagen progression of the hair-shaft was induced. The treatment with E. cava enzymatic extract resulted in the proliferation of immortalized vibrissa dermal papilla cells (DPC). Especially, dieckol, among the isolated compounds from the E. cava enzymatic extract, showed activity that increased the proliferation of DPC. When NIH3T3 fibroblasts were treated with the E. cava enzymatic extract and the isolated compounds from the E. cava enzymatic extract, the E. cava enzymatic extract increased the proliferation of NIH3T3 fibroblasts, but the isolated compounds such as eckol, dieckol, phloroglucinol and triphlorethol-A did not affect the proliferation of NIH3T3 fibroblasts. On the other hand, the E. cava enzymatic extract and dieckol significantly inhibited 5α-reductase activity. These results suggest that dieckol from E. cava can stimulate hair growth by the proliferation of DPC and/or the inhibition of 5α-reductase activity. PMID:22754373

  17. Beware of Venous Anomalies in Young Patients with Sick Sinus Syndrome: A Report of Two Cases of Sick Sinus Syndrome with Systemic Venous Anomalies

    PubMed Central

    Rathakrishnan, Shanmuga Sundaram; Kaliappan, Tamilarasu; Gopalan, Rajendiran

    2015-01-01

    We report two young patients with symptomatic sick sinus syndrome admitted for permanent pacemaker implantation (PPI). On evaluation with echocardiography, one of them was found to have persistent left superior vena cava and venography showed absent right superior vena cava also. He underwent PPI with leads inserted via left superior vena cava, coronary sinus, right atrium and right ventricle. The other patient was incidentally found to have interrupted inferior vena cava with azygos continuation while being planned for temporary pacemaker implantation. She underwent successful PPI. We would like to stress the importance of having a high suspicion for these systemic venous anomalies in patients presenting with sick sinus syndrome especially at young age. If we could diagnose preoperatively, we can avoid on table surprises. PMID:27326354

  18. Simulation of the Inferior Mirage

    NASA Astrophysics Data System (ADS)

    Branca, Mario

    2010-09-01

    A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior" mirage.2 The most common example of an inferior mirage is when, on a hot day, a stretch of dry road off in the distance appears to be wet (see Fig. 1). Many lab activities have been described that simulate the formation of superior mirages. In these demonstrations light beams curve downward as they pass through a nonuni-form fluid.3-6 Much less common are laboratory demonstrations of upward-curving light rays of the kind responsible for inferior mirages. This paper describes a simple version of such a demonstration.

  19. Circumaortic Left Renal Vein-A Rare Case Report

    PubMed Central

    Panagar, Anupama Doddappaiah; Subhash, R. Lakshmi Prabha; Suresh, B.S.; Nagaraj, D.N.

    2014-01-01

    During routine dissection which was carried out for the medical students, a circumaortic left renal vein draining into inferior vena cava was observed. There were 2 renal veins through which the left kidney drained into the inferior vena cava, of which the larger one ran ventral to aorta and the other smaller one ran posterior to aorta and received lumbar veins before opening into inferior vena cava. This is a relatively rare condition which can result in left renal hypertension (LRVH) syndrome which is otherwise called as anterior and posterior nutcracker syndromes. This venous anomaly results from the errors of embryological development. It is of clinical significance, mainly during retroperitoneal surgeries and intra caval interventions. It is also important in conditions which warrant extensive venous dissections, venous reconstructions as in transplantations and invasion of veins by cancerous tissue, resulting in life threatening haemorrhage. PMID:24783096

  20. Serotonin in the inferior colliculus.

    PubMed

    Hurley, Laura M; Thompson, Ann M; Pollak, George D

    2002-06-01

    It has been recognized for some time that serotonin fibers originating in raphe nuclei are present in the inferior colliculi of all mammalian species studied. More recently, serotonin has been found to modulate the responses of single inferior colliculus neurons to many types of auditory stimuli, ranging from simple tone bursts to complex species-specific vocalizations. The effects of serotonin are often quite strong, and for some neurons are also highly specific. A dramatic illustration of this is that serotonin can change the selectivity of some neurons for sounds, including species-specific vocalizations. These results are discussed in light of several theories on the function of serotonin in the IC, and of outstanding issues that remain to be addressed. PMID:12117504

  1. Simulation of the Inferior Mirage

    ERIC Educational Resources Information Center

    Branca, Mario

    2010-01-01

    A mirage can occur when a continuous variation in the refractive index of the air causes light rays to follow a curved path. As a result, the image we see is displaced from the location of the object. If the image appears higher in the air than the object, it is called a "superior" mirage, while if it appears lower it is called an "inferior"…

  2. Sonographic Findings in Fetal Renal Vein Thrombosis.

    PubMed

    Gerber, Rebecca E; Bromley, Bryann; Benson, Carol B; Frates, Mary C

    2015-08-01

    We present the sonographic findings of fetal renal vein thrombosis in a series of 6 patients. The mean gestational age at diagnosis was 31.2 weeks. Four cases were unilateral, and 2 were bilateral. The most common findings were renal enlargement and intrarenal vascular calcifications, followed by increased renal parenchymal echogenicity. Inferior vena cava thrombosis was found in 4 patients and common iliac vein thrombosis in 2. Fetal renal vein thrombosis is an uncommon diagnosis with characteristic sonographic findings. The presence of these findings should prompt Doppler interrogation of the renal vein and inferior vena cava to confirm the diagnosis.

  3. Rare Anatomical Variation of Dual IVC with Left Sided IVC Draining into Hemiazygous Vein- A Case Report

    PubMed Central

    Modi, Pranjal; Sutariya, Harsh; Patel, Kajal

    2016-01-01

    Congenital anomalies of the Inferior Vena Cava (IVC) result from the persistence of the embryonic venous system. Knowledge of such anomaly is of great importance during abdominal surgery, liver and kidney transplantation, renal venous sampling and in the treatment of thromboembolic diseases. Here, we report a rare anatomical variation of dual IVC with normal course of right sided IVC and hemiazygous continuation of left sided IVC with interiliac communication in potential renal donor. Congenital abnormalities of the inferior vena cava are easily identified on Computed Tomography (CT) and should be considered when interpreting any CT of the abdomen or chest. PMID:27134969

  4. Enhancement of Human Hair Growth Using Ecklonia cava Polyphenols

    PubMed Central

    Shin, Hyoseung; Cho, A-Ri; Kim, Dong Young; Munkhbayer, Semchin; Choi, Soon-Jin; Jang, Sunhyae; Kim, Seong Ho; Shin, Hyeon-Cheol

    2016-01-01

    Background Ecklonia cava is a brown alga that contains various compounds, including carotenoids, fucoidans, and phlorotannins. E. cava polyphenols (ECPs) are known to increase fibroblast survival. The human dermal papilla cell (hDPC) has the properties of mesenchymal-origin fibroblasts. Objective This study aims to investigate the effect of ECPs on human hair growth promotion in vitro and ex vivo. Methods MTT assays were conducted to examine the effect of ECPs on hDPC proliferation. Hair growth was measured using ex-vivo hair follicle cultures. Real-time polymerase chain reaction was performed to evaluate the mRNA expression of various growth factors in ECP-treated hDPCs. Results Treatment with 10 µg/ml purified polyphenols from E. cava (PPE) enhanced the proliferation of hDPCs 30.3% more than in the negative control (p<0.001). Furthermore, 0.1 µg/ml PPE extended the human hair shaft 30.8% longer than the negative control over 9 days (p<0.05). Insulin-like growth factor-1 (IGF-1) mRNA expression increased 3.2-fold in hDPCs following treatment with 6 µg/ml PPE (p<0.05). Vascular endothelial growth factor (VEGF) mRNA expression was also increased 2.0-fold by 3 µg/ml PPE (p<0.05). Treatment with 10 µg/ml PPE reduced oxidative stress in hDPCs (p<0.05). Conclusion These results suggest that PPE could enhance human hair growth. This can be explained by hDPC proliferation coupled with increases in growth factors such as IGF-1 and VEGF. Reducing oxidative stress is also thought to help increase hDPCs. These favorable results suggest that PPE is a promising therapeutic candidate for hair loss. PMID:26848214

  5. Inferior mirages: an improved model.

    PubMed

    Young, Andrew T

    2015-02-01

    A quantitative model of the inferior mirage is presented, based on a realistic temperature profile in the convective boundary layer, using Monin-Obukhov similarity theory. The top of the inverted image is determined by the logarithmic part of the profile; the bottom is the apparent horizon, which depends on optical obstruction by roughness elements. These effects of surface roughness are included in the model, which is illustrated with a simulation. The vertical magnification varies throughout the mirage, becoming infinite at Minnaert's ill-named "vanishing line"-which makes green flashes apparent to the naked eye. PMID:25967823

  6. Leonardo da Vinci and Kethem-Kiveris vena.

    PubMed

    Dolezal, Antonín; Skorepova-Honzlova, Zita; Jelen, Karel

    2012-01-01

    In the drawing of coitus by Leonardo da Vinci are pictured the contemporary hypotheses regarding this act. The authors analyze the mamillaruteral connection depicted by the artist and grow up to believe that this is a hypothetical kiveris vena, female vein described by Anatomist Master Nicolai Physicus from the Salerno School. The Hebrew roots were found in the name. The connection is described also by Mondino in The Anathomia. The same connection can be found in the picture of the pregnant woman in Fasciculus Medicinæ by Johannes De Ketham.

  7. INTERDEPENDENT SUPERIORITY AND INFERIORITY FEELINGS

    PubMed Central

    Ingham, Harrington V.

    1949-01-01

    It is postulated that in neurotic persons who have unrealistic feelings of superiority and inferiority the two are interdependent. This is a departure from the concept of previous observers that either one or the other is primary and its opposite is overcompensation. The author postulates considerable parallelism, with equal importance for each. He submits that the neurotic person forms two logic-resistant compartments for the two opposed self-estimates and that treatment which makes inroads of logic upon one compartment, simultaneously does so upon the other. Two examples are briefly reported. The neurotic benefits sought in exaggeration of capability are the same as those sought in insistence upon inferiority: Presumption of superiority at once bids for approbation and delivers the subject from the need to prove himself worthy of it in dreaded competition; exaggeration of incapability baits sympathy and makes competition unnecessary because failure is conceded. Some of the characteristics of abnormal self-estimates that distinguish them from normal are: Preoccupation with self, resistance to logical explanation of personality problems, inconsistency in reasons for beliefs in adequacy on the one hand and inadequacy on the other, unreality, rationalization of faults, and difficulty and vacillation in the selection of adequate goals. PMID:15390573

  8. Surgical Management of Vascular Stents in Pediatric Cardiac Surgery: Clues for a Staged Partnership.

    PubMed

    Gil-Jaurena, Juan-Miguel; Zunzunegui, José-Luis; Pérez-Caballero, Ramón; Pita, Ana; González-López, María-Teresa; Ballesteros, Fernando; Rodríguez, Alejandro; Medrano, Constancio

    2015-12-01

    Complex cases undergo step surgical and percutaneous procedures, including stent deployment. Concerns arise on stent removal at latest surgery. Our initial experience is presented. Forty-six stents in 35 patients were partially or totally removed at surgery. Univentricular heart was diagnosed in 20 patients. Stents were previously deployed in: ductus (6), right ventricle outflow tract (12), atrial septal defect (4), right pulmonary artery (4), left pulmonary artery (16), inferior vena cava (2), superior vena cava (1) and ascending aorta (1). Surgical procedures performed: 9 transplants, 6 Fontan, 4 Glenn, 1 comprehensive repair (Norwood + Glenn), 1 Glenn takedown, 8 conduit replacement, 2 Fallot, 2 Rastelli, 1 ventricular septal defect closure and 1 iatrogenic aortopulmonary window. Five ductal stents were clipped. Eleven stents in right ventricle, four ones in atrial septal defect, two in right pulmonary artery, seven in the left pulmonary artery and two in inferior vena cava were completely removed. Two stents in right pulmonary artery, one in superior vena cava, one in ascending aorta and nine in the left pulmonary artery were partially retrieved. Handling the stents in ductus, right ventricle and atrial septal defect was straightforward. On the contrary, stent removal in the ductus (comprehensive case), pulmonary branches, both vena cavae or aorta required short periods of deep hypothermia with circulatory arrest. Surgery over stents is increasing in complex, step procedures. Univentricular hearts are most prevalent. Congenital transplant surgery faces new challenges. Stent removal at the time of surgery may require deep hypothermic circulatory arrest.

  9. Modified Senning Procedure for Correction of Atrioventricular Discordance With Total Anomalous Pulmonary Venous Return, Atrial Situs Inversus, Dextrocardia, and Bilateral Superior Venae Cavae.

    PubMed

    Sebastian, Vinod A; Guleserian, Kristine J; Juraszek, Amy; Kane, Colin; Hamzeh, Rabih; Forbess, Joseph M

    2015-10-01

    The Senning and Mustard baffles remain important techniques for the treatment of congenitally corrected transposition (cc-TGA), isolated ventricular inversion, and D-transposition of the great arteries with delayed presentation. We describe the treatment of an 8-month old infant with atrioventricular discordance, ventriculoarterial concordance, and dextrocardia with atrial situs inversus. A modified Senning procedure was performed through the "left-sided" atrium. Modifications of the Senning and Mustard baffles remain important tools in the treatment of rare conditions like isolated ventricular inversion.

  10. Color flow imaging of the vena contracta in mitral regurgitation: technical considerations.

    PubMed

    Roberts, Brad J; Grayburn, Paul A

    2003-09-01

    Qualitative grading of mitral regurgitation severity has significant pitfalls secondary to hemodynamic variables, sonographic technique, blood pool entrainment, and the Coanda effect. Volumetric and proximal isovelocity surface area methods can be used to quantitate regurgitant orifice area, regurgitant volume, and regurgitant fraction, but have several limitations and can pose technical challenges. The vena contracta width method provides a rapid and accurate quantitative assessment of mitral regurgitation severity, but is clinically underused. This article is intended to generate an understanding of the flow mechanics of the vena contracta and the sonographic technique required to provide consistent and accurate measurements of vena contracta width in patients with mitral regurgitation. PMID:12931115

  11. Bilateral inferior petrosal sinus sampling.

    PubMed

    Zampetti, Benedetta; Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo; Loli, Paola

    2016-07-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50-70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  12. Bilateral inferior petrosal sinus sampling.

    PubMed

    Zampetti, Benedetta; Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo; Loli, Paola

    2016-07-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing's syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88-100% and 67-100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50-70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres.

  13. Bilateral inferior petrosal sinus sampling

    PubMed Central

    Grossrubatscher, Erika; Dalino Ciaramella, Paolo; Boccardi, Edoardo

    2016-01-01

    Simultaneous bilateral inferior petrosal sinus sampling (BIPSS) plays a crucial role in the diagnostic work-up of Cushing’s syndrome. It is the most accurate procedure in the differential diagnosis of hypercortisolism of pituitary or ectopic origin, as compared with clinical, biochemical and imaging analyses, with a sensitivity and specificity of 88–100% and 67–100%, respectively. In the setting of hypercortisolemia, ACTH levels obtained from venous drainage of the pituitary are expected to be higher than the levels of peripheral blood, thus suggesting pituitary ACTH excess as the cause of hypercortisolism. Direct stimulation of the pituitary corticotroph with corticotrophin-releasing hormone enhances the sensitivity of the procedure. The procedure must be undertaken in the presence of hypercortisolemia, which suppresses both the basal and stimulated secretory activity of normal corticotrophic cells: ACTH measured in the sinus is, therefore, the result of the secretory activity of the tumor tissue. The poor accuracy in lateralization of BIPSS (positive predictive value of 50–70%) makes interpetrosal ACTH gradient alone not sufficient for the localization of the tumor. An accurate exploration of the gland is recommended if a tumor is not found in the predicted area. Despite the fact that BIPSS is an invasive procedure, the occurrence of adverse events is extremely rare, particularly if it is performed by experienced operators in referral centres. PMID:27352844

  14. Intravenous Leiomyomatosis with Intracardiac Extension: Echocardiographic Study and Literature Review

    PubMed Central

    Li, Rongjuan; Shen, Yanguang; Sun, Yan; Zhang, Chuanchen; Yang, Jiao; Su, Ruijuan; Jiang, Bo

    2014-01-01

    Uterine leiomyomatosis is a common disease in women; however, intravenous leiomyomatosis with intracaval and intracardiac tumor extension is rare. We sought to analyze the clinical and echocardiographic features of intracardiac leiomyomatosis. From January 2003 through July 2012, 7 women (age range, 24–59 yr) underwent surgical resection of histopathologically diagnosed intracardiac leiomyomas at our hospital. Most of the patients had histories of hysterectomy or uterine leiomyoma. We retrospectively analyzed their preoperative echocardiograms. We found that the tumors had no stalks, did not adhere to the wall of the right side of the heart, were highly mobile, and moved back and forth in the right atrium near the tricuspid orifice. All tumors originated from the inferior vena cava and had borders well demarcated from that structure's wall. Most of the masses extended into the inferior vena cava and right atrium through the right internal and common iliac veins. Computed tomograms revealed pelvic tumors and contiguous filling defects in 6 patients. When echocardiograms reveal a right-sided cardiac mass that originates from the inferior vena cava, particularly in women who have a history of hysterectomy or uterine leiomyoma, intracardiac leiomyomatosis should be suspected. If the mass has no stalk and freely moves within the inferior vena cava and right-sided cardiac chambers without attachment to the endothelial surface or endocardium, intracardiac leiomyomatosis should be diagnosed. We discuss our findings and briefly review the relevant medical literature. PMID:25425982

  15. [Endovascular closure of iatrogenic arteriovenous anastomosis of the iliac artery and vein].

    PubMed

    Sin'kov, M A; Murashkovskiĭ, A L; Pogorelov, E A; Golovin, A A; Kalinichenko, N A; Khaes, B L; Kokov, A N; Kheraskov, V Iu; Evtushenko, S A; Popov, V A; Barbarash, L S

    2014-01-01

    The presented herein clinical case report concerns successful endovascular closure of a iatrogenic lesion of the iliac artery and inferior vena cava with formation of a pathological arteriovenous anastomosis manifesting itself by venous thromboembolic syndrome and severe right-ventricular insufficiency. PMID:24722024

  16. Scimitar syndrome with pulmonary arteriovenous fistulas.

    PubMed

    Le Rochais, J P; Icard, P; Davani, S; Abouz, D; Evrard, C

    1999-10-01

    Right abnormal pulmonary venous return into the inferior vena cava associated with abnormal fissure, dextrocardia, and systemic arterial supply of a variable degree, are the characteristics of the scimitar syndrome. We report on a patient in whom this rare syndrome was associated with pulmonary arteriovenous fistulas within the involved lung.

  17. Hepatoazygos venous shunt for Fontan completion after Kawashima operation

    PubMed Central

    Baruah, Sudip Dutta; Mishra, Smita; Marwah, Ashutosh; Sharma, Rajesh

    2016-01-01

    Fontan completion after prior Kawashima repair for single ventricle with interruption of the inferior vena cava can be accomplished by various methods. We describe a patient who underwent the connection of hepatic to hemiazygos vein that we believe would be superior to the conventional cavopulmonary connection in our patient.

