Rupture Of Inferior Vena Cava Research Articles

Treatment results of cardiac tamponade due to thoracic trauma at Jeju Regional Trauma Center, Korea: a case series

Purpose: The purpose of this study was to report the treatment results of patients with traumatic cardiac tamponade after the opening of Jeju Regional Trauma Center.Methods: We analyzed the treatment outcomes of patients with traumatic cardiac tamponade who were treated at Jeju Regional Trauma Center from January 2018 to August 2022.Results: Seven patients with traumatic cardiac tamponade were treated. The male to female ratio was 1.33:1 (four male and three female patients) and the average age was 60.3±7.2 years. The mechanism of injury was blunt trauma in six cases and penetrating injury in one case. Upon arrival at the emergency department, pericardiostomy was performed in four cases, and an emergency operation was performed in six cases. Pericardiostomy alone was performed in one patient, who had cardiac tamponade due to extrapericardial suprahepatic inferior vena cava rupture. The causes of cardiac tamponade were right atrium appendage rupture in one case, right ventricle rupture in one case, inferior vena cava rupture in two cases, right atrium and left atrium rupture in one case, both atria and left ventricle rupture in one case, and intercostal artery rupture in one case. In three cases, intraoperative cardiopulmonary bypass was required. Two of the seven patients died (mortality rate, 28.5%). Conclusions: Relatively favorable treatment results were observed for traumatic cardiac tamponade patients after Jeju Regional Trauma Center was established.

Inferior Vena Cava Rupture Caused by Balloon Angioplasty During the Treatment of Budd-Chiari Syndrome.

Percutaneous transluminal balloon angioplasty (PTA) is the main treatment option for Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction. However, IVC rupture caused by PTA has never been reported. Between August 2004 and December 2016, a consecutive cohort of 617 BCS patients with obstructed IVC who underwent PTA with or without stent placement were reviewed retrospectively to identify IVC rupture. Pre- and post-procedural imaging data, clinical and procedural technical data were analyzed. Of the 617 BCS patients, five patients had IVC rupture caused by PTA (0.81%). Four of these patients had retroperitoneal, intra-hepatic IVC rupture without extravasation into abdominal cavity which was successfully managed conservatively. One patient had supra-hepatic IVC rupture into the pericardial cavity which was surgically treated. IVC rupture is a rare complication of PTA treatment of BCS and most commonly located at the intra-hepatic IVC caused by oversized balloons which does not require additional treatment.

Study on interventional treatment of Budd-Chiari syndrome in rat models

Objective To explore the feasibility of interventional therapy in rat models of Budd-Chiari syndrome (BCS). Methods A total of 50 male clean SD rats were divided into model group and control group using random number table method, with 25 rats in each group. In the model group, BCS rat model was constructed by adopting partial ligation of the inferior vena cava (IVC), and the control group only had separation of surrounding tissues of IVC. Liver function was studied 12 weeks after postoperative raising, and digital subtraction angiography (DSA) and interventional therapy were performed, coupled with liver histopathology staining. Results Twenty BCS rats survived till the 12th week of raising, with the survival rate reaching 80.0%, and 22 survived in the control group. Compared with the control group, ALT [(43.1±5.5) U/L vs. (62.6±4.6) U/L] and AST [(84.7±26.5) U/L vs. (161.7±25.8) U/L)] in serum of rats in the model group increased, the differences were statistically significant (P<0.05). HE staining showed that obvious hepatocyte necrosis and inflammatory cell infiltration were observed in BCS rats, and liver fibrosis was spotted via Masson staining. DSA examination found IVC obstruction in the model group, among which 14 (70.0%, 14/20) received interventional therapy after successful probing of IVC obstructed segment, and 7 had balloon dilatation with a diameter of 3.5 mm, with 6 (85.7%, 6/7) successfully dilatatedand the other 1 (14.3%, 1/7) failed; the remaining 7 had balloon dilatation with a diameter of 4.5 mm, with 2 (28.6%, 2/7) successfully dilatated, and the other 5 (71.4%, 5/7) died of IVC rupture. Conclusion The BCS rat models by partial ligation of IVC can well simulate the pathophysiological changes and angiopathy characteristics of IVC obstructive BCS patients, which provide a platform for the basic research of interventional therapy of BCS. Key words: Budd-Chiari syndrome; Model, animal; Vena cava, inferior; Rat, Sprague-Dawley; Interventional treatment

Long-Term Outcomes of Endoluminal Sharp Recanalization of Occluded Inferior Vena Cava in Budd-Chiari Syndrome.

To report the long-term results of endoluminal sharp recanalization of occluded inferior vena cava (IVC) in patients with the Budd-Chiari syndrome (BCS). Seventy-two consecutive patients with BCS and IVC occlusion underwent endoluminal recanalization of the IVC occlusion during a 6-year period. BCS with occlusive IVC was detected by reviewing patient history and color Doppler ultrasonography. Data on technical success, morbidity, mortality, complications, and color Doppler sonographic outcome were collected and analyzed. Seventy-seven recanalizations were performed in 72 patients. Technical success (patent IVC with good blood flow) was achieved in 70 (97.4%) patients. No perioperative death was observed. Six complications were found during recanalization, and 10 complications were found for total interventional procedures. The complication rates were 7.8% and 7.3% for recanalization and total procedure, respectively. Bleeding of access veins was the most common complication, and 2 patients showed slight rupture of IVC. The postoperative IVC diameter and blood speed of IVC increased significantly. Fifty-seven patients (79.2%) were clinical cured, and 2 patients (2.8%) showed no improvement. The 1-year, 3-year, and 5-year primary patency rates were 92.5%, 86.8%, and 77.3%, respectively. The second patency rates were 100.0%, 97.8%, and 91.8% for 1, 3, and 5 years, respectively. There were 2 deaths during follow-up. Endoluminal sharp recanalization of occluded IVC in patients with BCS is safe and effective with good long-term outcomes.

