Compression Of Inferior Vena Cava Research Articles

Clinical outcome of perioperative nonpermanent vena cava filter placement in patients with deep venous thrombosis or blood stasis of the vein

To evaluate the recent clinical experience with nonpermanent inferior vena cava (IVC) filter placement preoperatively, especially with regard to patients who had deep venous thrombosis (DVT) due to compression by a tumor or an aneurysm. Preoperative prophylactic IVC filter placement was performed between October 2002 and March 2008 in 48 of 83 patients who underwent IVC filter placement. IVC filter placement was performed preoperatively in 35 of the 48 patients due to DVT located distally in an iliac vein or due to IVC compression by a tumor or aneurysm. This study examined the early and mid-term outcomes resulting from nonpermanent IVC filter placement. The mean implantation period was 11.1 +/- 9.3 days (range, 3-56 days). Three patients (8.6%) experienced minor complications during the IVC filter placement. A thrombus was captured in the filter in 4 patients (8.8%). One patient in whom the filter was left as a permanent filter died during the follow-up period. No patient experienced any pulmonary embolus during the follow-up period. Nonpermanent IVC filter insertion is perioperatively useful in surgical procedures that eliminate the compression of the vein by an excision of either the tumor or aneurysm compressing the vein.

Polycystic Liver Disease

To identify operative morbidity, mortality, and long-term outcome after operative treatment for symptomatic polycystic liver disease (PLD) and develop a treatment algorithm for patients with PLD. PLD represents a challenging clinical problem that can result in massive hepatomegaly and various complications, leading to significant decline in health status and quality of life. The optimal surgical treatment for this disease is still evolving. All patients who underwent hepatic resection, cyst fenestration, or liver transplantation for PLD from 1985 to 2006 were identified retrospectively. Long-term outcomes were evaluated by patient survey. Mean follow-up was 8 +/- 0.5 years. Of 141 patients (122 women; age: 51 +/- 1 years) with PLD, 117 had concomitant polycystic kidney disease. All patients suffered from symptomatic hepatomegaly with 85% being functionally impaired (Eastern Cooperative Oncology Group Performance Status: 1-3). Despite significant inferior vena cava or hepatic venous compression in 65%, hepatic function was commonly preserved. A total of 124 patients underwent partial hepatectomy with cyst fenestration, 10 underwent cyst fenestration alone, and 7 underwent liver transplantation for primary treatment of PLD. Overall operative morbidity and mortality was 58% and 4%, respectively, with major complications (Clavien grade: III-V) in 30%. Five- and 10-year survival was 90% and 78%, respectively. Eastern Cooperative Oncology Group Performance Status performance status normalized or improved in 75% of patients and 73% returned to work full-time. At follow-up, health survey scores were similar to the general population despite subsequent recurrence of symptoms in 73% of patients. Selective patients with massive hepatomegaly from PLD benefit from operative intervention. The type of operation performed is mainly dependent on the distribution of the cysts, coincident sectoral vascular patency and parenchymal preservation, and hepatic reserve. Hepatic resection can be performed with acceptable morbidity and mortality, prompt and durable relief of symptoms, and maintenance of liver function. Cyst fenestration and liver transplantation, though effective in selected patients, are less broadly applicable.

A Rare Cause of Iliocaval Thrombosis in Kidney Transplantation

Introduction Renal vein thrombosis (RVT) has an incidence of 0.55% to 3.4% and accounts for as many as one-third of early allograft losses. Rarely, RVT may be a consequence of an extension of ipsilateral iliac vein thrombosis. We present a rare case of iliocaval thrombosis as a consequence of inferior vena cava compression by a large-for-size kidney transplant. Case Report A 20-year-old woman with spina bifida and kidney failure received a living donor kidney from her 52-year-old father. On postoperative day 8, the patient had right lower quadrant abdominal pain associated with oliguria. Graft duplex ultrasonography examination revealed venous thrombosis arising in the right femoral vein and extending to the iliac vein. An urgent second laparotomy was performed, and the kidney was finally placed in the peritoneal cavity. Conclusions The eventuality of an inferior vena cava compression by a transplanted kidney should be considered in any recipient with sudden leg swelling and acute graft dysfunction. An early diagnosis and prompt intervention may reduce the progression to RVT and subsequent graft nephrectomy. When planning a kidney transplantation with a supposed size discrepancy between donor and recipient, positioning the kidney on the left side or in the peritoneal cavity may be preferred.