  18. Bleeding Duodenal: Varices Treatment by TIPS and Transcatheter Embolization

    SciTech Connect

    Lopera, Jorge E. Arthurs, Blain; Scheuerman, Christian; Sandoz, Charles; Petersosn, Scott; Castaneda-Zuniga, Wildriodo

    2008-03-15

    We describe our clinical experience in 4 patients with portal hypertension who presented with bleeding mesenteric varices originating from the superior mesenteric vein with retrograde filling of collaterals draining into the inferior vena cava. The clinical presentation, imaging findings, and potential therapeutic management are discussed.

  19. Venous outflow obstruction and portopulmonary hypertension after orthotopic liver transplantation

    PubMed Central

    Aguirre-Avalos, Guadalupe; Covarrubias-Velasco, Marco Antonio; Rojas-Sánchez, Antonio Gerardo

    2013-01-01

    Patient: Female, 54 Final Diagnosis: Suprahepatic inferior vena cava anastomosis stricture Symptoms: Ascites • fatigue • lower limb edema • hepatomegaly Medication: — Clinical Procedure: — Specialty: Transplantology • Critical Care Medicine Objective: Unusual clinical course Background: Suprahepatic inferior vena cava anastomosis stricture is an unusual vascular complication after orthotopic liver transplantation with the “piggyback” technique. Clinical manifestations are dependent upon the severity of the stenosis. Portopulmonary hypertension after orthotopic liver transplantation is a complication that carries high mortality due to cardiopulmonary dysfunction. The pathogenesis of pulmonary vascular disorders after orthotopic liver transplantation remains uncertain. Case Report: We report a case of acute right heart pressure overload after surgical correction of the suprahepatic inferior vena cava anastomotic stricture in a 54-year-old woman who had preexisting pulmonary arterial hypertension associated with portal hypertension after orthotopic liver transplantation. Twenty months posttransplantation, she developed fatigue and progressive ascites. On admission, the patient had hepatomegaly, ascites, and lower limb edema. Symptoms in the patient developed gradually over time. Conclusions: Recurrent portal hypertension by vascular complications is a cause of pulmonary arterial hypertension after orthotopic liver transplantation. Clinical manifestations of suprahepatic inferior vena cava anastomotic stenosis are dependent upon their severity. Sildenafil is an effective drug for treatment of pulmonary arterial hyper-tension after portal hypertension by vascular complications. PMID:24046802

  20. Hepatoazygos venous shunt for Fontan completion after Kawashima operation

    PubMed Central

    Baruah, Sudip Dutta; Mishra, Smita; Marwah, Ashutosh; Sharma, Rajesh

    2016-01-01

    Fontan completion after prior Kawashima repair for single ventricle with interruption of the inferior vena cava can be accomplished by various methods. We describe a patient who underwent the connection of hepatic to hemiazygos vein that we believe would be superior to the conventional cavopulmonary connection in our patient. PMID:27625526

  1. Adrenal Venous Sampling: Where Is the Aldosterone Disappearing to?

    SciTech Connect

    Solar, Miroslav; Ceral, Jiri; Krajina, Antonin; Ballon, Marek; Malirova, Eva; Brodak, Milos; Cap, Jan

    2010-08-15

    Adrenal venous sampling (AVS) is generally considered to be the gold standard in distinguishing unilateral and bilateral aldosterone hypersecretion in primary hyperaldosteronism. However, during AVS, we noticed a considerable variability in aldosterone concentrations among samples thought to have come from the right adrenal glands. Some aldosterone concentrations in these samples were even lower than in samples from the inferior vena cava. We hypothesized that the samples with low aldosterone levels were unintentionally taken not from the right adrenal gland, but from hepatic veins. Therefore, we sought to analyze the impact of unintentional cannulation of hepatic veins on AVS. Thirty consecutive patients referred for AVS were enrolled. Hepatic vein sampling was implemented in our standardized AVS protocol. The data were collected and analyzed prospectively. AVS was successful in 27 patients (90%), and hepatic vein cannulation was successful in all procedures performed. Cortisol concentrations were not significantly different between the hepatic vein and inferior vena cava samples, but aldosterone concentrations from hepatic venous blood (median, 17 pmol/l; range, 40-860 pmol/l) were markedly lower than in samples from the inferior vena cava (median, 860 pmol/l; range, 460-4510 pmol/l). The observed difference was statistically significant (P < 0.001). Aldosterone concentrations in the hepatic veins are significantly lower than in venous blood taken from the inferior vena cava. This finding is important for AVS because hepatic veins can easily be mistaken for adrenal veins as a result of their close anatomic proximity.

  2. Interventional radiology

    SciTech Connect

    Castaneda-Zuniga, W.R.

    1987-01-01

    This reference gives a step-by-step presentation of the elements of interventional radiology. CONTENTS: Introduction; Radiation protection; Embolotherapy; Interventional techniques in the management of gastrointestinal bleeding; Transluminal angioplasty; Thrombolytic therapy; Foreign body removal; Inferior vena cava filter placement; Percutaneous uroradiologic techniques; Interventional techniques in the biliary tract; Nonvascular gastrointestinal tract dilations; Percutaneous biopsy techniques; Drainage of abscess fluid collections in the abdomen.

  3. C-arm Cone Beam Computed Tomographic Needle Path Overlay for Fluoroscopic-Guided Placement of Translumbar Central Venous Catheters

    SciTech Connect

    Tam, Alda; Mohamed, Ashraf; Pfister, Marcus; Rohm, Esther; Wallace, Michael J.

    2009-07-15

    C-arm cone beam computed tomography is an advanced 3D imaging technology that is currently available on state-of-the-art flat-panel-based angiography systems. The overlay of cross-sectional imaging information can now be integrated with real-time fluoroscopy. This overlay technology was used to guide the placement of three percutaneous translumbar inferior vena cava catheters.

  4. Massive lymphocele following pelvic lymphadenectomy for staging of prostatic cancer.

    PubMed

    Brawer, M K; Williams, W; Witte, C L; Bocchini, T; McNeill, G C; Witte, M H

    1989-03-01

    Two patients developed massive pelvic lymphoceles within 30 days of retroperitoneal node dissection for staging of prostatic cancer. Excised lymph nodes were negative for metastases. Both patients developed severe bilateral peripheral edema, and one developed pulmonary thromboembolism from intraluminal thrombi in the adjacent, compressed inferior vena cava. Each patient responded to unroofing of the cyst wall with either concomitant external or internal drainage.

  5. Inferior alveolar nerve block: Alternative technique

    PubMed Central

    Thangavelu, K.; Kannan, R.; Kumar, N. Senthil

    2012-01-01

    Background: Inferior alveolar nerve block (IANB) is a technique of dental anesthesia, used to produce anesthesia of the mandibular teeth, gingivae of the mandible and lower lip. The conventional IANB is the most commonly used the nerve block technique for achieving local anesthesia for mandibular surgical procedures. In certain cases, however, this nerve block fails, even when performed by the most experienced clinician. Therefore, it would be advantageous to find an alternative simple technique. Aim and Objective: The objective of this study is to find an alternative inferior alveolar nerve block that has a higher success rate than other routine techniques. To this purpose, a simple painless inferior alveolar nerve block was designed to anesthetize the inferior alveolar nerve. Materials and Methods: This study was conducted in Oral surgery department of Vinayaka Mission's dental college Salem from May 2009 to May 2011. Five hundred patients between the age of 20 years and 65 years who required extraction of teeth in mandible were included in the study. Out of 500 patients 270 were males and 230 were females. The effectiveness of the IANB was evaluated by using a sharp dental explorer in the regions innervated by the inferior alveolar, lingual, and buccal nerves after 3, 5, and 7 min, respectively. Conclusion: This study concludes that inferior alveolar nerve block is an appropriate alternative nerve block to anesthetize inferior alveolar nerve due to its several advantages. PMID:25885503

  6. An adult case of polysplenia syndrome associated with sinus node dysfunction, dextrocardia, and systemic venous anomalies.

    PubMed

    Fukuda, Kentaro; Onda, Toshihito; Kimura, Yuki; Miura, Seiji; Matsumori, Rie; Masaki, Yoshiyuki; Nishino, Akihisa; Inoue, Kenji; Fujiwara, Yasumasa; Sumiyoshi, Masataka

    2015-01-01

    A 54-year-old woman was referred to our hospital for symptomatic sinus bradyarrhythmia with a sinus pause of 8 seconds. She was diagnosed with dextrocardia during childhood and discovered to have heterotaxy syndrome when she had an appendectomy during her teenager years. Chest and abdominal examinations by computed tomography showed multiple spleens located on the right side and abnormal drainages of the superior and inferior vena cava. Left isomerism was diagnosed by bilaterally bilobed lungs. Because of a patent bilateral superior vena cava, pacemaker leads were implanted using the right cephalic vein approach. Her fainting symptoms disappeared after pacemaker implantation.

  7. Symptomatic sick sinus syndrome requiring permanent pacemaker implantation in a patient uwith mirror image dextrocardia with situs inversus and infertility.

    PubMed

    Kahali, Dhiman; Mandal, Saroj; Mandal, Debasmita; Ghose, Arijit; Kanjilal, Souvik

    2013-01-01

    Situs inversus with dextrocardia is a congenital condition in which the heart is a mirror image of the anatomically normal heart on the right side. A patient presented with the sick sinus syndrome accompanying mirror image dextrocardia which was associated with double superior vena cava and a left sided inferior vena cava A permanent transvenous demand pacemaker was inserted because of repeated episodes of dizziness and a single episode of syncope with ECG showing bradycardia with junctional escape rhythm. Precise knowledge of the venous system and the location of the apex of the right ventricle were necessary prior to permanent pacemaker implantation. Without such knowledge pacing may be technically challenging.

  8. Heart Transplantation in a Patient with Left Isomerism

    PubMed Central

    Bang, Ji Hyun; Oh, You Na; Yoo, Jae Suk; Kim, Jae-Joong; Park, Chun Soo; Park, Jeong-Jun

    2015-01-01

    We report the case of a 37-year-old man who suffered from biventricular failure due to left isomerism, inferior vena cava interruption with azygos vein continuation, bilateral superior vena cava, double outlet of right ventricle, complete atrioventricular septal defect, pulmonary stenosis, and isolated dextrocardia. Heart transplantation in patients with systemic venous anomalies often requires the correction and reconstruction of the upper & lower venous drainage. We present a case of heart transplantation in a patient with left isomerism, highlighting technical modifications to the procedure, including the unifocalization of the caval veins and reconstruction with patch augmentation. PMID:26290840

  9. An adult case of polysplenia syndrome associated with sinus node dysfunction, dextrocardia, and systemic venous anomalies.

    PubMed

    Fukuda, Kentaro; Onda, Toshihito; Kimura, Yuki; Miura, Seiji; Matsumori, Rie; Masaki, Yoshiyuki; Nishino, Akihisa; Inoue, Kenji; Fujiwara, Yasumasa; Sumiyoshi, Masataka

    2015-01-01

    A 54-year-old woman was referred to our hospital for symptomatic sinus bradyarrhythmia with a sinus pause of 8 seconds. She was diagnosed with dextrocardia during childhood and discovered to have heterotaxy syndrome when she had an appendectomy during her teenager years. Chest and abdominal examinations by computed tomography showed multiple spleens located on the right side and abnormal drainages of the superior and inferior vena cava. Left isomerism was diagnosed by bilaterally bilobed lungs. Because of a patent bilateral superior vena cava, pacemaker leads were implanted using the right cephalic vein approach. Her fainting symptoms disappeared after pacemaker implantation. PMID:25948350

  10. Placement of the VenaTech LP Caval Filter in the Elderly: Feasibility and Clinical Benefits of Insertion Via the Arm

    SciTech Connect

    Le Blanche, Alain F. Pautas, Eric; Gouin, Isabelle; Baguees, Audrey; Piette, Francois; Chaibi, Pascal

    2005-12-15

    Purpose. To evaluate routine use of access sites in the arm for percutaneous caval filter placement (PCFP) in elderly patients. Neck arthritis, patient anxiety, access site thrombosis or fecal/urinary incontinence complicating jugular or femoral access may require alternative access sites in this population. Methods. Access via the right arm was chosen for PCFP (VenaTech LP). The indication for PCFP was deep vein thrombosis, a history of pulmonary embolism, and a contraindication to anticoagulant therapy. Ultrasound-guided puncture was performed after diameter measurement of the arm veins (O{sub AV}). The filter was inserted with standard imaging procedures. Procedural difficulty was graded and compared with O{sub AV} and the angle from the arm vein to the superior vena cava ({alpha}{sub AV/SVC}). Results. Over 2 years, 16 patients (14 women, 2 men) with an average age of 90 years (range 79-97 years) were included in the study. The average O{sub AV} value of the basilic or brachial veins was 4.2 mm (range 3.0-5.1 mm). The minimal O{sub AV} for successful access was determined after the first 15 patients. No hematoma occurred at the puncture sites. The average {alpha}{sub AV/SVC} value was 62 deg. (range 29 deg. - 90 deg.). Arm access was possible in 12 of 16 patients (75%) with O{sub AV} {>=} 3.5 mm and {alpha}{sub AV/SVC} {>=} 29 deg. Every procedure via the arm was graded 'easy' by the operator, regardless of angulation values. Femoral access was used in one case due to the impossibility of traversing the heart (patient no. 2), and jugular access was used in 3 of 16 (19%) patients due to puncture failure (patient no. 4), small O{sub AV} (3 mm) (patient no. 6), and stenosis of the distal right subclavian vein (patient no.16), respectively. Conclusion. PCFP via the arm can be routinely accomplished in patients older than 75 years, provided O{sub AV} {>=} 3.5 mm, and {alpha}{sub AV/SVC} {>=} 200119 d.

  11. Functional organization of the left inferior precentral sulcus: dissociating the inferior frontal eye field and the inferior frontal junction.

    PubMed

    Derrfuss, J; Vogt, V L; Fiebach, C J; von Cramon, D Y; Tittgemeyer, M

    2012-02-15

    Two eye fields have been described in the human lateral frontal cortex: the frontal eye field (FEF) and the inferior frontal eye field (iFEF). The FEF has been extensively studied and has been found to lie at the ventral part of the superior precentral sulcus. Much less research, however, has focused on the iFEF. Recently, it was suggested that the iFEF is located at the dorsal part of the inferior precentral sulcus. A similar location was proposed for the inferior frontal junction area (IFJ), an area thought to be involved in cognitive control processes. The present study used fMRI to clarify the topographical and functional relationship of the iFEF and the IFJ in the left hemispheres of individual participants. The results show that both the iFEF and the IFJ are indeed located at the dorsal part of the inferior precentral sulcus. Nevertheless, the activations were spatially dissociable in every individual examined. The IFJ was located more towards the depth of the inferior precentral sulcus, close to the junction with the inferior frontal sulcus, whereas the iFEF assumed a more lateral, posterior and superior position. Furthermore, the results provided evidence for a functional double dissociation: the iFEF was activated only in a comparison of saccades vs. button presses, but not in a comparison of incongruent vs. congruent Stroop conditions, while the opposite pattern was found at the IFJ. These results provide evidence for a spatial and functional dissociation of two directly adjacent areas in the left posterior frontal lobe.

  12. In Vivo Evaluation of Vena Caval Filters: Can Function Be Linked to Design Characteristics?

    SciTech Connect

    Proctor, Mary C.; Cho, Kyung J.; Greenfield, Lazar J.

    2000-11-15

    Purpose: To compare the five vena caval filters marketed in the United States and one investigational vena caval filter and to determine whether there is an association between their design and their in vivo function.Methods: Four of each type of filter-Simon Nitinol (SN), Bird's Nest (BN), Vena Tech (VT), Greenfield stainless steel (PSGF), Greenfield titanium (TGF), and the investigational stent cone filter (NGF)-were studied for 60 days in 12 sheep. Radiographic and pathologic outcomes to be assessed included clot capture and resolution, vena caval penetration, position of the filter, thrombogenicity, and vessel wall reaction.Results: Filters differed with respect to the number of clot-trapping levels and the interdependence of the legs. All devices were successfully placed. Intentionally embolized clot was captured. One VT and two SN filters migrated in response to clot capture. Resolution of thrombus was variable, and related to the design of the device. Fibrin webbing was widely present with the VT, BN, and SN filters but limited in the others. The VT and NGF filters demonstrated the most stable filter base diameter.Conclusions: The performance of vena caval filters differs with respect to clot resolution and mechanical stability. Interdependent filter limbs and single-stage conical capture sites appear to result in more favorable performance in in vivo studies.

  13. [Inferior alveolar nerve repositioning in implant surgery].