Pentax-AWS airway Scope as an alternative for awake flexible fiberoptic intubation of a morbidly obese patient in the semi-sitting position

For anesthesia induction in a morbidly obese patient with a full stomach, awake flexible fiberoptic bronchoscope (FOB) intubation in the semi-sitting position may be a suitable choice. A new rigid indirect videolaryngoscope, the Pentax-AWS system, has a unique feature of an adjustable built-in monitor and is designed to be used in patients in various positions. However, the efficacy of its use in such situations has not been investigated or reported. We used the Pentax-AWS system for the intubation of a morbidly obese patient (body mass index >50) who was at risk of regurgitation, anticipated difficult intubation, and supine hypotensive syndrome due to inferior vena cava compression by a huge ovarian cyst. The patient was placed in the sitting position during the intubation procedure. The patient's trachea was intubated with the Pentax-AWS by an anesthesiologist positioned at the patient's right and facing her. The Pentax-AWS offered easy intubation under good visualization of the glottic aperture as a consequence of its adjustable integrated monitor, in contrast to difficult intubation with other videolaryngoscopes which require an external monitor. This report illustrates that the Pentax-AWS is useful as an alternative for flexible fiberoptic intubation under these circumstances, as a consequence of its adjustable built-in monitor and integrated tube channel.

Uterine Leiomyomata-Related Thromboembolic Disease: A Case Report

Venous thromboembolic disease rarely presents as a complication of uterine leiomyomata via inferior vena cava compression. We describe a case associated with venous thrombotic disease and subsequent pulmonary emboli and discuss the complexities of Emergency Department (ED) management. This case typifies the challenge of caring for the ill patient with multiple, potentially related disease processes whose treatments may actually conflict with one another.

Occlusion of Inferior Vena Cava: A Singular Presentation of Abdominal Aortic Aneurysm

Even though the majority of abdominal aortic aneurysm s(AAAs) are asymptomatic, they can occasionally manifest as a result of adjacent structures involvement. Although the most frequent venous complication of AAA is rupture into the inferior vena cava (IVC), venous compression can infrequently occur. The authors report a particularly rare case of compression and thrombosis of the IVC by AAA. Patient was treated by preoperative placement of an IVC filter to impede pulmonary embolism and subsequently by open surgical repair. Besides discussing the circumstances associated with IVC compression by AAA, the authors also discuss the treatment strategy adopted and the possible alternatives.

Migration of inferior vena cava stent into right ventricle: two- and three-dimensional echocardiographic imaging

Right ventricular migration of a systemic venous stent is a rare complication. We present a case of stent migration in a 65-year-old male who underwent palliative intervention for inferior vena cava compression secondary to malignant mesothelioma. Two- and three-dimensional echocardiographic images revealed evidence of a free-stent trapped in the tricuspid valvular apparatus causing severe tricuspid regurgitation.

Mechanical Occlusion of the Inferior Vena Cava: An Unusual Complication After Repair of Pectus Excavatum Using the Nuss Procedure

We describe the case of a 13-year-old girl with a pectus excavatum in whom acute occlusion of the inferior vena cava developed after a nuss repair. In this hemodynamically unstable patient, we evaluated the possibility of a penetrating injury to the thoracic and abdominal structures before confirming the diagnosis of inferior vena cava obstruction with a venogram. Removal of the nuss bar relieved the unexpected problem.

Challenges to cannulation for extracorporeal support in neonates with right-sided congenital diaphragmatic hernia

Right-sided diaphragmatic defects represent less than 20% of all congenital diaphragmatic hernias (CDH). Recent data suggest that right CDH (R-CDH) may carry a disproportionately high morbidity as well as increased rates of extracorporeal support when compared with left CDH. Treatment of infants with R-CDH may be further complicated by anatomical distortion unique to right-sided defects. We report 2 cases of azygous vein cannulation in neonates with large isolated R-CDH. Both infants had postnatal deteriorations within 48 hours, met our criteria for extracorporeal membrane oxygenation (ECMO), and underwent venoarterial cannulations through the right neck. In each case, the venous cannula passed directly into the azygous vein and failed to provide adequate ECMO support. Echocardiography confirmed both cases of azygous cannulation. In one child, the right atrium was successfully cannulated after 90 minutes of extensive cannula manipulation. This child survived a 5-day ECMO course and is alive at 22-month follow-up. In the second child, despite prolonged efforts at cannula repositioning, cannulation of the right atrium was not achieved. We did not offer central cannulation because of a rapidly deteriorating clinical course, with expiration in several hours. At autopsy, a dilated azygous vein was evident as a result of inferior vena cava compression by a malpositioned liver. The possibility of azygous vein cannulation may be increased in neonates with R-CDH and has not been previously reported. When evaluating infants with R-CDH for ECMO, clinicians must recognize the possibility of azygous cannulation and its potentially lethal consequences, and should anticipate alternative venous cannulation.

Inferior Vena Cava Compression Due to Biloma: A Case Report

Purpose: Biloma is an uncommon but well known complication of cholecystectomy. It varies in sizes from very small inconsequential leaks to very large collections causing pressure symptoms such as in gastric outlet obstruction. However, biloma causing inferior vena cava compression leading to significant edema has not been reported so far. Case Report: We report the case of a 55 year old female presenting with abdominal distention and lower extremity edema, a month after an open cholecystectomy. Physical examination showed distended abdomen with hepatomegaly and pitting edema of bilateral lower extremities. Laboratory data revealed normal hepatic function test except for an elevated alkaline phosphatase. Contrast enhanced computed axial tomography scan (CAT scan) of the abdomen revealed a 15 cm × 20 cm fluid collection (open arrows) displacing the liver far to the left and compressing on the inferior vena cava (closed arrows). The diagnosis of biloma was established at percutaneous drainage with resolution and relief of her symptoms. Discussion: Biloma is a localized collection of bile usually from iatrogenic injury. Laparoscopic cholecystectomy is the most common cause of bile duct injury leading to biloma formation although it can also occur spontaneously when gall stones are impacted in the bile ducts leading to disruption. The incidence varies from 0–7%. Other causes include local infection, cholangiocarcinoma, transarterial chemoembolization of hepatic malignancy and endoscopic retrograde cholangiopancreatography. Postoperative biloma commonly manifests within one week after surgery characterized by abdominal pain, fever, vomiting and jaundice. CAT scan and magnetic resonance imaging are superior to ultrasonography. Continuity between fluid collection and biliary tree can be determined by radionuclide cholescintigraphy. Chemical analysis of the aspirate can confirm the diagnosis. Percutaneous drainage is the treatment of choice for large collections otherwise endoscopic sphincterotomy with or without stent placement is usually adequate. Occasionally surgery may be needed for a persistent biloma particularly if infection ensues.[figure1]Figure

Hémorragie intra-tumorale massive responsable d’un syndrome cave: Une complication rare d’un carcinome hépato-cellulaire

Intralesional massive haemorrhage responsible for inferior vena cava syndrome is a very rare complication of hepatocellular carcinoma. A 36-year-old man with no past medical history was referred to hospital for abdominal pain with clinical and biological signs of internal bleeding. An abdominal CT scan showed a huge right liver mass, with regular margins and a fluid content, indicating a large intratumoral haemorrhage complicating hepatocellular carcinoma. Due to haemodynamic stability and the signs of inferior vena cava compression conservative management was chosen prior to surgical treatment of the tumour. Three months later, the huge liver mass remained unchanged but the inferior vena cava syndrome had decreased and the patient's condition improved. After evaluation of liver function and the extent of the tumour, a surgical procedure was performed via a subcostal incision with midline extension and sternotomy to control the intrapericardial inferior vena cava and perform a veno-venous bypass with the technique used for orthotopic liver transplantation. Then, right hepatectomy (segments V to VIII) was performed with an anterior approach. The postoperative course was uneventful. This two-step strategy allowed successful surgery for this rare complication of a hepatocellular carcinoma on a normal liver and could be recommended for the management of any unruptured intratumoral haemorrhages.

Intra-operative inferior vena cava syndrome in a patient with autosomal dominant polycystic kidney disease

The renal and hepatic cysts characteristic of autosomal dominant polycystic kidney disease can exert a mass effect on surrounding structures. If this involves the inferior vena cava (IVC), patients usually present with signs and symptoms characteristic of congestive heart failure. However, the absence of these signs or symptoms does not exclude a potentially hemodynamically significant IVC syndrome. This case report describes a patient with no pre-operative evidence of congestive heart failure or IVC compression, who subsequently experienced intra-operative hypotension and hypoxemia due to an IVC syndrome.

Flegmasia cerulea dolens en paciente con carcinoma testicular

We describe a case of phlegmasia cerulea dolens secondary to venous thrombosis due to compression of inferior vena cava, in a 31-year-old man with a germ cell tumour. He was treated with systemic thrombolytic agents, intravenous heparin and urgent chemotherapy He presented a complete tumoral response and complete revascularization of the vena cava and right femoral vein.

Benign external compression of the inferior vena cava associated with thrombus formation

Malignant and benign causes of inferior vena cava (IVC) occlusion and compression are recognized. Cases of benign IVC compression with associated distal thrombus formation have not however been frequently described. We present two cases of benign external IVC compression associated with distal thrombus formation; one resulting from a giant, benign, hepatic cyst, and another due to pelviureteric junction obstruction, resulting in massive hydronephrosis.