    PubMed

    Ardekian, L; Salnea, J; Abu el-Naaj, I; Gutmacher, T; Peled, M

    2001-04-01

    Severe resorption of the posterior mandible possesses one of the most difficult restorative challenges to the implant surgery today. This resorption may prevent the placement of dental implants without the potentially damage to the inferior alveolar nerve. To create the opportunity of insertion dental implants of adequately length in those cases, the technique of nerve repositioning has been advocated. The purpose of this article is to describe two cases of nerve repositioning combined with placement of dental implants. Both cases showed appropriate postoperative healing without damage to the inferior alveolar nerve. The inferior alveolar nerve repositioning technique seems to be an acceptable alternative to augmentation procedure prior to dental implants placement in cases exhibiting atrophic posterior mandibular ridges. PMID:11494807

  14. Lateralization Technique and Inferior Alveolar Nerve Transposition

    PubMed Central

    Sanches, Marco Antonio; Ramalho, Gabriel Cardoso; Manzi, Marcello Roberto

    2016-01-01

    Bone resorption of the posterior mandible can result in diminished bone edge and, therefore, the installation of implants in these regions becomes a challenge, especially in the presence of the mandibular canal and its contents, the inferior alveolar nerve. Several treatment alternatives are suggested: the use of short implants, guided bone regeneration, appositional bone grafting, distraction osteogenesis, inclined implants tangential to the mandibular canal, and the lateralization of the inferior alveolar nerve. The aim was to elucidate the success rate of implants in the lateralization technique and in inferior alveolar nerve transposition and to determine the most effective sensory test. We conclude that the success rate is linked to the possibility of installing implants with long bicortical anchor which favors primary stability and biomechanics. PMID:27433360

  15. Anatomy of Inferior Mesenteric Artery in Fetuses.

    PubMed

    Nuzhat, Ayesha

    2016-01-01

    Aim. To analyze Inferior Mesenteric Artery in fetuses through its site of origin, length, diameter, and variation of its branches. Method. 100 fetuses were collected from various hospitals in Warangal at Kakatiya Medical College in Andhra Pradesh, India, and were divided into two groups, group I (second-trimester fetuses) and group II (third-trimester fetuses), followed by dissection. Result. (1) Site of Origin. In group I fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra in 33 out of 34 fetuses (97.2%). In one fetus it was at first lumbar vertebra, 2.8%. In all group II fetuses, origin of Inferior Mesenteric Artery was at third lumbar vertebra. (2) Length. In group I fetuses it ranged between 18 and 30 mm, average being 24 mm except in one fetus where it was 48 mm. In group II fetuses the length ranged from 30 to 34 mm, average being 32 mm. (3) Diameter. In group I fetuses it ranged from 0.5 to 1 mm, and in group II fetuses it ranged from 1 to 2 mm, average being 1.5 mm. (4) Branches. Out of 34 fetuses of group I, 4 fetuses showed variation. In one fetus left colic artery was arising from abdominal aorta, 2.9%. In 3 fetuses, Inferior Mesenteric Artery was giving a branch to left kidney, 8.8%. Out of 66 fetuses in group II, 64 had normal branching. In one fetus left renal artery was arising from Inferior Mesenteric Artery, 1.5%, and in another fetus one accessory renal artery was arising from Inferior Mesenteric Artery and entering the lower pole of left kidney. Conclusion. Formation, course, and branching pattern of an artery depend on development and origin of organs to attain the actual adult position. PMID:27313956

  16. Outcomes of Unilateral Inferior Oblique Myectomy Surgery in Inferior Oblique Overaction Due to Superior Oblique Palsy

    PubMed Central

    Yumuşak, Erhan; Yolcu, Ümit; Küçükevcilioğlu, Murat; Diner, Oktay; Mutlu, Fatih Mehmet

    2016-01-01

    Objectives: To present the outcomes of unilateral inferior oblique myectomy performed in patients with inferior oblique overaction due to superior oblique palsy. Materials and Methods: Twenty-seven eyes of 27 patients that underwent inferior oblique myectomy surgery for superior oblique palsy between 2002 and 2008 were included. Inferior oblique overaction scores (between 0-4) at preoperative, early postoperative (within 1 week after surgery) and late postoperative (earliest 6 months) visits were reviewed. Results: There were 12 male and 15 female patients. Eighteen were operated on the right eye, and 9 were operated on the left eye. The mean age was 15.62±13.31 years, and the mean follow-up was 17±11.28 months (range, 6-60 months). Patients who had horizontal component and V-pattern deviation were excluded. Preoperative and early postoperative inferior oblique overaction scores were 2.55±0.75 and 0.14±0.36, respectively, and the difference was statistically significant (p<0.01). This improvement was maintained up to the late postoperative period. Conclusion: Due to its promising short-term and long-term results, inferior oblique myectomy can be the first choice of surgery for inferior oblique overaction due to superior oblique palsy. PMID:27800253

  17. [Liver failure in a 27 years old female patient].

    PubMed

    Gertsch, T; Pfammatter, T; Braun, M; Hechelhammer, L; Meyenberger, C; Semela, D; Sawatzki, M

    2012-08-01

    We report about a 27-years old female patient with acute liver failure due to an acute Budd Chiari Syndrom (thrombosis of all three liver veins an vena cava inferior) with caval web, birth control pills and after long distance flight. After successfull aspiration of the caval thrombus and dilatation of caval web liver transplantation could be bypassed. Two weeks after intervention the patient was in a good healthy condition with normal laboratory values, normal liver size, normal perfusion of the V. cava inferior and signs of reperfusion of the middle liver vein. PMID:22878949

  18. Concurrent cranial mediastinal Blastomyces granuloma and carcinoma with cranial vena caval syndrome in a dog

    PubMed Central

    Evans, Natashia A.; Viviano, Katrina R.

    2015-01-01

    This report describes an unusual progression of blastomycosis in a dog with concurrent mediastinal carcinoma. The dog was evaluated for respiratory distress. Diagnostic results revealed chylothorax and a cranial vena caval thrombus. Histopathology of the cranial mediastinal mass diagnosed mediastinal carcinoma and fungal granuloma. Intercurrent disease may complicate the clinical presentation and clinical course of blastomycosis. PMID:26538674

  19. Endovascular Treatment of Ruptured Abdominal Aortic Aneurysm with Aortocaval Fistula

    SciTech Connect

    Guzzardi, Giuseppe Fossaceca, Rita; Divenuto, Ignazio; Musiani, Antonello; Brustia, Piero; Carriero, Alessandro

    2010-08-15

    Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA). We report the endovascular repair of an AAA rupture into the inferior vena cava. A 78-year-old woman was admitted to our hospital for acute hypotension. She presented with a pulsatile abdominal mass and became rapidly anuric. Abdominal computed tomography (CT) showed an AAA rupture into the inferior vena cava. The features of the AAA made it suitable for endovascular repair. To prevent pulmonary embolism caused by the presence of sac thrombosis near the vena cava lumen, a temporary vena cava filter was deployed before the procedure. A bifurcated stent-graft was placed with the patient under local anaesthesia, and the AAA was successfully treated. A transient type II endoleak was detected on CT 3 days after endograft placement. At routine follow-up 6 and 12 months after the procedure, the patient was in good clinical condition, and the type II endoleak had sealed completely. Endovascular treatment offers an attractive therapeutic alternative to open repair in case of ACF; however, only small numbers of patients have been treated, and long-term follow-up interval is lacking.

  20. Multidirectional Instability Accompanying an Inferior Labral Cyst

    PubMed Central

    Ji, Jong-Hun; Kim, Sung-Jae

    2010-01-01

    Paralabral cyst of the shoulder joint can be observed in 2% to 4% of the general population, particularly in men during the third and fourth decade. On average, these cysts measure 10 mm to 20 mm in diameter and are located preferentially on the postero-superior aspect of the glenoid. The MRI has increased the frequency of the diagnosis of paralabral cysts of the shoulder joint. Paralabral cysts of the shoulder joint usually develop in the proximity of the labrum. The relationship between shoulder instability and labral tears is well known, however, the association of shoulder instability with a paralabral cyst is rare. Shoulder instability may cause labral injury or labral injury may cause shoulder instability, and then injured tear develops paralabral cyst. In our patient, the inferior paralabral cyst may be associated with inferior labral tears and instability MRI. PMID:20514270

  1. A case of May-Thurner syndrome with inconsistent radiological and surgical findings.

    PubMed

    Akin, Fatih; Aygun, Serhat; Gormus, Niyaziv; Kar, Yeter Duzenli; Susam, Hanife Tugce; Ozel, Ahmet

    2015-03-23

    May-Thurner syndrome is the result of compression of the left common iliac vein between the right common iliac artery and the overlying vertebrae. In this case report, we describe an 11-year-old boy presenting with swelling of the left lower extremity. An iliac MR venography showed compression of the left proximal iliac vein between the vertebra and the left iliac artery. In surgery, it was seen that the left common iliac vein was connected to the postero-inferior part of the inferior vena cava, and it was compressed between the right common iliac artery and the columna vertebralis, which was inconsistent with the radiological findings. An interposition of the great saphenous vein graft between the left common iliac vein and the inferior vena cava was made, with a successful outcome. Our case is interesting in that it showed inconsistent findings between the radiological images and surgery.

  2. Abnormal branch of the testicular artery.

    PubMed

    Bhaskar, P Vijaya; Bhasin, Vishu; Kumar, Sushil

    2006-09-01

    We present a case report of an abnormal course and branching of the right testicular artery, which was uncovered during routine dissection of the abdomen in our first year medical class. It arose from the anterior surface of the abdominal aorta and immediately divided into two branches; one branch coursed inferiorly behind the inferior vena cava as the testicular artery proper, while the other branch passed behind the inferior vena cava and emerged on the anterior surface of the right kidney. After crossing the anterior surface of the kidney, it bifurcated into an ascending branch that went to the right suprarenal gland and a descending branch that ended in the posterior abdominal wall. The left testicular artery was normal in its course and distribution. This is a very rare variation.

  3. Pulmonary hypertension in patient with elevated homocystein level and blast injuries.

    PubMed

    Zuljević, Ervin; Redzepi, Gzim; Plestina, Sanja; Vidjak, Vinko; Loncarić, Vlasta; Jakopović, Marko; Samarzija, Miroslav

    2009-03-01

    38-year-old man had chronic deep venous thrombosis (DVT) as a result of multiple injuries caused by an explosion of grenade 12 years ago, with recurrent pulmonary thromboembolisms and pulmonary hypertension which was unrecognized for a decade. Patient was admitted with a progressive dyspnea and exercise intolerance (NYHA II). The diagnosis was established according to clinical symptoms, transthoracic echocardiography, phlebography, lung scintigraphy and pulmonary angiography. Oral anticoagulant therapy was introduced and cava filter indicated to implant. During phlebography a floating thrombus was found in the inferior cava vein underneath renal vein. Implantation was delayed and patient received systemic fibrinolytic therapy with streptokinase (7500 000 UI within 4 days), followed by heparin infusion and warfarin. Post-fibrinolytic phlebography showed clear lumen of inferior vena cava. Fibrinolysis had also affected pulmonary hypertension-systolic pressure in the right ventricle measured by Doppler echocardiography decreased from 90 to 65 mmHg. Permanent intravenous cava filter was implanted. PMID:19408648

  4. Maxillary antral lavage using inferior meatal cannula anaesthesia.

    PubMed

    Mochloulis, G; Hern, J D; Hollis, L J; Tolley, N S

    1996-08-01

    Antral puncture and lavage through the inferior meatus is a minor but common otolaryngological procedure, usually performed under local anaesthesia. We describe a new method of introducing local anaesthetic into the inferior meatus, via the use of a soft intravenous cannula connected to a syringe containing 10 per cent cocaine paste. We have called this new technique inferior meatal cannula anaesthesia (IMCA).

  5. Inferior alveolar and lingual nerve imaging.

    PubMed

    Miloro, Michael; Kolokythas, Antonia

    2011-03-01

    At present, there are no objective testing modalities available for evaluation of iatrogenic injury to the terminal branches of the trigeminal nerve, making such clinical diagnosis and management complicated for the oral and maxillofacial surgeon. Several imaging modalities can assist in the preoperative risk assessment of the trigeminal nerve as related to commonly performed procedures in the vicinity of the nerve, mostly third molar surgery. This article provides a review of all available imaging modalities and their clinical application relative to preoperative injury risk assessment of the inferior alveolar nerve and lingual nerve, and postinjury and postsurgical repair recovery status.

  6. Spanish sparkling wines (Cavas) as inhibitors of in vitro human low-density lipoprotein oxidation.

    PubMed

    Satué-Gracia, M T; Andrés-Lacueva, C; Lamuela-Raventós, R M; Frankel, E N

    1999-06-01

    Forty-seven dealcoholized sparkling wines (cava) from the Penedès area in Spain were tested for their antioxidant activity in a low-density lipoprotein system. The effect of different quality-related parameters, such as harvest year or grape variety, was investigated. Twenty-two phenolic compounds were separated by high-performance liquid chromatography and identified by comparing their retention time and their ultraviolet spectra with those of pure standards. When tested at the same total phenol concentration, the antioxidant activity of these white sparkling wines was found to be similar to that reported for red wines. This activity was positively correlated with the total phenolic content, trans-caffeic acid, coumaric acid, protocatechuic acid, and quercetin 3-glucuronide. The wines made of the classic cava wine coupage had superior antioxidant activity compared to those of other cultivars.

  7. An Experimental and Computational Study on the Effect of Caval Valved Stent Oversizing.

    PubMed

    Ismail, Munirah; Kumar, Gideon Praveen; Kabinejadian, Foad; Nguyen, Yen Ngoc; Cui, Fangsen; Tay, Edgar Lik Wui; Leo, Hwa Liang

    2016-09-01

    Heterotopic implantation of transcatheter tricuspid valve is a new treatment option for tricuspid regurgitation. Transcatheter tricuspid valves are implanted onto the cavoatrial junction in order to avoid the challenging task of anchoring the valve onto the complex tricuspid valve annulus. However, little is known about optimum extent of oversizing of the valved stent in a vena cava. In this study, we implanted valves of the same diameter onto the larger sized inferior vena cava (IVC) and a smaller sized superior vena cava (SVC). The valve in the IVC was oversized by 10.7% while the valve in the SVC was oversized by 21.6%. Finite element analysis was performed (i) to assess the strain on the nitinol stent during manufacturing and deployment; (ii) the stents were deployed in a patient-specific vena cava model and the intramural stress of the vena cava was calculated computationally. These valves were fabricated and placed in a silicone model of a patient-specific right atrium which was part of a mock circulatory system that emulated the patho-physiological flow rate and pressure of a patient with tricuspid regurgitation. Flow measurements were conducted by particle image velocimetry (PIV). It was found that the maximum crimping strain on the nitinol stent was 6.85% which was lower than the critical threshold of 10%. The maximum stress on the vena cava was located at the spot where the hooks met the wall. The maximum stress on the IVC was 0.5098 MPa while the maximum stress on the SVC was 0.7 MPa. The maximum Reynolds shear stress (mRSS) in the vena cava was found to be higher in the IVC than SVC with the highest mRSS being 1741 dynes/cm(2) found in the region of high flow during the peak flow phase. The overtly oversized valve in the SVC did not cause flow disturbances and exhibited mostly laminar flows. The mRSS at the downstream of the vena cava valve and the middle of the atrium remained at low magnitudes. However, velocity fluctuations were high in the IVC in

  8. First evidence that Ecklonia cava-derived dieckol attenuates MCF-7 human breast carcinoma cell migration.

    PubMed

    Kim, Eun-Kyung; Tang, Yujiao; Kim, Yon-Suk; Hwang, Jin-Woo; Choi, Eun-Ju; Lee, Ji-Hyeok; Lee, Seung-Hong; Jeon, You-Jin; Park, Pyo-Jam

    2015-04-01

    We investigated the effect of Ecklonia cava (E. cava)-derived dieckol on movement behavior and the expression of migration-related genes in MCF-7 human breast cancer cell. Phlorotannins (e.g., dieckol, 6,6'-biecko, and 2,7″-phloroglucinol-6,6'-bieckol) were purified from E. cava by using centrifugal partition chromatography. Among the phlorotannins, we found that dieckol inhibited breast cancer cell the most and was selected for further study. Radius™-well was used to assess cell migration, and dieckol (1-100 µM) was found to suppress breast cancer cell movement. Metastasis-related gene expressions were evaluated by RT-PCR and Western blot analysis. In addition, dieckol inhibited the expression of migration-related genes such as matrix metalloproteinase (MMP)-9 and vascular endothelial growth factor (VEGF). On the other hand, it stimulated the expression of tissue inhibitor of metalloproteinase (TIMP)-1 and TIMP-2. These results suggest that dieckol exerts anti-breast cancer activity via the regulation of the expressions of metastasis-related genes, and this is the first report on the anti-breast cancer effect of dieckol. PMID:25830682

  9. Surgical anatomy of the retroperitoneal spaces, Part III: Retroperitoneal blood vessels and lymphatics.

    PubMed

    Mirilas, Petros; Skandalakis, John E

    2010-02-01

    In this article, we discuss the surgical anatomy of the blood vessels and the lymphatic vessels and lymph nodes found in the retroperitoneum. Retroperitoneal blood vessels include the aorta and all its branches--parietal and visceral--from the diaphragm to the pelvis, and the inferior vena cava and its tributaries. The retroperitoneal lymphatics form a very rich and extensive chain. As a general rule, lymphatics follow the arteries and named lymph nodes are found at the root of the arteries. Retroperitoneal nodes of the abdomen comprise the inferior diaphragmatic nodes and the lumbar nodes. The latter are classified as left lumbar (aortic), intermediate (interaorticovenous), and right lumbar (caval). These nodes surround the aorta and the inferior vena cava. Around the aorta lie the paraortic nodes, preaortic nodes (include celiac, superior mesenteric, inferior mesenteric nodes collecting lymph from the splanchna supplied by the homonymous arteries), and retroaortic nodes. Similarly, around the vena cava lie the paracaval, precaval, and retrocaval nodes. Pelvic nodes include the common iliac, external and internal iliac, obturator, and sacral nodes.

  10. Morphological study of the innervation pattern of the rabbit sinoatrial node

    NASA Technical Reports Server (NTRS)

    Roberts, L. A.; Slocum, G. R.; Riley, D. A.

    1989-01-01

    The pattern of sinoatrial (SA) node innervations in rabbit was elucidated using a newly developed highly reproducible cholinesterase/silver impregnation staining procedure which made it possible to delineate large nerves, fine processes, and ganglion cells. The SA node and dominant pacemaker sites were identified by microelectrode recording. A generalized pattern of innnervation was recognized, which includes a large ganglionic complex inferior to the SA node; two or more moderately large nerves traversing the SA node parallel to the crista terminalis; nerves entering the intercaval region from the septum, the superior vena cava, and the inferior vena cava to impinge on the SA node; and a fine network of nerve processes, which was particularly dense in the SA node. From the location and distribution of the nerves and ganglionic branches, it can be inferred that the neural network in the intercaval region is capable of performing complex modulatory and integrative functions among the structures within this region.

  11. [Clinical and echocardiographic characteristics of scimitar syndrome].

    PubMed

    Espinola-Zavaleta, Nilda; Játiva-Chávez, Silvio; Muñoz-Castellanos, Luis; Zamora-González, Carlos

    2006-03-01

    Seven patients with scimitar syndrome underwent retrospective clinical and echocardiographic examination. The findings were: respiratory infection with dyspnea on moderate exercise in 90%, scimitar sign in four (57%), dextrocardia in five (71%), and interatrial septal defect in five (71%), one of whom had patent ductus arteriosus. Overall, two patients had patent ductus arteriosus: one also had aortic coarctation and the other, a bicuspid aortic valve. Dilation of the right cavities was found in five (71%) and blunt edge in five (71%). In two patients, anomalous drainage was into the right atrium; in another two, into the inferior vena cava; and in three, towards the junction of the right atrium and the inferior vena cava. In three patients, drainage was obstructed. Six patients with cardiac abnormalities proceeded to surgery. Scimitar syndrome is a rare entity. In the large majority of patients (86%), diagnosis and follow-up can be performed echocardiographically.

  12. Ascites Due to Anastomotic Stenosis After Liver Transplantation Using the Piggyback Technique: Treatment with Endovascular Prosthesis

    SciTech Connect

    Bilbao, Jose Ignacio; Herrero, Jose Ignacio; Martinez-Cuesta, Antonio; Quiroga, Jorge; Pueyo, Jesus Ciro; Vivas, Isabel; Delgado, Carlos; Pardo, Fernando

    2000-03-15

    Liver transplantation preserving the retrohepatic inferior vena cava, the so-called piggyback technique, is becoming more frequently used because it avoids caval cross-clamping during the anhepatic phase of surgery. However, hepatic venous outflow blockade causing ascites seems to be less infrequent after piggyback than with cavo-caval anastomosis. We report a 62-year-old patient who underwent liver transplantation using the piggyback technique and developed a stenosis in the anastomosis between the hepatic veins and the inferior vena cava leading to severe postoperative ascites. Ascites was unresponsive to diuretic therapy and was associated with renal function impairment. Since the etiology of the stenosis was mechanical (torsion), percutaneous transluminal angioplasty was unsuccessful. Finally, an autoexpandable prosthesis was placed across the anastomosis resulting in rapid and permanent (3 years of follow-up) resolution of ascites.

  13. [Treatment of renal vein thrombosis associated with nephrotic syndrome].

    PubMed

    Funami, M; Takaba, T; Tanaka, H; Murakami, A; Kadokura, M; Hori, G; Ishii, J

    1988-06-01

    Renal vein thrombosis is a rare entity in which true incidence is unknown. The disease occurs most frequently in patients with nephrotic syndrome, but it also can occur in the presence of other hypercoagulable state. Two cases of renal vein thrombosis with nephrotic syndrome which were treated by thrombectomy are reported here. One patient was successfully treated by renal vein and inferior vena cava thrombectomy before developing severe pulmonary embolism. The other was treated by renal vein thrombectomy by which fatal shock was able to be prevented. In those cases, immediate operation was indicated, primarily to prevent additional, possibly fatal, pulmonary embolism and also to improve perfusion of the kidney. In the hope of salvaging the kidney, thrombectomy may be the treatment of choice for acute renal vein thrombosis, complication of pulmonary embolism and inferior vena cava thrombosis, right renal vein thrombosis without collateral flow and acute renal vein thrombosis with shock.

  14. Budd-Chiari syndrome as an initial presentation of hepatocellular carcinoma: a case report.

    PubMed

    Bălăceanu, Lavinia Alice; Diaconu, Camelia Cristina; Aron, Gheorghiţa

    2014-06-01

    We report the case of a 84-year-old admitted with symptoms of congestive heart failure. Ultrasonography revealed a hyperechoic nodule in the left lobe of the liver, with a peripheral hypoechoic rim, multiple irregular hypoechoic nodules in both hepatic lobes, portal vein, inferior vena cava, and right atrium thrombosis. On ultrasonographic and alpha-fetoprotein criteria the case was interpreted as hepatocellular carcinoma with Budd-Chiari syndrome. The particularity of the case is the initial presentation of the hepatocellular carcinoma as Budd-Chiari syndrome. The inferior vena cava and right atrium thrombosis, as a cause of secondary Budd-Chiari syndrome in a patient with hepatocellular carcinoma, has been rarely reported.

  15. Cardiovascular Surgery in the Management of Malignant Renal Neoplasms: Survey of 187 Cases in the Literature

    PubMed Central

    Schechter, David Charles

    1983-01-01

    Transmural or endovascular invasion of regional veins is often a characteristic of malignant renal neoplasms. Tumor thrombus that ascends in the inferior vena cava and sometimes invades the heart seldom adheres to intima. Radical surgical management of malignant renal neoplasms necessitates concomitant extraction of tumor thrombus. This may be achieved by cavotomy alone, but often resection of portions of the suprarenal inferior vena cava (either partial mural cavectomy, or circumferential cavectomy) is also required. Atriotomy is mandatory whenever intracardiac tumor thrombus exists. Most of the 187 reported operations for venous extension related to malignant renal neoplasms were done in the past decade. Technical problems have included embolism, hemorrhage, and incomplete removal. Because the left kidney is endowed with vast collateral venous channels, right nephrectomy and suprarenal caval interruption are usually well tolerated. Conversely, since the right kidney lacks venous collaterals, survival after left nephrectomy and suprarenal cavectomy hinges on creation of a shunt to divert venous outflow from the remaining kidney. PMID:15227133

  16. Intravenous leiomyomatosis: a rare cause of intracardiac mass.

    PubMed

    Cruz, Inês; João, Isabel; Stuart, Bruno; Iala, Mário; Bento, Luísa; Cotrim, Carlos; Nobre, Angelo; Pereira, Hélder

    2014-11-01

    Intravenous leiomyomatosis is an unusual clinical condition characterized by histologically benign smooth muscle lesions extending from the uterus into pelvic and systemic veins and, more rarely, into the right cardiac chambers. We report the case of a 45-year-old woman who presented with a three-week history of dyspnea on exertion, shortness of breath and fatigue. Echocardiography showed a large mobile mass in the right atrium prolapsing into the right ventricle and extending to the inferior vena cava. A computed tomography scan revealed a large mass extending from the right atrium to the inferior vena cava and through the systemic veins as far as the popliteal veins. A presumptive diagnosis of large thrombus was made; the correct diagnosis of intravenous leiomyomatosis with intracardiac involvement was obtained only after surgical resection and histologic examination.

  17. A case report of an intracaval extrathoracic solitary fibrous tumour

    PubMed Central

    Tiong, HY; Wang, S; Madhavan, K

    2013-01-01

    Solitary fibrous tumours are infrequent neoplasms based in the pleura that are predominantly benign with malignant pathology and behaviour described in 10–36% of cases. Extrathoracic solitary fibrous tumours (ESFTs) have been considered separately to their intrathoracic counterparts and comprise a third of all solitary fibrous tumours. The extrathoracic location was identified as an adverse prognostic factor for local recurrence but not for metastatic disease. So far, there have not been any reports of solitary fibrous tumours demonstrating caval infiltration. We present a case of a benign ESFT infiltrating into the perirenal inferior vena cava. Together with extrauterine leiomyomas, ESFTs should also be considered as a differential diagnosis for the rare benign lesions invading the inferior vena cava. PMID:23676804

  18. Uterus transplantation model in sheep with heterotopic whole graft and aorta and cava anastomoses.

    PubMed

    Gonzalez-Pinto, I M; Tryphonopoulos, P; Avison, D L; Nishida, S; Tekin, A; Santiago, S; Tzakis, A G

    2013-06-01

    Uterine transplantation in the sheep model has been described as a partial or whole orthotopic graft from a living donor with vascular anastomoses. As an alternative to surrogate pregnancy or adoption uterus transplantation might be indicated for cases of infertility of uterine origin. The main complications might be rejection and thrombosis. The objective of this work was to develop a model of whole uterus transplantation that was applicable to the human setting, using grafts obtained from brain-dead donors, and suitable for immunologic and viability follow-up with a reduced risk of thrombosis. Two donors and 1 recipient were operated. The first graft was used for an anatomic study; the second was used for transplantation. The donor operation consisted of an en bloc harvest of the uterus, adnexa, and proximal vagina with the distal aorta and cava. After harvest the donor sheep was humanely killed. In the recipient ewe, heterotopic implantation was performed in the lower abdomen. An End-to-side anastomoses of aorta and cava were performed below the recipient's renal vessels. A cutaneous vaginal stoma was performed in the right lower quadrant. The recipient ewe was humanely killed for an autopsy study. The anatomy of uterine veins of the ewe differs from the human. The uterine and ovarian veins join, forming the utero-ovarian vein, which drains at the confluence of the common iliac to the cava. En bloc harvesting allows for rapid graft preparation, with vascular cuffs easily anastomosed with a low risk of thrombosis. The vaginal stoma seems appropriate to facilitate follow-up and graft biopsy. This approach can be a suitable experimental model applicable to humans using grafts from brain-dead donors. PMID:23769047

  19. On-and offshore tephrostratigraphy and -chronology of the southern Central American Volcanic Arc (CAVA)

    NASA Astrophysics Data System (ADS)

    Schindlbeck, J. C.; Kutterolf, S.; Hemming, S. R.; Wang, K. L.

    2015-12-01

    Including the recently drilled CRISP sites (IODP Exp. 334&344) the deep sea drilling programs have produced 69 drill holes at 29 Sites during 9 Legs at the Central American convergent margin, where the Cocos plate subducts beneath the Caribbean plate. The CAVA produced numerous plinian eruptions in the past. Although abundant in the marine sediments, information and data regarding large late Cenozoic explosive eruptions from Costa Rica, Nicaragua, Honduras, El Salvador, and Guatemala remain very sparse and discontinuous on land. We have established a tephrostratigraphy from recent through Miocene times from the unique archive of ODP/IODP sites offshore Central America in which we identify tephra source regions by geochemical fingerprinting using major and trace element glass shard compositions. Here we present first order correlations of ­~500 tephra layers between multiple holes at a single site as well as between multiple sites. We identified ashes supporting Costa Rican (~130), Nicaraguan (17) and Guatemalan (27) sources as well as ~150 tephra layers from the Galápagos hotspot. Within our marine record we also identified well-known marker beds such as the Los Chocoyos tephra from Atitlán Caldera in Guatemala and the Tiribi Tuff from Costa Rica but also correlations to 15 distinct deposits from known Costa Rican and Nicaraguan eruptions within the last 4.1 Ma. These correlations, together with new radiometric age dates, provide the base for an improved tephrochronostratigraphy in this region. Finally, the new marine record of explosive volcanism offshore southern CAVA provides insights into the eruptive history of long-living volcanic complexes (e.g., Barva, Costa Rica) and into the distribution and frequency of large explosive eruptions from the Galápagos hotspot. The integrated approach of Ar/Ar age dating, correlations with on land deposits from CAVA, biostratigraphic ages and sediment accumulation rates improved the age models for the drilling sites.

  20. Extravasation of parenteral alimentation fluid into the renal pelvis--a complication of central venous catheter in a neonate.

    PubMed

    Nadroo, A M; al-Sowailem, A M

    2001-01-01

    Many complications of central venous catheters, which include perforation of the vessel walls and extravasation of the infusate into pericardial, pleural, and peritoneal cavities, have been reported. We report an infant with a central venous catheter in inferior vena cava who experienced extravasation of parenteral alimentation fluid into the right renal pelvis secondary to perforation of the renal vein. To our knowledge, this rare complication has not been reported earlier.

  1. Advanced testicular cancer presenting with phlegmasia cerulea dolens

    PubMed Central

    Mulatero, C; Brogan, G; Oliver, R

    2000-01-01

    A case of fulminating deep venous thrombosis secondary to invasion of the inferior vena cava is described in a 45 year old man presenting with a germ cell tumour. Despite aggressive supportive care and emergency chemotherapy his late presentation caused his death. The case highlights the necessity for increased public education of the attendant risks in delayed presentation with a testicular lump.


Keywords: phlegmasia cerulea dolens; testicular carcinoma PMID:10727571

  2. Gonadal vein tumor thrombosis due to renal cell carcinoma.

    PubMed

    Haghighatkhah, Hamidreza; Karimi, Mohammad Ali; Taheri, Morteza Sanei

    2015-01-01

    Renal cell carcinoma (RCC) had a tendency to extend into the renal vein and inferior vena cava, while extension into the gonadal vein has been rarely reported. Gonadal vein tumor thrombosis appears as an enhancing filling defect within the dilated gonadal vein anterior to the psoas muscle and shows an enhancement pattern identical to that of the original tumor. The possibility of gonadal vein thrombosis should be kept in mind when looking at an imaging study of patients with RCC.

  3. 18F-fluorodeoxyglucose positron emission tomography-computed tomography finding of left gonadal vein thrombosis in a case of renal cell carcinoma.

    PubMed

    Narayan, Ravishwar; Ravishankar, Uma; Natarajan, Savita; Vohra, Sandeep

    2016-01-01

    Tumor thrombus from renal cell carcinoma is commonly reported in renal vein and inferior vena cava with a few reports of gonadal vein involvement. Here, we report a case of an elderly female who underwent fluorodeoxyglucose (FDG) positron emission tomography-computed tomography scan for initial staging of left renal cell carcinoma. Along with an FDG avid left renal mass lesion, scan also revealed FDG avid tumor thrombus in the entire length of the left gonadal vein.

  4. Hemoptysis Complicating Scimitar Syndrome: From Diagnosis to Treatment

    SciTech Connect

    Nedelcu, Cosmina; Carette, Marie-France; Parrot, Antoine; Hammoudi, Nadjib; Marsault, Claude; Khalil, Antoine

    2008-07-15

    We report the case of a 24-year-old patient with known scimitar syndrome presenting with hemoptysis. Multidetector CT angiography showed the scimitar vein draining the right lung to the inferior vena cava associated with right lower lobe bronchopulmonary sequestration. The presence of hemoptysis associated with scimitar syndrome is likely secondary to an anomalous systemic arterial blood supply. We treated this patient successfully with transcatheter occlusion of the anomalous feeding arterial vessels.

  5. Arteriovenous fistula complicating iliac artery pseudo aneurysm: diagnosis by CT angiography.

    PubMed

    Huawei, L; Bei, D; Huan, Z; Zilai, P; Aorong, T; Kemin, C

    2002-01-01

    Fistula formation to the inferior vena cava is a rare complication of aortic aneurysm which is often misdiagnosed clinically. In one hundred of reported arteriocaval fistulae, none was originating from the right common iliac artery. We report a case of ileo-caval fistula due to a iatrogenic pseudoaneurysm. High resolution 3D imaging using breath-hold CT angiography is highly specific in identifying the location, extent of the aortocaval fistula as well as the neighbouring anatomic structures.

  6. Right Renal Vein Aplasia Associated With Diverted Renal Venous Drainage Through Lower Pole

    SciTech Connect

    Bozlar, Ugur; Ugurel, Mehmet Sahin; Bedir, Selahattin; Ors, Fatih; Coskun, Unsal; Aydur, Emin

    2008-07-15

    We report a unique anomalous renal venous drainage on a 25-year-old man who had congenital absence of the right renal vein and an aberrant venous drainage through the lower pole of the kidney into the inferior vena cava. To our knowledge, this anomaly has not been previously reported in the peer-reviewed literature. State-of-the-art imaging findings are presented.

  7. A unique case of venous air embolus with survival.

    PubMed

    Davare, Dafney L; Chaudry, Zishan; Sanchez, Rafael; Lee, Seong K; Kiffin, Chauniqua; Rosenthal, Andrew A; Carrillo, Eddy H

    2016-01-01

    Venous air embolus (VAE) occurs when gas, specifically atmospheric air, enters into the vascular system. Although rare, they can be fatal due to risk of cardiovascular collapse. In this report, we present a unique case of a 66-year-old female trauma patient with an inferior vena cava air embolism. An overview of the potential cause is presented, along with a review of the management of VAE. PMID:27587307

  8. Ultrasound of epigastric injuries after blunt trauma.

    PubMed

    Foley, L C; Teele, R L

    1979-04-01

    Blunt trauma to the epigastrum may result in a retroperitoneal hematoma involving the head of the pancreas and descending duodenum. Secondary effects include obstruction of the gastric outlet, obstruction of the biliary tree, and extrinsic compression of the inferior vena cava. Four patients with epigastric trauma were reviewed who had been examined by ultrasound of the abdomen. Ultrasound showed the extent of the retroperitoneal hematoma, its effect on contiguous organs, and was helpful in clinical management.

  9. Unusual primary locations of hydatid disease. Case report.

    PubMed

    Manouras, A J; Tzardis, P J; Katergiannakis, V A; Apostolidis, N S

    1989-03-01

    Two unusual cases of primary hydatid disease are described. In one of them a retroperitoneal cyst, presenting as a palpable abdominal mass, was strongly adherent to the inferior vena cava and dislocated the right kidney. Partial cystectomy and drainage were performed. The other cyst, of the right ischiorectal fossa, was initially misinterpreted as a perineal of sciatic hernia. It was completely removed. No other site of hydatid disease was found and the patients remain well 3 and 4 years postoperatively.

  10. A unique case of venous air embolus with survival

    PubMed Central

    Davare, Dafney L.; Chaudry, Zishan; Sanchez, Rafael; Lee, Seong K.; Kiffin, Chauniqua; Rosenthal, Andrew A.; Carrillo, Eddy H.

    2016-01-01

    Venous air embolus (VAE) occurs when gas, specifically atmospheric air, enters into the vascular system. Although rare, they can be fatal due to risk of cardiovascular collapse. In this report, we present a unique case of a 66-year-old female trauma patient with an inferior vena cava air embolism. An overview of the potential cause is presented, along with a review of the management of VAE. PMID:27587307

  11. Epithelioid angiomyolipoma: imaging appearances.

    PubMed

    Bharwani, N; Christmas, T J; Jameson, C; Moat, N; Sohaib, S A

    2009-12-01

    Epithelioid angiomyolipoma is a recently described rare variant of renal angiomyolipoma. It can occur in patients with or without tuberous sclerosis, and may potentially be malignant. We report the imaging findings from two cases of epithelioid angiomyolipoma: the first in a patient with tuberous sclerosis complex, arising in a horse-shoe kidney and growing into the inferior vena cava and right atrium; the second in a 62-year-old hypertensive man.

  12. Progressive limb ataxia following inferior olive lesions

    PubMed Central

    Horn, K M; Deep, A; Gibson, A R

    2013-01-01

    Cerebellar climbing fibres originate in the inferior olive (IO). Temporary IO inactivation produces movement deficits. Does permanent inactivation produce similar deficits and, if so, do they recover? The excitotoxin, kainic acid, was injected into the rostral IO of three cats. Behaviour was measured during reaching and locomotion. Two cats were injected during the reaching task. Within minutes, grasping became difficult and the trajectories of the reaches showed higher arcing than normally seen. During locomotion, both cats showed head and trunk deviation to the injected side, walking paths curved to the injected side, and the paws were lifted higher than normal. Limbs contralateral to the injections became rigid. Within 1 day, posture had normalized, locomotion was unsteady and high lifting of the paws had reversed to a tendency to drag the dorsum of the paws. Passive body movement produced vestibular signs. Over a few days, locomotion normalized and vestibular signs disappeared. Reach trajectories were normal but grasping deficits persisted. Over the first week, the amplitude of limb lift during reaching and locomotion began to increase. The increase continued over time and, after several months, limb movements became severely ataxic. The effects followed the somatotopy of the rostral IO: a loss of cells in medial rostral IO only affected the forelimb, whereas a loss of cells in medial and lateral IO affected both forelimb and hindlimb. Deficits produced by IO lesions involve multiple mechanisms; some recover rapidly, some appear stable, and some worsen over time. The nature of the progressive deficit suggests a gradual loss of Purkinje cell inhibition on cerebellar nuclear cells. PMID:23027819

  13. Transesophageal Echocardiographic Study of Decompression-Induced Venous Gas Emboli

    NASA Technical Reports Server (NTRS)

    Butler, B. D.; Morris, W. P.

    1995-01-01

    Transesophageal echo-cardiography was used to evaluate venous bubbles produced in nine anesthetized dogs following decompression from 2.84 bar after 120 min at pressure. In five dogs a pulsed Doppler cuff probe was placed around the inferior vena cava for bubble grade determination. The transesophageal echo images demonstrated several novel or less defined events. In each case where the pulmonary artery was clearly visualized, the venous bubbles were seen to oscillate back and forth several times, bringing into question the effect of coincidental counting in routine bubble grade analysis using precordial Doppler. A second finding was that in all cases, extensive bubbling occurred in the portal veins with complete extraction by the liver sinusoids, with one exception where a portal-to-hepatic venous anastomosis was observed. Compression of the bowel released copious numbers of bubbles into the portal veins, sometimes more than were released into the inferior vena cava. Finally, large masses of foam were routinely observed in the non-dependent regions of the inferior vena cava that not only delayed the appearance of bubbles in the pulmonary artery but also allowed additional opportunity for further reaction with blood products and for coalescence to occur before reaching the pulmonary microcirculation. These novel observations are discussed in relation to the decompression process.