Peliosis hepatis causing inferior vena cava compression in a 3-year-old child

Peliosis hepatis is a rare benign condition characterized by oval or irregular, multiple blood-filled spaces within the liver parenchyma. It is most commonly seen in adults and may be idiopathic, but has various associations including malignancy, infection and drugs. The imaging findings are often non-specific and the condition may be mistaken for multiple abscesses, metastases or vascular malformations. Peliosis hepatis is an especially rare condition in children and to our knowledge only six cases have been described in the literature. Our case describes and illustrates peliosis in a 3-year-old girl and is the first described in any age group to cause complete IVC obstruction. The patient subsequently made a full recovery.

Transit thrombus entrapped in a patent foramen ovale

We describe the case of a 39-year-old man with a diagnosis of inferior vena cava compression caused by metastases of a testicular seminoma, who developed massive pulmonary embolism. Emergency operation was performed because of acute hemodynamic deterioration. Preoperatively, a free-floating mass was seen echocardiographically in the right atrium. Intraoperatively, a thrombus entrapped in a patent foramen ovale with a short free-floating end in the left atrium and a long end in the right atrium was found in addition to the pulmonary emboli. The thrombus was removed, the foramen ovale was closed by direct suture, and pulmonary embolectomy was performed. Histological examination confirmed thrombi but no malignant tissue. Further diagnostic studies documented a malignant seminoma with paraaortic lymph node metastases giving rise to the thrombembolism. Three years after oncologic therapy, he is alive and free from recurrence of embolic and malignant disease.

Perioperative Management with Epidural Anesthesia for a Parturient with Superior Vena Caval Obstruction

Perioperative management of patients with superior vena cava obstruction presents an anesthetic challenge because of severe cardiopulmonary compromise. This is particularly important in the parturient because of increased upper airway edema and inferior vena caval compression. We describe the management of a parturient who presented at 34 wk of gestation with signs and symptoms of superior vena cava obstruction from metastatic breast cancer. The patient was scheduled for a cesarean delivery followed by chemotherapy, as other therapies were deemed excessively risky because of the anatomic characteristics of the large mediastinal mass. This report describes the successful use of regional anesthesia in this setting and discusses the relevant anesthetic and perioperative management considerations for this complex scenario. Perioperative management of patients with superior vena caval obstruction presents an anesthetic challenge because of the severe cardiopulmonary compromise. This case report describes a parturient who presented for cesarean delivery with superior vena caval obstruction resulting from metastasis from breast cancer.

Trauma in pregnancy

The anatomic and physiologic changes make treatment of the pregnant trauma patient complex. The fetus is the challenge, because, in pregnancy, trauma has little effect on maternal morbidity and mortality. Aggressive resuscitation of the mother, in general, is the best management for the fetus, because fetal outcome is directly related to maternal outcome. Recent literature has attempted, with little success, to identify factors that may predict poor fetal outcomes. Cardiotocographic monitoring should be initiated as soon as possible in the emergency department to evaluate fetal well-being. Other key points include: Maternal blood pressure and respiratory rate return to baseline as pregnancy approaches term. Initial fetal health may be the best indicator of maternal health. Inferior vena cava compression in the supine patient may cause significant hypotension. Maternal acidosis may be predictive of fetal outcome. Kleihauer-Betke testing is not necessary in the emergency department. Early ultrasonographic evaluation can identify free intraperitoneal fluid and assess fetal health. Necessary radiographs should not be withheld at any period of gestation. Radiation beyond 20 weeks' gestation is safe. Patients with viable gestations require at least 4 hours of CTM monitoring after even minor trauma.

Pulse transit time: a new approach to haemodynamic monitoring in obstetric spinal anaesthesia

Part of the Portfolio Thesis by Geoffrey H. Sharwood-Smith: The inferior vena caval compression theory of hypotension in obstetric spinal anaesthesia: studies in normal and preeclamptic pregnancy, a literature review and revision of fundamental concepts, available at http://hdl.handle.net/10023/1815

Torção hepática e obstrução de cólon transverso: relato de um caso e revisão da literatura

Os autores relatam o caso de uma paciente de 20 anos de idade, sem antecedentes patológicos, que apresentou quadro de abdome agudo obstrutivo. Realizou exames radiológicos, ultra-som e tomografia computadorizada, seguidos de laparotomia exploradora, sendo constatadas: a) rotação hepática completa para o hipocôndrio esquerdo; b) hipotensão severa por compressão da veia cava inferior; c) malformação congênita dos ligamentos falciforme e coronários; d) obstrução do cólon transverso por bridas constritivas congênitas; e) importante distensão gasosa de alças cólicas no hipocôndrio direito. Foram ressecadas as bandas pericólicas, com redução imediata da dilatação no hemiabdome direito, havendo retorno espontâneo do fígado à posição anatômica. Esta condição ímpar, e os outros três casos similares já descritos na literatura mundial, são comentados neste trabalho.