  14. Heterotopic gastrointestinal mucosa and pancreatic tissue in a retroperitoneal tumor.

    PubMed

    Hashimoto, Naoki; Hakamada, Kenichi; Narumi, Shunji; Totsuka, Eishi; Aoki, Kazunori; Kamata, Yoshimasa; Sasaki, Mutsuo

    2006-01-01

    We believe that this is the first report of a retroperitoneal tumor consisting of heterotopic gastrointestinal mucosa and pancreatic tissue. The patient was a 19-year-old woman with the chief complaint being occasional back pain. Abdominal computerized tomography demonstrated a 3.1 x 2.5 x 3.2-cm low-density solid and cystic lesion adjoining the left renal vein between the aorta and inferior vena cava. Angiography revealed that the inferior vena cava was displaced by the hypovascular tumor. The retroperitoneal lesion was diagnosed preoperatively as a benign tumor such as a neurogenic neoplasm or lymphangioma. At laparotomy, a cystic tumor was found, which existed behind the inferior vena cava and renal vessels, and contained reddish-brown fluid, suggesting hemorrhage in the past. The cut surface of the tumor showed a unilocular cyst with partially hypertrophic wall. Histopathological examination revealed a cystic tumor lined with heterotopic gastric and duodenal mucosa, with pancreatic tissue in the muscularis propria. In addition, evidence of bleeding from the gastric mucosa was observed in the cystic tumor. External secretion from these tissues could have triggered the hemorrhage and expanded the tumor, possibly resulting in the back pain.

  15. Spatial selectivity in the temporoparietal junction, inferior frontal sulcus, and inferior parietal lobule.

    PubMed

    Hansen, Kathleen A; Chu, Carlton; Dickinson, Annelise; Pye, Brandon; Weller, J Patrick; Ungerleider, Leslie G

    2015-01-01

    Spatial selectivity, as measured by functional magnetic resonance imaging (fMRI) activity patterns that vary consistently with the location of visual stimuli, has been documented in many human brain regions, notably the occipital visual cortex and the frontal and parietal regions that are active during endogenous, goal-directed attention. We hypothesized that spatial selectivity also exists in regions that are active during exogenous, stimulus-driven attention. To test this hypothesis, we acquired fMRI data while subjects maintained passive fixation. At jittered time intervals, a briefly presented wedge-shaped array of rapidly expanding circles appeared at one of three contralateral or one of three ipsilateral locations. Positive fMRI activations were identified in multiple brain regions commonly associated with exogenous attention, including the temporoparietal junction, the inferior parietal lobule, and the inferior frontal sulcus. These activations were not organized as a map across the cortical surface. However, multivoxel pattern analysis of the fMRI activity correctly classified every pair of stimulus locations, demonstrating that patterns of fMRI activity were correlated with spatial location. These observations held for both contralateral and ipsilateral stimulus pairs as well as for stimuli of different textures (radial checkerboard) and shapes (squares and rings). Permutation testing verified that the obtained accuracies were not due to systematic biases and demonstrated that the findings were statistically significant. PMID:26382006

  16. Spatial selectivity in the temporoparietal junction, inferior frontal sulcus, and inferior parietal lobule

    PubMed Central

    Hansen, Kathleen A.; Chu, Carlton; Dickinson, Annelise; Pye, Brandon; Weller, J. Patrick; Ungerleider, Leslie G.

    2015-01-01

    Spatial selectivity, as measured by functional magnetic resonance imaging (fMRI) activity patterns that vary consistently with the location of visual stimuli, has been documented in many human brain regions, notably the occipital visual cortex and the frontal and parietal regions that are active during endogenous, goal-directed attention. We hypothesized that spatial selectivity also exists in regions that are active during exogenous, stimulus-driven attention. To test this hypothesis, we acquired fMRI data while subjects maintained passive fixation. At jittered time intervals, a briefly presented wedge-shaped array of rapidly expanding circles appeared at one of three contralateral or one of three ipsilateral locations. Positive fMRI activations were identified in multiple brain regions commonly associated with exogenous attention, including the temporoparietal junction, the inferior parietal lobule, and the inferior frontal sulcus. These activations were not organized as a map across the cortical surface. However, multivoxel pattern analysis of the fMRI activity correctly classified every pair of stimulus locations, demonstrating that patterns of fMRI activity were correlated with spatial location. These observations held for both contralateral and ipsilateral stimulus pairs as well as for stimuli of different textures (radial checkerboard) and shapes (squares and rings). Permutation testing verified that the obtained accuracies were not due to systematic biases and demonstrated that the findings were statistically significant. PMID:26382006

  17. Variant Inferior Alveolar Nerves and Implications for Local Anesthesia.

    PubMed

    Wolf, Kevin T; Brokaw, Everett J; Bell, Andrea; Joy, Anita

    2016-01-01

    A sound knowledge of anatomical variations that could be encountered during surgical procedures is helpful in avoiding surgical complications. The current article details anomalous morphology of inferior alveolar nerves encountered during routine dissection of the craniofacial region in the Gross Anatomy laboratory. We also report variations of the lingual nerves, associated with the inferior alveolar nerves. The variations were documented and a thorough review of literature was carried out. We focus on the variations themselves, and the clinical implications that these variations present. Thorough understanding of variant anatomy of the lingual and inferior alveolar nerves may determine the success of procedural anesthesia, the etiology of pathologic processes, and the avoidance of surgical misadventure.

  18. Gastrointestinal Congestion Dilates the Hepatic Artery Through the P38 MAPK Signal Transduction Pathway During Liver Transplantation.

    PubMed

    Cao, Zhongping; Tang, Xiaowen; Hou, Shike

    2016-01-01

    During the neohepatic stage of liver transplantation, hemodynamics change markedly. The current study aimed to investigate whether gastrointestinal congestion caused by inferior vena cava and hepatic portal vein clamping can dilate the hepatic artery and to determine the associated mechanisms. Ring segments of the hepatic artery were treated with the plasma from gastrointestinal congestion or the superior vena cava. The fractions in gastrointestinal congestion and the superior vena cava plasma were tested, and the effect of these fractions on the tone of the hepatic artery ring was examined. Different signal transduction blockers and different inhibitors were then used to determine the exact signal transduction pathway involved. In addition, endothelial cell structure was observed by transmission electron microscopy after treatment with the gastrointestinal congestion plasma or the superior vena cava plasma. Gastrointestinal congestion plasma contained more inflammatory cytokines than superior vena cava plasma, and these cytokines could cause hepatic artery ring dilatation. A P38 mitogen-activated protein kinase (P38 MAPK) signal transduction pathway blocker and nitric oxide (NO), prostaglandin (PGI2), nuclear factor-κB (NF-κB), and adenosine triphosphate (ATP)-sensitive K (KATP) channel inhibitors were able to significantly reverse the ring tension caused by gastrointestinal congestion plasma. The normal endothelium was also injured by treatment with gastrointestinal congestion plasma. The inflammatory cytokines in gastrointestinal congestion can cause hepatic artery ring dilatation through the P38 MAPK signal transduction pathway, and this phenomenon is also associated with NO, PGI2, NF-κB, and the KATP channel. These inflammatory cytokines can injure endothelial cells in the hepatic artery. PMID:26955003

  19. Preparative isolation and purification of phlorotannins from Ecklonia cava using centrifugal partition chromatography by one-step.

    PubMed

    Lee, Ji-Hyeok; Ko, Ju-Young; Oh, Jae-Young; Kim, Chul-Young; Lee, Hee-Ju; Kim, Jaeil; Jeon, You-Jin

    2014-09-01

    Various bioactive phlorotannins of Ecklonia cava (e.g., dieckol, eckol, 6,6-bieckol, phloroglucinol, phloroeckol, and phlorofucofuroeckol-A) are reported. However, their isolation and purification are not easy. Centrifugal partition chromatography (CPC) can be used to efficiently purify the various bioactive-compounds efficiently from E. cava. Phlorotannins are successfully isolated from the ethyl acetate (EtOAc) fraction of E. cava by CPC with a two-phase solvent system comprising n-hexane:EtOAc:methanol:water (2:7:3:7, v/v) solution. The dieckol (fraction I, 40.2mg), phlorofucofuroeckol-A (fraction III, 31.1mg), and fraction II (34.1mg) with 2,7-phloroglucinol-6,6-bieckol and pyrogallol-phloroglucinol-6,6-bieckol are isolated from the crude extract (500 mg) by a one-step CPC system. The purities of the isolated dieckol and phlorofucofuroeckol-A are ⩾90% according to high performance liquid chromatography (HPLC) and electrospray ionization multi stage tandem mass spectrometry analyses. The purified 2,7-phloroglucinol-6,6-bieckol and pyrogallol-phloroglucinol-6,6-bieckol are collected from fraction II by recycle-HPLC. Thus, the CPC system is useful for easy and simple isolation of phlorotannins from E. cava.

  20. Marine algae-mediated synthesis of gold nanoparticles using a novel Ecklonia cava.

    PubMed

    Venkatesan, Jayachandran; Manivasagan, Panchanathan; Kim, Se-Kwon; Kirthi, Arivarasan Vishnu; Marimuthu, Sampath; Rahuman, Abdul Abdul

    2014-08-01

    In the present study, we report rapid biological synthesis of gold nanoparticles (Au NPs) using a novel marine brown alga Ecklonia cava (Family: Lessoniaceae) by the reduction of chloroauric acid. The formation of Au NPs reaction was complete within 1 min at 80 °C and physiochemically characterized with different analytical techniques. FTIR spectroscopy revealed that Au NPs were functionalized with biomolecules that have primary amine group, hydroxyl group and other stabilizing functional groups. X-ray diffraction pattern showed high purity and face-centered cubic structure of Au NPs. Microscopy results showed that these Au NPs are formed with shapes like spherical and triangular with an average size of 30 ± 0.25 nm. Synthesized Au NPs showed good antimicrobial and biocompatibility with human keratinocyte cell line. Thus, physiochemical characteristic results suggest that Au NPs will have promising biomedical applications in different area such as drug delivery, tissue engineering, biosensor, etc.

  1. Cava-suprarenal line: new position for sonographic imaging of left adrenal gland.

    PubMed

    Krebs, C A; Eisenberg, R L; Ratcliff, S; Jouppi, L

    1986-09-01

    Because of overlying attenuating structures, sonographic imaging of the left adrenal gland is often difficult, especially in obese or pediatric patients. In a series of 50 consecutive patients, the left adrenal glands were examined in both the conventional right posterior oblique (RPO) position and using the new cava-suprarenal line (CSL) position. The CSL position permitted identification of the left adrenal gland in 90% of the patients; in contrast, the gland could be demonstrated in only 60% of the patients using the conventional RPO position. With the CSL position, the left adrenal gland could be imaged in half the time required with the conventional RPO position. The improved ability to demonstrate the left adrenal gland as well as the reduction in the required scanning time was particularly marked in obese and pediatric patients.

  2. A basic review on the inferior alveolar nerve block techniques

    PubMed Central

    Khalil, Hesham

    2014-01-01

    The inferior alveolar nerve block is the most common injection technique used in dentistry and many modifications of the conventional nerve block have been recently described in the literature. Selecting the best technique by the dentist or surgeon depends on many factors including the success rate and complications related to the selected technique. Dentists should be aware of the available current modifications of the inferior alveolar nerve block techniques in order to effectively choose between these modifications. Some operators may encounter difficulty in identifying the anatomical landmarks which are useful in applying the inferior alveolar nerve block and rely instead on assumptions as to where the needle should be positioned. Such assumptions can lead to failure and the failure rate of inferior alveolar nerve block has been reported to be 20-25% which is considered very high. In this basic review, the anatomical details of the inferior alveolar nerve will be given together with a description of its both conventional and modified blocking techniques; in addition, an overview of the complications which may result from the application of this important technique will be mentioned. PMID:25886095

  3. Inferior oblique muscle paresis as a sign of myasthenia gravis.

    PubMed

    Almog, Yehoshua; Ben-David, Merav; Nemet, Arie Y

    2016-03-01

    Myasthenia gravis may affect any of the six extra-ocular muscles, masquerading as any type of ocular motor pathology. The frequency of involvement of each muscle is not well established in the medical literature. This study was designed to determine whether a specific muscle or combination of muscles tends to be predominantly affected. This retrospective review included 30 patients with a clinical diagnosis of myasthenia gravis who had extra-ocular muscle involvement with diplopia at presentation. The diagnosis was confirmed by at least one of the following tests: Tensilon test, acetylcholine receptor antibodies, thymoma on chest CT scan, or suggestive electromyography. Frequency of involvement of each muscle in this cohort was inferior oblique 19 (63.3%), lateral rectus nine (30%), superior rectus four (13.3%), inferior rectus six (20%), medial rectus four (13.3%), and superior oblique three (10%). The inferior oblique was involved more often than any other muscle (p<0.01). Eighteen (60%) patients had ptosis, six (20%) of whom had bilateral ptosis. Diagnosing myasthenia gravis can be difficult, because the disease may mimic every pupil-sparing pattern of ocular misalignment. In addition diplopia caused by paresis of the inferior oblique muscle is rarely encountered (other than as a part of oculomotor nerve palsy). Hence, when a patient presents with vertical diplopia resulting from an isolated inferior oblique palsy, myasthenic etiology should be highly suspected.

  4. The effects of inferior olive lesion on strychnine seizure

    SciTech Connect

    Anderson, M.C.; Chung, E.Y.; Van Woert, M.H. )

    1990-10-01

    Bilateral inferior olive lesions, produced by systemic administration of the neurotoxin 3-acetylpyridine (3AP) produce a proconvulsant state specific for strychnine-induced seizures and myoclonus. We have proposed that these phenomena are mediated through increased excitation of cerebellar Purkinje cells, through activation of glutamate receptors, in response to climbing fiber deafferentation. An increase in quisqualic acid (QA)-displaceable ({sup 3}H)AMPA ((RS)-alpha-amino-3-hydroxy-5-methyl-isoxazole-4-propionic acid) binding in cerebella from inferior olive-lesioned rats was observed, but no difference in ({sup 3}H)AMPA binding displaced by glutamate, kainic acid (KA) or glutamate diethylester (GDEE) was seen. The excitatory amino acid antagonists GDEE and MK-801 ((+)-5-methyl-10,11-dihydro-5H-dibenzo(a,d)cyclo-hepten-5,10 imine) were tested as anticonvulsants for strychnine-induced seizures in 3AP inferior olive-lesioned and control rats. Neither drug effected seizures in control rats, however, both GDEE and MK-801 produced a leftward shift in the strychnine-seizure dose-response curve in 3AP inferior olive-lesioned rats. GDEE also inhibited strychnine-induced myoclonus in the lesioned group, while MK-801 had no effect on myoclonus. The decreased threshold for strychnine-induced seizures and myoclonus in the 3AP-inferior olive-lesioned rats may be due to an increase in glutamate receptors as suggested by the ({sup 3}H)AMPA binding data.

  5. Traumatic neuroma of the inferior alveolar nerve: a case report.

    PubMed

    Arribas-García, Ignacio; Alcalá-Galiano, Andrea; Gutiérrez, Ramón; Montalvo-Moreno, Juan José

    2008-03-01

    Traumatic neuromas are rare entities which characteristically arise subsequently to surgery and are usually accompanied by pain, typically neuralgic. We present an unusual case of an intraosseous traumatic neuroma of the inferior alveolar nerve following tooth extraction. A 56-year-old man consulted for paresthesias and hyperesthesia in the left mandibular region following extraction of the left mandibular third molar (#38). The panoramic radiograph revealed a radiolucent lesion in the inferior alveolar nerve canal, and CT demonstrated the existence of a mass within the canal, producing widening of the same. Nerve-sparing excisional biopsy was performed. Histopathology and immunohistochemistry were consistent with traumatic neuroma of the left inferior alveolar nerve. After 3 years of follow-up, the patient is asymptomatic and there are no signs of recurrence.

  6. Variant Inferior Alveolar Nerves and Implications for Local Anesthesia.

    PubMed

    Wolf, Kevin T; Brokaw, Everett J; Bell, Andrea; Joy, Anita

    2016-01-01

    A sound knowledge of anatomical variations that could be encountered during surgical procedures is helpful in avoiding surgical complications. The current article details anomalous morphology of inferior alveolar nerves encountered during routine dissection of the craniofacial region in the Gross Anatomy laboratory. We also report variations of the lingual nerves, associated with the inferior alveolar nerves. The variations were documented and a thorough review of literature was carried out. We focus on the variations themselves, and the clinical implications that these variations present. Thorough understanding of variant anatomy of the lingual and inferior alveolar nerves may determine the success of procedural anesthesia, the etiology of pathologic processes, and the avoidance of surgical misadventure. PMID:27269666

  7. Inferior oblique recession in thyroid-related orbitopathy.

    PubMed

    Salchow, Daniel J

    2015-06-01

    Thyroid-related orbitopathy is a form of orbital inflammation associated with thyroid dysfunction, developing in many patients with Graves disease. Fibrosis of the inferior rectus muscle can lead to restricted elevation and vertical ocular misalignment, which may be improved by recessing this muscle. In some patients, vertical misalignment persists after surgical weakening of one or more vertical rectus muscles. In this case series, unilateral inferior oblique recession as a secondary procedure after inferior rectus recession reduced hypertropia in primary gaze from 9(Δ) ± 3(Δ) to 1.3(Δ) ± 1.5(Δ) (mean ± standard deviation) and largest hypertropia in side gaze from 18.3 ± 2.1(Δ) to 3.3(Δ) ± 1.5(Δ). Postoperatively, all 3 patients were diplopia free in primary and downgaze. PMID:26059675

  8. [Mitral valve replacement in dextrocardia and situs inversus].

    PubMed

    Uchimuro, Tomoya; Fukui, Toshihiro; Matsuyama, Shigefumi; Tabata, Minoru; Takanashi, Shuichirou

    2012-09-01

    Cardiac surgery for acquired valvular diseases in patients with dextrocardia is extremely rare. We report a surgical case of mitral valve replacement and tricuspid annuloplasty in a patient with dextrocardia and situs inversus. A 74-year-old man with dextrocardia and situs inversus, who had undergone patch closure of atrial septal defect 25 years before, was referred for surgical treatment of severe mitral and tricuspid valve regurgitation. Preoperative computed tomography( CT) showed dextrocardia, situs inversus, interruption of the inferior vena cava with an azygos vein continuation, and drainage of the hepatic vein into the right atrium. Under redo-median sternotomoy, cardiopulmonary bypass was established by cannulating the ascending aorta, the superior vena cava, the right femoral and the hepatic veins. The surgeon operated from the left side of the operating table, and had an excellent exposure to the mitral and tricuspid valves during the operation. Mitral valve replacement and tricuspid annuloplasty were performed successfully. The postoperative course was uneventful.

  9. Laparoscopic Single Site Surgery for Repair of Retrocaval Ureter in a Morbidly Obese Patient

    PubMed Central

    Abdel-Karim, Aly M.; Yahia, Elsayed; Hassouna, M.; Missiry, M.

    2015-01-01

    This is to describe a case of a morbidly obese (BMI = 40) female with retrocaval ureter treated with laparoendoscopic single-site surgery. A JJ stent was positioned. A 2 cm umbilical access was created. A single port platform was positioned. The entire ureter was mobilized posterior to the vena cava and transected where the dilated portion ended. The distal ureter was repositioned lateral to the inferior vena cava. Anastomosis was done. A 3 mm trocar was used to assist suturing. At 4-month follow-up, CT revealed no evidence of obstruction of the right kidney and the patient was symptomless. Although challenging, in a morbidly obese patient, LESS repair for retrocaval ureter is feasible. PMID:26793585

  10. Acquired Fontan paradox in isolated right ventricular cardiomyopathy.

    PubMed

    Saran, Mahim; Sivasubramonian, Sivasankaran; Abhilash, Sreevilasam P; Tharakan, Jaganmohan A

    2016-01-01

    A 44-year-old woman presented with features of congestive heart failure. Echocardiography revealed severe right ventricular dysfunction along with passive minimally pulsatile pulmonary blood flow suggesting very high systemic venous pressures. This was confirmed with cardiac catheterization in which the pressures of superior vena cava and inferior vena cava (19 mmHg) were higher than the pulmonary artery pressures (17 mmHg). Elevation of systemic venous pressures above the pulmonary venous pressures, Fontan paradox, to drive the forward flow, is a specific feature of artificially created cavopulmonary shunts. Late stage of isolated right ventricular cardiomyopathy resulted in the spontaneous evolution of Fontan circulation with a nonfunctional right ventricle in this patient. PMID:27625525

  11. Bilateral iliac and popliteal arterial thrombosis in a child with focal segmental glomerulosclerosis

    PubMed Central

    Han, Kyoung Hee; Park, Ji Youn; Min, Seung-Kee; Ha, Il-Soo; Cheong, Hae Il

    2016-01-01

    Thromboembolic complications (TECs) are clinically important sequelae of nephrotic syndrome (NS). The incidence of TECs in children is approximately 2%–5%. The veins are the most commonly affected sites, particularly the deep veins in the legs, the inferior vena cava, the superior vena cava, and the renal veins. Arterial thrombosis, which is less common, typically occurs in the cerebral, pulmonary, and femoral arteries, and is associated with the use of steroids and diuretics. Popliteal artery thrombosis in children has been described in cases of traumatic dissection, osteochondroma, Mycoplasma pneumoniae infection, and fibromuscular dysplasia. We report of a 33-month-old girl with bilateral iliac and popliteal arterial thrombosis associated with steroid-resistant NS due to focal segmental glomerulosclerosis. Her treatment involved thrombectomy and intravenous heparinization, followed by oral warfarin for 8 months. Herein, we report a rare case of spontaneous iliac and popliteal arterial thrombosis in a young child with NS. PMID:27279890

  12. Acquired Fontan paradox in isolated right ventricular cardiomyopathy

    PubMed Central

    Saran, Mahim; Sivasubramonian, Sivasankaran; Abhilash, Sreevilasam P; Tharakan, Jaganmohan A

    2016-01-01

    A 44-year-old woman presented with features of congestive heart failure. Echocardiography revealed severe right ventricular dysfunction along with passive minimally pulsatile pulmonary blood flow suggesting very high systemic venous pressures. This was confirmed with cardiac catheterization in which the pressures of superior vena cava and inferior vena cava (19 mmHg) were higher than the pulmonary artery pressures (17 mmHg). Elevation of systemic venous pressures above the pulmonary venous pressures, Fontan paradox, to drive the forward flow, is a specific feature of artificially created cavopulmonary shunts. Late stage of isolated right ventricular cardiomyopathy resulted in the spontaneous evolution of Fontan circulation with a nonfunctional right ventricle in this patient. PMID:27625525

  13. Unusual fistulas and connections in the cardiovascular system: A pictorial review

    PubMed Central

    Ghandour, Abed; Rajiah, Prabhakar

    2014-01-01

    A fistula is an abnormal vascular connection leading to diversion of blood from a high resistance arterial circuit to low resistance venous circuit. Coronary artery fistulas are abnormal communications of the coronary artery with a chamber of the heart, or with any segment of systemic or pulmonary circulation, bypassing the myocardial capillaries. Other unusual fistulas include connection between aorta and the right atrium/superior vena cava, aorta and the inferior vena cava or between a coronary artery bypass graft and a cardiac vein. Abnormal connections also include origin of the coronary artery from the pulmonary artery. In this article, we review the imaging, particularly computed tomography and magnetic resonance imaging of unusual fistulas and connections involving the cardiovascular system, particularly the coronary arteries and the aorta. PMID:24876921

  14. Modified Valsalva Maneuver for Venous Cannulation in Cardiopulmonary Bypass for Minimal Incision Mitral Valve Surgery.

    PubMed

    Rajaratnam, Kawryshanker; Tak, Chaitanya; Alexander, Sweeka; Passage, Jurgen

    2016-01-01

    A 69-year-old man underwent minimal incision mitral valve repair for severe symptomatic mitral regurgitation. The echocardiography showed that he had normal left ventricular function with a moderately to severely dilated left atrium, a mildly dilated right atrium, and a large patent foramen ovale. The multistage venous cannulation was very challenging because we could not negotiate the guide wire from the inferior vena cava via the right atrium into the superior vena cava. Despite several attempts, the guide wire would pass into the patent foramen ovale. Methods that we routinely attempt with difficult cannulations such as withdrawing and reinserting, twisting, and to-and-fro movements did not result in success. Eventually, we attempted a novel maneuver, the modified "Valsalva maneuver," that worked incredibly well. PMID:27532301

  15. Excessive bleeding from genital ulcers of Behçet's disease.

    PubMed

    Bostankolu, A; Aksungur, V L; Aksungur, E H; Ozpoyraz, M; Yücel, A; Memisoglu, H R

    1997-09-01

    Although genital ulcers are a common manifestation of Behçet's disease, bleeding from these lesions is unusual. In this report, a patient with excessive bleeding from genital ulcers is presented. A 22-year-old man with recurrent oral and genital ulcers, erythema nodosum, folliculitis, positive pathergic reaction, uveitis, superior vena cava syndrome, and generalized lymphadenopathy fulfilled the diagnostic criteria of Behçet's disease. Three years after presenting he was admitted to our clinic with excessive bleeding from large ulcers on the scrotum and upper thighs and with a leg ulcer. Bleeding was controlled with compresses. Examination of a biopsy specimen obtained from the leg ulcer showed findings consistent with Kaposi-like acroangiodermatitis. Results of various radiologic investigations showed thrombosis of the inferior vena cava, peritesticular varicosities, and venous insufficiency of the lower extremities. We suggest that the bleeding was secondary to the extension of genital ulcers to the varicose veins.

  16. [Bullet embolism].

    PubMed

    Engelgardt, Piotr; Wolska, Ewa; Bloch-Bogusławska, Elzbieta

    2008-01-01

    Bullet embolism is an uncommon consequence of penetrating firearm injuries, rarely observed in everyday forensic practice. The present report presents two cases of gunshot bullet embolism. The first examined case is a contact gunshot wound with the entry wound situated at the back of the victim. The wound channel terminated in the thoracic aorta, where from, in keeping with the blood flow, the bullet was transported into the left common iliac artery. The second case pertains to a gunshot in the head, with the bullet shot from a point blank range. The wound channel had a downward course and terminated in the superior vena cava at the level of the pericardium, where from the bullet was transported down the inferior vena cava to the right femoral vein.

  17. [Myelopathies in impairment of extravertebral venous blood circulation].

    PubMed

    Tsuladze, I I; Dreval', O N; Kornienko, V N

    2009-01-01

    Development of myelopathies of venous genesis is based on venous hypertension inside vertebral canal which was initially described by J. Aboulker. According to anatomical and functional features of epidural venous system, two factors contribute in development of venous congestion: decreased outflow and increased inflow. Clinical manifestation is presented by spastic movement disorders. Morphological study performed in 18 cadavers allowed to discover so called 'narrow areas' which cause impaired circulation through large feeders of caval veins, which can be discovered by selective phlebography. Main phlebographic features include stenosis, compression, atresia, thrombosis and retrograde flow towards epidural venous plexus. We examined 58 patients with spastic para- and tetraparesis of unknown nature. Phlebographic signs of venous dyscirculation were revealed in 34 cases. 28 surgical operations were performed: 24 on feeders of vena cava superior and 4 on feeders of vena cava inferior. In 18 cases we obtained satisfactory results. This investigation should be continued.

  18. Pleomorphic adenoma originates from inferior nasal turbinate causing epiphora.

    PubMed

    Erol, Bekir; Selçuk, Ömer Tarik; Gürses, Cemil; Osma, Üstün; Köroğlu, Mert; Süren, Dinç

    2013-01-01

    Pleomorphic adenoma is the most common benign tumor of the salivary glands. A 62-year-old female patient presented with epiphora and was suffering from breathing difficulties. With the diagnostic nasal endoscopy, a mass, originating from right inferior nasal turbinate and filling the entire nasal cavity, was seen. Originating from the inferior nasal turbinate is a very rare entity. Paranasal sinus computed tomography and magnetic resonance images revealed a mass that fills and expands the right nasal cavity. Mass was hypoechoic in B-mode ultrasonography and hypovascular in color Doppler ultrasonography, and rate of tissue stiffness was high in sonoelastography. These were helpful for the diagnosis.

  19. Polyphenol-Rich Fraction of Ecklonia cava Improves Nonalcoholic Fatty Liver Disease in High Fat Diet-Fed Mice

    PubMed Central

    Park, Eun-Young; Choi, Hojung; Yoon, Ji-Young; Lee, In-Young; Seo, Youngwan; Moon, Hong-Seop; Hwang, Jong-Hee; Jun, Hee-Sook

    2015-01-01

    Ecklonia cava (E. cava; CA) is an edible brown alga with beneficial effects in diabetes via regulation of various metabolic processes such as lipogenesis, lipolysis, inflammation, and the antioxidant defense system in liver and adipose tissue. We investigated the effect of the polyphenol-rich fraction of E. cava produced from Gijang (G-CA) on nonalcoholic fatty liver disease (NAFLD) in high-fat diet (HFD)-fed mice. C57BL6 mice were fed a HFD for six weeks and then the HFD group was administered 300 mg/kg of G-CA extracts by oral intubation for 10 weeks. Body weight, fat mass, and serum biochemical parameters were reduced by G-CA extract treatment. MRI/MRS analysis showed that liver fat and liver volume in HFD-induced obese mice were reduced by G-CA extract treatment. Further, we analyzed hepatic gene expression related to inflammation and lipid metabolism. The mRNA expression levels of inflammatory cytokines and hepatic lipogenesis-related genes were decreased in G-CA-treated HFD mice. The mRNA expression levels of cholesterol 7 alpha-hydroxylase 1 (CYP7A1), the key enzyme in bile acid synthesis, were dramatically increased by G-CA treatment in HFD mice. We suggest that G-CA treatment ameliorated hepatic steatosis by inhibiting inflammation and improving lipid metabolism. PMID:26569269

  20. Polyphenol-Rich Fraction of Ecklonia cava Improves Nonalcoholic Fatty Liver Disease in High Fat Diet-Fed Mice.

    PubMed

    Park, Eun-Young; Choi, Hojung; Yoon, Ji-Young; Lee, In-Young; Seo, Youngwan; Moon, Hong-Seop; Hwang, Jong-Hee; Jun, Hee-Sook

    2015-11-12

    Ecklonia cava (E. cava; CA) is an edible brown alga with beneficial effects in diabetes via regulation of various metabolic processes such as lipogenesis, lipolysis, inflammation, and the antioxidant defense system in liver and adipose tissue. We investigated the effect of the polyphenol-rich fraction of E. cava produced from Gijang (G-CA) on nonalcoholic fatty liver disease (NAFLD) in high-fat diet (HFD)-fed mice. C57BL6 mice were fed a HFD for six weeks and then the HFD group was administered 300 mg/kg of G-CA extracts by oral intubation for 10 weeks. Body weight, fat mass, and serum biochemical parameters were reduced by G-CA extract treatment. MRI/MRS analysis showed that liver fat and liver volume in HFD-induced obese mice were reduced by G-CA extract treatment. Further, we analyzed hepatic gene expression related to inflammation and lipid metabolism. The mRNA expression levels of inflammatory cytokines and hepatic lipogenesis-related genes were decreased in G-CA-treated HFD mice. The mRNA expression levels of cholesterol 7 alpha-hydroxylase 1 (CYP7A1), the key enzyme in bile acid synthesis, were dramatically increased by G-CA treatment in HFD mice. We suggest that G-CA treatment ameliorated hepatic steatosis by inhibiting inflammation and improving lipid metabolism.

  1. Mediastinal solitary fibrous tumor with right diaphragm invasion: report of a case.

    PubMed

    Xue, Xingyang; Chen, Jun; Ma, Wei; Zhu, Daxing; Zhang, Weiguo; Chen, Gang; Wei, Sen; Zhou, Qinghua

    2009-01-01

    Mediastinal solitary fibrous tumors (SFTs) are rarely found in adults and there are few reports describing primary mediastinal SFT invading the diaphragm. We report the case of a 47-year-old woman with a large right inferior mediastinal SFT. Magnetic resonance imaging showed the tumor invading the right lower lobe of the lung and the right hemidiaphragm, with displacement of the inferior vena cava (IVC) and right lobe of the liver. Angiogram showed IVC stenosis. To our knowledge, this is the first report of complete resection of the tumor combined with right lower lobectomy of the lung and partial resection and reconstruction of the right diaphragm with a Dacron flap.

  2. Traumatic longitudinal splitting of the inferior rectus muscle

    PubMed Central

    Laursen, Jessica; Demer, Joseph L.

    2011-01-01

    Orbital floor fractures and associated injuries can cause strabismus. We present the case of a 34-year-old man with incomitant strabismus following orbital reconstruction after a high-impact baseball injury. Multipositional, high-resolution magnetic resonance imaging (MRI) revealed extensive longitudinal splitting of the inferior rectus muscle by an orbital floor implant that separated its orbital and global layers. PMID:21463958

  3. Corticofugal regulation of auditory sensitivity in the bat inferior colliculus.

    PubMed

    Jen, P H; Chen, Q C; Sun, X D

    1998-12-01

    Under free-field stimulation conditions, corticofugal regulation of auditory sensitivity of neurons in the central nucleus of the inferior colliculus of the big brown bat, Eptesicus fuscus, was studied by blocking activities of auditory cortical neurons with Lidocaine or by electrical stimulation in auditory cortical neuron recording sites. The corticocollicular pathway regulated the number of impulses, the auditory spatial response areas and the frequency-tuning curves of inferior colliculus neurons through facilitation or inhibition. Corticofugal regulation was most effective at low sound intensity and was dependent upon the time interval between acoustic and electrical stimuli. At optimal inter-stimulus intervals, inferior colliculus neurons had the smallest number of impulses and the longest response latency during corticofugal inhibition. The opposite effects were observed during corticofugal facilitation. Corticofugal inhibitory latency was longer than corticofugal facilitatory latency. Iontophoretic application of gamma-aminobutyric acid and bicuculline to inferior colliculus recording sites produced effects similar to what were observed during corticofugal inhibition and facilitation. We suggest that corticofugal regulation of central auditory sensitivity can provide an animal with a mechanism to regulate acoustic signal processing in the ascending auditory pathway.

  4. A periodic network of neurochemical modules in the inferior colliculus.

    PubMed

    Chernock, Michelle L; Larue, David T; Winer, Jeffery A

    2004-02-01

    A new organization has been found in shell nuclei of rat inferior colliculus. Chemically specific modules with a periodic distribution fill about half of layer 2 of external cortex and dorsal cortex. Modules contain clusters of small glutamic acid decarboxylase-positive neurons and large boutons at higher density than in other inferior colliculus subdivisions. The modules are also present in tissue stained for parvalbumin, cytochrome oxidase, nicotinamide adenine dinucleotide phosphate-diaphorase, and acetylcholinesterase. Six to seven bilaterally symmetrical modules extend from the caudal extremity of the external cortex of the inferior colliculus to its rostral pole. Modules are from approximately 800 to 2200 microm long and have areas between 5000 and 40,000 microm2. Modules alternate with immunonegative regions. Similar modules are found in inbred and outbred strains of rat, and in both males and females. They are absent in mouse, squirrel, cat, bat, macaque monkey, and barn owl. Modules are immunonegative for glycine, calbindin, serotonin, and choline acetyltransferase. The auditory cortex and ipsi- and contralateral inferior colliculi project to the external cortex. Somatic sensory influences from the dorsal column nuclei and spinal trigeminal nucleus are the primary ascending sensory input to the external cortex; ascending auditory input to layer 2 is sparse. If the immunopositive modular neurons receive this input, the external cortex could participate in spatial orientation and somatic motor control through its intrinsic and extrinsic projections. PMID:14759566

  5. Inferior Colliculus Lesions Impair Eyeblink Conditioning in Rats

    ERIC Educational Resources Information Center

    Freeman, John H.; Halverson, Hunter E.; Hubbard, Erin M.

    2007-01-01

    The neural plasticity necessary for acquisition and retention of eyeblink conditioning has been localized to the cerebellum. However, the sources of sensory input to the cerebellum that are necessary for establishing learning-related plasticity have not been identified completely. The inferior colliculus may be a source of sensory input to the…

  6. Traumatic longitudinal splitting of the inferior rectus muscle.

    PubMed

    Laursen, Jessica; Demer, Joseph L

    2011-04-01

    Orbital floor fractures and associated injuries can cause strabismus. We present the case of a 34-year-old man with incomitant strabismus after orbital reconstruction following a high-impact baseball injury. Multipositional, high-resolution magnetic resonance imaging revealed extensive longitudinal splitting of the inferior rectus muscle by an orbital floor implant that separated its orbital and global layers.

  7. Traumatic longitudinal splitting of the inferior rectus muscle.

    PubMed

    Laursen, Jessica; Demer, Joseph L

    2011-04-01

    Orbital floor fractures and associated injuries can cause strabismus. We present the case of a 34-year-old man with incomitant strabismus after orbital reconstruction following a high-impact baseball injury. Multipositional, high-resolution magnetic resonance imaging revealed extensive longitudinal splitting of the inferior rectus muscle by an orbital floor implant that separated its orbital and global layers. PMID:21463958

  8. Surgical outcomes of superior versus inferior glaucoma drainage device implantation

    PubMed Central

    Martino, Amy Z.; Iverson, Shawn; Feuer, William J.; Greenfield, David S.

    2013-01-01

    Purpose To compare the safety and intraocular pressure (IOP) lowering efficacy of initial glaucoma drainage device (GDD) implantation performed at the superior versus inferior limbus. Methods A retrospective chart review was conducted to identify glaucoma patients that had undergone initial Baerveldt GDD surgery at the inferior limbus for uncontrolled IOP. All eyes had a minimum of 6 months of postoperative follow-up. These eyes were frequency matched to eyes with initial Baerveldt GDD implantation performed at the superior limbus to within 5 years of age and 6 months of follow-up. Baseline demographic and clinical information, as well as preoperative and postoperative IOP, visual acuity, and number of anti-glaucoma medications were extracted. Failure was defined as IOP > 21 mmHg or not reduced by 20% below baseline on two consecutive follow-up visits after 3 months, IOP ≤ 5 mmHg on two consecutive follow-up visits after 3 months, reoperation for glaucoma, or loss of light perception vision. Statistical methods consisted of Student's t-tests, chi-squared test, and Kaplan-Meier time to failure analysis. Results Fifty eyes (17 inferior, 33 superior) of 43 patients were enrolled. Mean postoperative follow-up in both groups were similar (mean 26.2 ± 15.2 for inferior and 23.9 ± 10.43 months for superior, p=0.54). Prior trabeculectomy had been performed in 8/17 (47%) and 11/33 (33%) eyes (p=0.34) with inferior and superior implants, respectively. Mean preoperative IOP (mmHg) in the superior group (26 ± 11) was significantly higher (p=0.02) than in the inferior group (21 ± 7). Success rates were similar (p>0.05) between the inferior and superior GDD groups during the study period, with 64.7% and 75.8% classified as successful at 1-year of follow-up and 43.1% and 65.7% at 2-years of follow-up, respectively. There was no difference in cumulative proportions of eyes failing between the groups (p=0.20, log-rank test). Mean postoperative IOP and number of anti

  9. Inferior turbinate osteoma as a cause of unilateral nose obstruction.

    PubMed

    Grabovac, Stjepan; Hadzibegović, Ana Danić; Markesić, Josip

    2012-11-01

    Osteomas are benign, slow growing bone tumors often seen in paranasal sinuses, mostly in the frontal sinus, whereas they are rare in the nasal cavity. Inferior turbinate osteoma is extremely rare and our case is the third reported in the literature to date. Symptoms vary depending on the location, size and spreading and nasal obstruction is the most common symptom. Treatment of osteomas is surgical and is reserved only for rapidly growing osteomas with symptoms of infection or compression. Although endoscopic surgery is preferred modality, external approach with lateral rhinotomy should be considered with larger osteomas especially those that involve the ethmoid labyrinth. In cases like ours, when large osteoma is localized on the inferior nasal turbinate, sublabial incision through the vestibulum is very suitable approach because it provides wide access and good visibility and leaves no visible scar.

  10. [Aneurysm of the anterior inferior cerebellar artery: case report].

    PubMed

    Adorno, Juan Oscar Alarcón; de Andrade, Guilherme Cabral

    2002-12-01

    The intracranial aneurysms of the posterior circulation have been reported between 5 and 10% of all cerebral aneurysms and the aneurysms of the anterior inferior cerebellar artery (AICA) are considered rare, can cause cerebello pontine angle (CPA) syndrome with or without subarachnoid hemorrhage. Since 1948 few cases were described in the literature. We report on a 33 year-old female patient with subarachnoid hemorrhage due to sacular aneurysm of the left AICA. She was submitted to clipage of the aneurysm without complications.

  11. Truncal ataxia from infarction involving the inferior olivary nucleus.

    PubMed

    Park, Jae Hyun; Ryoo, Sookyung; Moon, So Young; Seo, Sand Won; Na, Duk L

    2012-08-01

    Truncal ataxia in medullary infarction may be caused by involvement of the lateral part of the medulla; however, truncal ataxia in infarction involving the inferior olivary nucleus (ION) has received comparatively little attention. We report a patient with truncal ataxia due to medial medullary infarction located in the ION. A lesion in the ION could produce a contralateral truncal ataxia due to increased inhibitory input to the contralesional vestibular nucleus from the contralesional flocculus.

  12. [One case of pleomorphic adenoma originates from inferior nasal turbinate].

    PubMed

    Hao, Fang; Xu, Xuehai

    2014-10-01

    Pleomorphic adenoma (PA) is the most common benign tumor of the salivary glands. Originating from the nasal cavity is very rare. This paper reports one case of pleomorphic adenoma of the inferior nasal turbinate to analyze the clinic characteristic of this disease. Although these tumors are rarely seen in everyday practice, one should consider this possibility as an uncommon aetiology when confronted with an intranasal mass.

  13. Inferior hip dislocation after falling from height: A case report

    PubMed Central

    Tekin, Ali Çağrı; Çabuk, Haluk; Büyükkurt, Cem Dinçay; Dedeoğlu, Süleyman Semih; İmren, Yunus; Gürbüz, Hakan

    2016-01-01

    Introduction Traumatic inferior hip dislocation is the least common of all hip dislocations. Adult inferior hip dislocations usually occur after high-energy trauma, very few cases are reported without fracture. Presentation of case A 26-year-old female was brought to the emergency department with severe pain in the left hip, impaired posture and restricted movement following a fall from 15 m height. The hip joint was fixed in 90° flexion, 15° abduction, and 20° external rotation. No neurovascular impairment was determined. On radiologic examination, a left ischial type inferior hip dislocation was detected. Hemorrhagic shock which developed due to acute blood loss to thoracic and abdominal cavity and patient died at third hour after she was brought to the hospital. Discussion Traumatic hip dislocations have high morbidity and mortality rates due to multiple organ damage, primarily of the extremities, chest and abdomen. In the treatment of traumatic hip dislocation, closed reduction is recommended through muscle relaxation under general anesthesia or sedation. This procedure should be applied before any intervention for concomitant extremity injuries. A detailed evaluation on emergency presentation, a multi-disciplinary approach and early diagnosis with the rapid application of imaging methods could be life-saving for such patients. PMID:27058153

  14. Gaining Surgical Access for Repositioning the Inferior Alveolar Neurovascular Bundle

    PubMed Central

    Al-Siweedi, Saif Yousif Abdullah; Nambiar, P.; Shanmuhasuntharam, P.; Ngeow, W. C.

    2014-01-01

    This study is aimed at determining anatomical landmarks that can be used to gain access to the inferior alveolar neurovascular (IAN) bundle. Scanned CBCT (i-CAT machine) data of sixty patients and reconstructions performed using the SimPlant dental implant software were reviewed. Outcome variables were the linear distances of the mandibular canal to the inferior border and the buccal cortex of the mandible, measured immediately at the mental foramen (D1) and at 10, 20, 30, and 40 mm (D2–D5) distal to it. Predictor variables were age, ethnicity, and gender of subjects. Apicobasal assessment of the canal reveals that it is curving downward towards the inferior mandibular border until 20 mm (D3) distal to the mental foramen where it then curves upwards, making an elliptic-arc curve. The mandibular canal also forms a buccolingually oriented elliptic arc in relation to the buccal cortex. Variations due to age, ethnicity, and gender were evident and this study provides an accurate anatomic zone for gaining surgical access to the IAN bundle. The findings indicate that the buccal cortex-IAN distance was greatest at D3. Therefore, sites between D2 and D5 can be used as favorable landmarks to access the IAN bundle with the least complications to the patient. PMID:24892077

  15. Combination-sensitive neurons in the inferior colliculus.

    PubMed

    Mittmann, D H; Wenstrup, J J

    1995-10-01

    We examined whether neurons in the inferior colliculus of the mustached bat (Pteronotus parnellii) are combination sensitive, responding to both low- and high-frequency components of the bat's sonar signal. These neurons, previously reported in the thalamus and cortex, analyze sonar target features including distance. Of 82 single units and 36 multiple units from the 58-112 kHz representations of the inferior colliculus, most (86%) displayed sensitivity to low-frequency sounds that was tuned in the range of the fundamental biosonar component (24-31 kHz). All histologically localized units were in the central nucleus of the inferior colliculus (ICC). There were two major types of combination-sensitive influences. Many neurons were facilitated by low-frequency sounds and selective for particular delays between the low- and high-frequency components. In other neurons, the low-frequency signal was inhibitory if presented simultaneously or a few milliseconds prior to the high-frequency signal. The results indicate that mechanisms creating specialized frequency comparisons and delay sensitivity in combination-sensitive neurons operate at the ICC or below. Since combination sensitivity or multipeaked tuning curves occur in the auditory systems of many species, ICC neurons in these animals may also respond to species-specific frequency combinations.

  16. [Inferior vertical nystagmus: is magnetic resonance imaging mandatory?].

    PubMed

    Esteban-Sánchez, Jonathan; Rueda-Marcos, Almudena; Sanz-Fernández, Ricardo; Martín-Sanz, Eduardo

    2016-02-01

    Introduccion. La aparicion de un nistagmo vertical inferior clasicamente obliga a descartar una patologia vascular o de la union craneocervical mediante resonancia magnetica (RM). Estudios recientes demuestran una baja rentabilidad de esta prueba, ya que sugieren que este signo oculomotor puede tener una causa vestibular periferica, sobre todo cuando el paciente presenta un vertigo posicional paroxistico benigno (VPPB) del canal semicircular superior. Objetivo. Comprobar la rentabilidad de la RM en una poblacion de pacientes con nistagmo de posicion vertical inferior. Pacientes y metodos. Estudio retrospectivo de 42 pacientes consecutivos a los que se les realizo una historia clinica, exploracion fisica, y pruebas vestibulares caloricas y rotatorias. A todos ellos se les practico una RM craneal y cervical. Resultados. El 52% de los pacientes con nistagmo de posicion vertical inferior presentaba una clinica y exploracion fisica compatibles con VPPB del canal semicircular superior. La RM fue normal en un 67%, un 26% mostraba datos de espondilopatia y un 5% de microangiopatia cerebral no relacionados con la clinica del paciente. La prevalencia de malformacion de Arnold-Chiari de tipo I fue de un 9% en la poblacion estudiada, sin que nadie tuviera un antecedente reciente de VPPB. Los resultados obtenidos en las pruebas complementarias vestibulares no aportaron informacion adicional para llegar a un diagnostico etiologico. Conclusion. En los pacientes con un VPPB, la RM craneal y las pruebas vestibulares tienen una baja rentabilidad diagnostica, y se debe evaluar la necesidad real de esta prueba con el contexto clinico.

  17. Winogradskyella eckloniae sp. nov., a marine bacterium isolated from the brown alga Ecklonia cava.

    PubMed

    Kim, Ji-Young; Park, So-Hyun; Seo, Ga-Young; Kim, Young-Ju; Oh, Duck-Chul

    2015-09-01

    A novel bacterial strain, designated EC29(T), was isolated from the brown alga Ecklonia cava collected on Jeju Island, Republic of Korea. Cells of strain EC29(T) were Gram-stain-negative, aerobic, rod-shaped and motile by gliding. Growth was observed at 10-30 °C (optimum, 20-25 °C), at pH 6.0-9.5 (optimum, pH 7.5) and in the presence of 1-5% (w/v) NaCl. Phylogenetic analyses based on the 16S rRNA gene sequence revealed that the strain belonged to the genus Winogradskyella. Strain EC29(T) exhibited the highest 16S rRNA gene sequence similarities, of 96.5-97.8%, to the type strains of Winogradskyella pulchriflava EM106(T), Winogradskyella echinorum KMM 6211(T) and Winogradskyella ulvae KMM 6390(T). Strain EC29(T) exhibited < 27% DNA-DNA relatedness with Winogradskyella pulchriflava EM106(T) and Winogradskyella echinorum KMM 6211(T). The predominant fatty acids of strain EC29(T) were iso-C15 : 0, iso-C15 : 1 G, C15 : 0, iso-C17 : 0 3-OH, iso-C15 : 0 3-OH and anteiso-C15 : 0. The DNA G+C content was 31.1 mol% and the major respiratory quinone was menaquinone-6 (MK-6). Based on a polyphasic study, strain EC29(T) is considered to represent a novel species of the genus Winogradskyella, for which the name Winogradskyella eckloniae sp. nov. is proposed. The type strain is EC29(T) ( = KCTC 32172(T) = JCM 18703(T)). PMID:25979633

  18. Flavobacterium jejuensis sp. nov., isolated from marine brown alga Ecklonia cava.

    PubMed

    Park, So-Hyun; Kim, Ji-Young; Kim, Young-Ju; Heo, Moon-Soo

    2015-11-01

    A bacterial strain, designated EC11(T) was isolated from brown alga Ecklonia cava collected from Jeju Island, Korea. EC11(T) was identified as a Gram-negative, rod-shaped and yellow-pigmented bacterial strain. The strain EC11(T) grew over a temperature range of 10 °C to 30 °C (optimally at 25 °C), and a pH range of 6.0-10.5 (optimally at pH 7.5). Phylogenetic analysis based on 16S rRNA gene sequences showed that strain EC11(T) belongs to the genus Flavobacterium. Strain EC11(T) shared close similarity with Flavobacterium jumunjinense HME7102(T) (96.4%), Flavobacterium dongtanense LW30(T) (95.8%), Flavobacterium haoranii LQY-7(T) (95.3%), and Flavobacterium urocaniciphilum (95.1%). The major fatty acids (> 5%) were iso-C17:0 3-OH (22.4%), iso-C15:0 3-OH (19.0%), C15:0 (12.4%), summed feature 3 (comprising C16:1 ω7c/ C16:1 ω6c; 9.78%), iso-C15:1 G (9.6%), and iso-C16:0 3-OH (9.0%). The DNA G+C content was 28.1 mol% and the strain contained MK-6 as the predominant menaquinone. The major polar lipids were phosphatidylethanolamine, two unknown aminolipids and three unknown polar lipids. Based on phenotypic, chemotaxonomic and phylogenetic analysis, strain EC11T represents a novel species of the Flavobacterium genus, for which the name Flavobacterium jejuensis sp. nov. is proposed. The type strain of F. jejuensis is EC11(T) (=KCTC 42149(T) = JCM 30735(T)). PMID:26502959

  19. Mandibular osteotomies after drawing out the inferior alveolar nerve along the canal.

    PubMed

    Jin, Hoon; Kim, Byung-Gun

    2003-01-01

    In some cases, the inferior alveolar nerve runs through a lower course than usual. In such cases, osteotomy of the mandible can injure the inferior alveolar nerves. In other instances, the course of the mandibular osteotomy can meet that of the inferior alveolar nerve. In these cases, a useful method may be excavating the canal and drawing the nerve out through it. With this technique, we can make the osteotomy as initially planned with minimal damage to the inferior alveolar nerve. PMID:14629066

  20. Perforation of the IVC: Rule Rather Than Exception After Longer Indwelling Times for the Guenther Tulip and Celect Retrievable Filters

    SciTech Connect

    Durack, Jeremy C. Westphalen, Antonio C.; Kekulawela, Stephanie; Bhanu, Shiv B.; Avrin, David E.; Gordon, Roy L.; Kerlan, Robert K.

    2012-04-15

    Purpose: This study was designed to assess the incidence, magnitude, and impact upon retrievability of vena caval perforation by Guenther Tulip and Celect conical inferior vena cava (IVC) filters on computed tomographic (CT) imaging. Methods: Guenther Tulip and Celect IVC filters placed between July 2007 and May 2009 were identified from medical records. Of 272 IVC filters placed, 50 (23 Guenther Tulip, 46%; 27 Celect, 54%) were retrospectively assessed on follow-up abdominal CT scans performed for reasons unrelated to the filter. Computed tomography scans were examined for evidence of filter perforation through the vena caval wall, tilt, or pericaval tissue injury. Procedure records were reviewed to determine whether IVC filter retrieval was attempted and successful. Results: Perforation of at least one filter component through the IVC was observed in 43 of 50 (86%) filters on CT scans obtained between 1 and 880 days after filter placement. All filters imaged after 71 days showed some degree of vena caval perforation, often as a progressive process. Filter tilt was seen in 20 of 50 (40%) filters, and all tilted filters also demonstrated vena caval perforation. Transjugular removal was attempted in 12 of 50 (24%) filters and was successful in 11 of 12 (92%). Conclusions: Longer indwelling times usually result in vena caval perforation by retrievable Guenther Tulip and Celect IVC filters. Although infrequently reported in the literature, clinical sequelae from IVC filter components breaching the vena cava can be significant. We advocate filter retrieval as early as clinically indicated and increased attention to the appearance of IVC filters on all follow-up imaging studies.

  1. Strategies for the Management of SVC Stent Migration into the Right Atrium

    SciTech Connect

    Taylor, J. D. Lehmann, E. D.; Belli, A.-M.; Nicholson, A. A.; Kessel, D.; Robertson, I. R.; Pollock, J. G.; Morgan, R. A.

    2007-09-15

    Purpose. Stent migration into the right atrium is a potentially fatal complication of stenting in the venous system and is most likely to occur during the treatment of superior vena cava obstruction. Endovascular approaches that can salvage this hazardous situation are described and the keys to successful treatment are highlighted. Materials and Methods. Four different strategies are reviewed: (1) snaring the stent directly, (2) angioplasty balloon-assisted snaring of the stent, (3) guide wire-assisted snaring of the stent, and (4) superior vena cava-to-inferior vena cava bridging stent. Results. These techniques have been employed in the successful management of four cases. No short- or long-term complications as a result of these maneuvers have been identified. Additional treatment of the underlying disease was possible at the same time in each case. Conclusion. We conclude that prompt management of right atrial stent migration is essential and can be successfully achieved by a variety of 'bale-out' techniques which are within the technical range of most interventional radiologists.

  2. Cardiorespiratory response to cyanide of arterial chemoreceptors in fetal lambs

    SciTech Connect

    Itskovitz, J.; Rudolph, A.M.

    1987-05-01

    Cardiorespiratory response to the stimulation of the carotid and aortic receptors by sodium cyanide was examined in fetal lambs in utero at 0.8 (120 days) gestation. Injections of 50-400 ..mu..g cyanide into the inferior vena cava or the carotid artery of intact fetuses elicited bradycardia and respiratory responses that varied from a single gasp to rhythmic respiratory movements but no significant change in arterial blood pressure. Carotid sinus denervation eliminated the cardiorespiratory response to intracarotid injection of cyanide and sinoaortic denervation abolished the response to inferior vena caval injection. It is concluded that in fetal lamb in utero the aortic and carotid bodies are active, and hypoxic stimulation of these chemoreceptors results in cardiorespiratory response characterized by slowing of fetal heart rate, respiratory effort, and no consistent change in arterial blood pressure.

  3. Anesthetic technique for inferior alveolar nerve block: a new approach

    PubMed Central

    PALTI, Dafna Geller; de ALMEIDA, Cristiane Machado; RODRIGUES, Antonio de Castro; ANDREO, Jesus Carlos; LIMA, José Eduardo Oliveira

    2011-01-01

    Background Effective pain control in Dentistry may be achieved by local anesthetic techniques. The success of the anesthetic technique in mandibular structures depends on the proximity of the needle tip to the mandibular foramen at the moment of anesthetic injection into the pterygomandibular region. Two techniques are available to reach the inferior alveolar nerve where it enters the mandibular canal, namely indirect and direct; these techniques differ in the number of movements required. Data demonstrate that the indirect technique is considered ineffective in 15% of cases and the direct technique in 1329% of cases. Objective Objective: The aim of this study was to describe an alternative technique for inferior alveolar nerve block using several anatomical points for reference, simplifying the procedure and enabling greater success and a more rapid learning curve. Materials and Methods A total of 193 mandibles (146 with permanent dentition and 47 with primary dentition) from dry skulls were used to establish a relationship between the teeth and the mandibular foramen. By using two wires, the first passing through the mesiobuccal groove and middle point of the mesial slope of the distolingual cusp of the primary second molar or permanent first molar (right side), and the second following the oclusal plane (left side), a line can be achieved whose projection coincides with the left mandibular foramen. Results The obtained data showed correlation in 82.88% of cases using the permanent first molar, and in 93.62% of cases using the primary second molar. Conclusion This method is potentially effective for inferior alveolar nerve block, especially in Pediatric Dentistry. PMID:21437463

  4. Determining the non-inferiority margin for patient reported outcomes.

    PubMed

    Gerlinger, Christoph; Schmelter, Thomas

    2011-01-01

    One of the cornerstones of any non-inferiority trial is the choice of the non-inferiority margin delta. This threshold of clinical relevance is very difficult to determine, and in practice, delta is often "negotiated" between the sponsor of the trial and the regulatory agencies. However, for patient reported, or more precisely patient observed outcomes, the patients' minimal clinically important difference (MCID) can be determined empirically by relating the treatment effect, for example, a change on a 100-mm visual analogue scale, to the patient's satisfaction with the change. This MCID can then be used to define delta. We used an anchor-based approach with non-parametric discriminant analysis and ROC analysis and a distribution-based approach with Norman's half standard deviation rule to determine delta in three examples endometriosis-related pelvic pain measured on a 100-mm visual analogue scale, facial acne measured by lesion counts, and hot flush counts. For each of these examples, all three methods yielded quite similar results. In two of the cases, the empirically derived MCIDs were smaller or similar of deltas used before in non-inferiority trials, and in the third case, the empirically derived MCID was used to derive a responder definition that was accepted by the FDA. In conclusion, for patient-observed endpoints, the delta can be derived empirically. In our view, this is a better approach than that of asking the clinician for a "nice round number" for delta, such as 10, 50%, π, e, or i. PMID:21932298

  5. Bruxism elicited by inferior alveolar nerve injury: a case report.

    PubMed

    Melis, Marcello; Coiana, Carlo; Secci, Simona

    2012-02-01

    The aim of this case report is to describe the history of a patient who received an injury to the right inferior alveolar nerve after placement of a dental implant, with bruxism noted afterward. The symptoms were managed by the use of an occlusal appliance worn at night and occasionally during the day, associated with increased awareness of parafunction during the day to reduce muscle pain and fatigue. Paresthesia of the teeth, gingiva, and lower lip persisted but were reduced during appliance use. PMID:22254232

  6. Evidence of mirror neurons in human inferior frontal gyrus.

    PubMed

    Kilner, James M; Neal, Alice; Weiskopf, Nikolaus; Friston, Karl J; Frith, Chris D

    2009-08-12

    There is much current debate about the existence of mirror neurons in humans. To identify mirror neurons in the inferior frontal gyrus (IFG) of humans, we used a repetition suppression paradigm while measuring neural activity with functional magnetic resonance imaging. Subjects either executed or observed a series of actions. Here we show that in the IFG, responses were suppressed both when an executed action was followed by the same rather than a different observed action and when an observed action was followed by the same rather than a different executed action. This pattern of responses is consistent with that predicted by mirror neurons and is evidence of mirror neurons in the human IFG.

  7. Laparoscopic management of inferior lumbar hernia (Petit triangle hernia).

    PubMed

    Ipek, T; Eyuboglu, E; Aydingoz, O

    2005-05-01

    Lumbar hernias are rare defects in the posterolateral abdominal wall that may be congenital or acquired. We present a case of laparoscopic approach to repair an acquired inferior triangle (Petit) lumbar hernia in a woman by using polytetrafluoroethylene mesh. The size of the hernia was 8 x 10 cm. The length of her hospital stay was 2 days. The patient resumed normal activities in less than 2 weeks. The main advantage of this approach is excellent operative visualization, thus avoiding injury to structures near the hernia during repair. Patients benefit from a minimally invasive approach with less pain, shortened hospital course, less analgesic requirements, better cosmetic result, and minimal life-style interference.

  8. Pleomorphic adenoma originated from the inferior nasal turbinate.

    PubMed

    Unlu, H Halis; Celik, Onur; Demir, M Akif; Eskiizmir, Gorkem

    2003-12-01

    Although pleomorphic adenoma is the most common benign neoplasm of the salivary glands, it has also been reported to be present in the neck, ear, mediastinum, external nose and nasal cavity. Intranasal localization of this lesion is very rare and mainly originates from the nasal septum. From wherever the lesion originates, the main treatment modality should be surgical. We presented a very rare case of intranasal pleomorphic adenoma originated from the inferior nasal turbinate. Due to the expansile nature of the lesion, a midfacial degloving approach was preferred.

  9. In Vitro Investigation of the Hemodynamics of Transcatheter Heterotopic Valves Implantation in the Cavo-Atrial Junction.

    PubMed

    Ismail, Munirah; Kabinejadian, Foad; Nguyen, Yen Ngoc; Tay, Edgar; Kim, Sangho; Leo, Hwa Liang

    2015-09-01

    Severe tricuspid regurgitation (TR) is life-threatening but is often undertreated. Many patients with severe TR are denied heart valve replacement surgery because their old age or comorbidities predispose them to a higher risk of surgical complications associated with open-heart surgery. With the advent of transcatheter technology, it is now possible to deliver the valve to the desired location without the need for open-heart surgery. However, presently, there is no commercially available transcatheter tricuspid valve. This may be due to the complex tricuspid valve anatomy, which lacks an anchorage zone for the percutaneous valves. In view of this drawback, we have recently developed and tested two percutaneous caval heart valves that are designed to deploy at the vena cava and atrium junction. The hemodynamic characteristics of these valves are tested in a mock circulatory system with patient-specific silicone atrium and vena cava, which emulates the physiological pressure and flow conditions at the right side of the human heart. Particle imaging velocimetry results showed that flow velocity and the associated Reynolds shear stress (RSS) and the turbulent kinetic energy (TKE) downstream of the valves increased after the implantation of the valves. A maximum flow velocity of 0.94 m/s was observed at the region downstream of the percutaneous valve at the superior vena cava (SVC). Maximum RSS value of 2076.1 dynes/cm(2) was observed downstream of the valve at the inferior vena cava during the deceleration phase while maximum TKE measured was 572.6 J/m(3) at the upstream of the valve in the SVC during the peak flow phase. While these values appear high, they are significantly lower than those reported in prosthetic mitral and aortic valves. Hence, caval stented valves can be potentially considered as a minimally invasive option to treat TR.

  10. Vena-venous hemofiltration in treating severe injury-induced multiple organ dysfunction syndrome.

    PubMed

    Fang, Y; Zong, H L; Zhang, L; Wang, Z H; Sun, L M; Zhang, R F

    2016-01-01

    Severe multiple injury (SMI) can induce multiple organ dysfunction syndrome (MODS) and easily result in complications, as well as having a high mortality rate. To explore the curative effect of continuous vena-venous hemofiltration (CVVH) in treating MODS and its effect on serum tumor necrosis factor (TNF)-α interleukin (IL)-10 and nitric oxide (NO), we selected 200 patients who suffered from SMI and received treatment in the First Affiliated Hospital of Zhengzhou University between April 2012 and April 2014 as research subjects. All patients were treated with CVVH. Vital signs, blood oxygen pressure (PaO(2)) and oxygenation index (OI) of artery, electrolyte and acid-base balance were observed before and after treatment. Before treatment, 1 h and 12 h after the start of treatment, and at the end of treatment, TNF-α and IL-10 concentrations in serum and ultrafiltrate were tested using enzyme linked immunosorbent assay, and NO concentration in serum and ultrafiltrate was detected using nitrate reduction method. After treatment, heart rate and respiratory rate of patients had significant decline (P less than 0.05) and average arterial pressure rose remarkably (P less than 0.05); blood urea nitrogen and creatinine decreased (P less than 0.05 or 0.01); PaO(2) and OI were both significantly increased (P less than 0.01); hyperkalemia and acidosis were effectively corrected (P less than 0.01); but differences of Na+, Ca2+ and Cl- before and after treatment had no statistical significance (P>0.05). Serum IL-10 concentration had a significant increase after treatment, while TNF-α and NO concentrations had a significant decline after treatment. A small quantity of IL-10, but not of TNF-α, was detected from ultrafiltrate. Concentration of NO in ultrafiltrate was higher. It can be concluded that CVVH can effectively relieve clinical symptoms of MODS patients, improve function of organs, correct electrolyte disturbance and acid-base imbalance and eliminate TNF-α and NO in

  11. Ectopic supernumerary tooth on the inferior nasal concha.

    PubMed

    Ray, Bappaditya; Singh, Lav Kumar; Das, Chandan Jyoti; Roy, T S

    2006-01-01

    Variations regarding the location of an ectopic tooth in the human nasal cavity, although rare, are documented in the literature, but presence of an ectopic tooth on the inferior nasal concha (INC) has not been reported. We observed an anomalous tooth projecting from the posterior margin of the right INC in two adult female skulls. A small quadrangular tooth projected beyond the posterior margin of the hard palate in one of the skulls and a medium sized conical tooth was observed in the other skull. The affected INC in both skulls were located more inferiorly compared to the opposite side and were in close approximation with the hard palate. No similar findings were noted on the contralateral side nor were there any associated congenital or iatrogenic deformity. The phylogenetic, ontogenetic, and clinical importance of this variant is described. Knowledge of such an anomaly is of paramount importance to otorhinolaryngologists, reconstructive and dental surgeons, and radiologists for identification of such rarities encountered during invasive or non-invasive procedures. PMID:16283635

  12. Aneurysm in the anterior inferior cerebellar artery-posterior inferior cerebellar artery variant: Case report and review of literature

    PubMed Central

    Akhtar, Saad; Azeem, Abdul; Jiwani, Amyna; Javed, Gohar

    2016-01-01

    Introduction There are variations in the anatomy of the vertebrobasilar system amongst which the Anterior Inferior Cerebellar Artery-Posterior Inferior Cerebellar Artery (AICA-PICA) variant is thought to have a prevalence of 20–24% (based on retrospective studies). Despite this, aneurysms of the AICA-PICA variant are rare. We present a case of an AICA-PICA aneurysm and discuss its presentation and management, along with a review of literature. Presentation of case We describe the case of a 35 year old female who presented with signs of meningismus. On the basis of radiological imaging it was initially misdiagnosed as a thrombosed arteriovenous malformation (AVM). The patient was eventually discharged with a plan of interval imaging and interventional radiology (if required). The patient presented again with similar signs and symptoms. Re-evaluation of imaging revealed an aneurysm of the AICA-PICA variant which was managed surgically. Discussion Aneurysms of the AICA-PICA variant are rare. The radiological features and surgical management represent a unique clinical entity and are discussed below. Conclusion The prevalence of the AICA-PICA variant might be high but aneurysms in this vessel are rare. The scant knowledge available on this subject makes it a diagnostic difficulty. PMID:27017276

  13. ['Non-inferiority' trials. Tips for the critical reader. Research methodology 3].

    PubMed

    Soonawala, Darius; Dekkers, Olaf M

    2012-01-01

    The aim of non-inferiority trials is to show that a new treatment is not less effective than standard treatment, in other words 'non-inferior'. The non-inferiority margin should be determined before a study commences. This margin determines the maximal magnitude of difference in effectiveness permissible if it is to be concluded that a new treatment is not less effective than the standard treatment. There is usually a good reason for a non-inferiority design. For example, because the new treatment is easier to use, provides better cost-effectiveness or has fewer side effects. The reader of a non-inferiority trial should consider a number of aspects critically: (a) the reason for use of this study design, (b) the assumed benefit of the new treatment, (c) the rationale for the choice of non-inferiority margin and (d) the choice of the standard therapy with which the new treatment is compared.

  14. Inhibition and the right inferior frontal cortex: one decade on.

    PubMed

    Aron, Adam R; Robbins, Trevor W; Poldrack, Russell A

    2014-04-01

    In our TICS Review in 2004, we proposed that a sector of the right inferior frontal cortex (rIFC) in humans is critical for inhibiting response tendencies. Here we survey new evidence, discuss ongoing controversies, and provide an updated theory. We propose that the rIFC (along with one or more fronto-basal-ganglia networks) is best characterized as a brake. This brake can be turned on in different modes (totally, to outright suppress a response; or partially, to pause), and in different contexts (externally, by stop or salient signals; or internally, by goals). We affirm inhibition as a central component of executive control that relies upon the rIFC and associated networks, and explain why rIFC disruption could generally underpin response control disorders.

  15. Does the left inferior parietal lobule contribute to multiplication facts?

    PubMed

    van Harskamp, Natasja J; Rudge, Peter; Cipolotti, Lisa

    2005-12-01

    We report a single case, who presents with a selective and severe impairment for multiplication and division facts. His ability to retrieve subtraction and addition facts was entirely normal. His brain lesion affected the left superior temporal and to lesser extent in the left middle temporal gyri and the left precentral gyrus extending inferiorly to the pars opercularis of the left frontal lobe. Interestingly, the left supramarginal and angular gyri (SMG/AG) were spared. This finding realised a double dissociation with a previously reported patient, who despite lesions in the SMG/AG did not have a multiplication impairment (van Harskamp et al., 2002). The previously suggested crucial role of the SMG/AG in the retrieval of simple multiplication facts is therefore poorly supported (Cohen et al., 2000; Lee, 2000). PMID:16350657

  16. Anesthetic Efficacy of Bupivacaine Solutions in Inferior Alveolar Nerve Block

    PubMed Central

    Volpato, Maria Cristina; Ranali, José; Ramacciato, Juliana Cama; de Oliveira, Patrícia Cristine; Ambrosano, Glaúcia Maria Bovi; Groppo, Francisco Carlos

    2005-01-01

    The purpose of this study was to compare the anesthetic efficacy of 2 bupivacaine solutions. Twenty-two volunteers randomly received in a crossover, double-blinded manner 2 inferior alveolar nerve blocks with 1.8 mL of racemic bupivacaine and a mixture of 75% levobupivacaine and 25% dextrobupivacaine, both 0.5% and with 1 : 200,000 epinephrine. Before and after the injection, the first mandibular pre-molar was evaluated every 2 minutes until no response to the maximal output (80 reading) of the pulp tester and then again every 20 minutes. Data were analyzed using the Wilcoxon paired test and the paired t test. No differences were found between the solutions for onset and duration of pulpal anesthesia and duration of soft tissue anesthesia (P > .05). It was concluded that the solutions have similar anesthetic efficacy. PMID:16596912

  17. Auditory recognition memory is inferior to visual recognition memory

    PubMed Central

    Cohen, Michael A.; Horowitz, Todd S.; Wolfe, Jeremy M.

    2009-01-01

    Visual memory for scenes is surprisingly robust. We wished to examine whether an analogous ability exists in the auditory domain. Participants listened to a variety of sound clips and were tested on their ability to distinguish old from new clips. Stimuli ranged from complex auditory scenes (e.g., talking in a pool hall) to isolated auditory objects (e.g., a dog barking) to music. In some conditions, additional information was provided to help participants with encoding. In every situation, however, auditory memory proved to be systematically inferior to visual memory. This suggests that there exists either a fundamental difference between auditory and visual stimuli, or, more plausibly, an asymmetry between auditory and visual processing. PMID:19307569

  18. Scorpion envenomation-induced acute thrombotic inferior myocardial infarction.

    PubMed

    Baykan, Ahmet Oytun; Gür, Mustafa; Acele, Armağan; Şeker, Taner; Çaylı, Murat

    2016-01-01

    The occurrence of a serious cardiac emergency following scorpion envenomation has rarely been reported and, when so, mostly presented as non-ST segment elevation myocardial infarction, cardiogenic shock, or myocarditis. Possible mechanisms include imbalance in blood pressure and coronary vasospasm caused by the combination of sympathetic excitation, scorpion venom-induced release of catecholamines, and the direct effect of the toxin on the myocardium. We report a case of a 55-year-old man who presented with acute inferior wall myocardial infarction (MI) within 2 h of being stung by a scorpion. Coronary angiogram revealed total thrombotic occlusion of the left circumflex artery, which was treated successfully with glycoprotein IIb/IIIa inhibitor, thrombus aspiration, antivenom serum, and supportive therapy. Therefore, life-threatening MI can complicate the clinical course during some types of scorpion envenomation and should be managed as an acute coronary syndrome. PMID:26875137

  19. Evidence of Mirror Neurons in Human Inferior Frontal Gyrus

    PubMed Central

    Kilner, James M.; Neal, Alice; Weiskopf, Nikolaus; Friston, Karl J.; Frith, Chris D.

    2009-01-01

    There is much current debate about the existence of mirror neurons in humans. To identify mirror neurons in the inferior frontal gyrus (IFG) of humans we employed a repetition suppression paradigm while measuring neural activity with functional magnetic resonance imaging. Subjects either executed or observed a series of actions. Here we show that in the IFG, responses were suppressed both when an executed action was followed by the same rather than a different observed action and when an observed action was followed by the same rather than a different executed action. This pattern of responses is consistent with that predicted by mirror neurons and is evidence of mirror neurons in the human IFG. PMID:19675249

  20. Sensitivity of rat inferior colliculus neurons to frequency distributions.

    PubMed

    Herrmann, Björn; Parthasarathy, Aravindakshan; Han, Emily X; Obleser, Jonas; Bartlett, Edward L

    2015-11-01

    Stimulus-specific adaptation refers to a neural response reduction to a repeated stimulus that does not generalize to other stimuli. However, stimulus-specific adaptation appears to be influenced by additional factors. For example, the statistical distribution of tone frequencies has recently been shown to dynamically alter stimulus-specific adaptation in human auditory cortex. The present study investigated whether statistical stimulus distributions also affect stimulus-specific adaptation at an earlier stage of the auditory hierarchy. Neural spiking activity and local field potentials were recorded from inferior colliculus neurons of rats while tones were presented in oddball sequences that formed two different statistical contexts. Each sequence consisted of a repeatedly presented tone (standard) and three rare deviants of different magnitudes (small, moderate, large spectral change). The critical manipulation was the relative probability with which large spectral changes occurred. In one context the probability was high (relative to all deviants), while it was low in the other context. We observed larger responses for deviants compared with standards, confirming previous reports of increased response adaptation for frequently presented tones. Importantly, the statistical context in which tones were presented strongly modulated stimulus-specific adaptation. Physically and probabilistically identical stimuli (moderate deviants) in the two statistical contexts elicited different response magnitudes consistent with neural gain changes and thus neural sensitivity adjustments induced by the spectral range of a stimulus distribution. The data show that already at the level of the inferior colliculus stimulus-specific adaptation is dynamically altered by the statistical context in which stimuli occur. PMID:26354316