Conservative Management of Ureteral Injury Caused by a Lumbar Osteophyte

Background: Osteophytes are bony outgrowths commonly found on lumbar vertebrae. They rarely produce complications with the most common complication being nerve entrapment, but rarer complications including aorta or inferior vena cava rupture, superior mesenteric artery syndrome, compression of the iliopsoas muscle, and cerebrospinal fluid leaks have been described. Rare cases affecting the ureter resulting in ureteral colic or extravasation of urine have been described.Case Presentation: We describe a case in which a lumbar osteophyte bridging the L4 and L5 disks was encircling the ureter and minor trauma caused a ureteral injury, resulting in urine extravasation into the L4 and L5 disks space and the retroperitoneum. Owing to the comorbidities of this patient, this case was treated conservatively with stenting and the patient has suffered no further complications.Conclusion: This is a rare complication of a lumbar osteophyte but should be considered as a potential cause of ureter injury. Treatment should be individualized by patient preference and comorbidities, as some patients would elect to pursue more aggressive therapy whereas others would incline for conservative measures.

Spontaneous Rupture of Inferior Vena Cava Associated with Enoxaparin Use; Case Report and Review of the Literature

Tears of inferior vena cava (IVC) leading to retroperitoneal hemorrhage, generally occur due to blunt or penetrating trauma. Spontaneous rupture of IVC without any trauma history, however, is an extremely rare clinical entity with high mortality. A 75-year-old female patient receiving low molecular weight heparin for the last 5 days due to atrial fibrillation and peripheral artery disease referred to our Emergency Service with hypovolemic shock. Abdominal computed tomography revealed diffuse retroperitoneal hematoma. The patient required cardiopulmonary resuscitation upon development of cardiac arrest. Following resuscitation, she underwent emergency laparotomy, and the hematoma in the right retroperitoneal region was evacuated. During exploration, a 1-cm smooth edged tear located in the anterior aspect of IVC was found, and was repaired. Unfortunately, the patient failed to recover, and passed away within 72 hours due to multiple organ failure. The postmortem examination of vein specimens obtained from the patient revealed no histopathological abnormality. To our knowledge, the patient we are presenting here is the 3rd case in the English literature. Spontaneous rupture of the IVC is a clinical entity that should be kept in mind among other etiologies in cases presenting with acute abdominal symptoms.

The value of three-dimensional DSA in diagnosis and interventional treatment of Budd-Chiari syndrome caused by the obstruction of the inferior vena cava

Objective To investigate the value of three-dimensional digital subtraction angiography (3D-DSA)in the diagnosis and interventional treatment of Budd-Chiari syndrome caused by the obstruction of inferior vena cava(IVC).Methods Twenty-one patients with complex Budd-Chiari syndrome caused by the obstruction of IVC underwent 3D-DSA after two-dimensional-DSA(2D-DSA)was performed with posterior-anterior view.The images of 2D-DSA and 3D-DSA were independently reviewed by two senior interventional radiologists iu a double-blinded way.Percutaneous transluminal angioplasty or stent placement of IVC were performed according to the results of 2D-DSA and 3D-DSA.Results Different aspects of the IVC in all patients were demonstrated on the 3D-DSA images,including the mowhology and the location of obstructions,the origins of collateral vessels and their relationships to the IVC.Collateral vessels originated from the site of IVC occlusions in 9 patients were detected by the 3D-DSA.However.the 2D-DSA provided excellent visualization of the vascular structures of the IVC in 7 patients.and the collateral vessels origihated from the site of IVC occlusions were shown in 2 patients.The 3D-DSA was significantly superior to the 2D-DSA in detecting the IVC obstructions and the collateral vessels(P＜0.05).The virtual angioscopy of the 3D-DSA was able to visualize free IVC thrombosis in 3 paitents.and mural IVC thrombosis in 1 patient.The procedures were successful in all patients.There were no other complications except the rupture of IVC in 1 patient.Conclusion The 3D-DSA can offer valuable informations in diagnosis of IVC obstruction.and it may play an important role in interventional treatment of Budd-Chiari syndrome. Key words: Angiography,digital subtraction; Imaging,three-dimensional; Vena cava,inferior; Radiology,intcrventional; Budd-Chiari syndrome

Test de lecture

Spontaneous ruptures of the inferior vena cava (IVC) are rare. The mortality rate is high associated with all IVC injuries despite prompt resuscitation or operation. We present a case of 68-year-old women with spontaneous IVC dissection, presented as acute chest pain. Chest CT demonstrated a large amount of hemopericardium, and dilated inferior vena cava (IVC), suggesting cardiac tampon. Subsequently, hypovolemic shock and cardiac arrest occurred. After resuscitation, abdomen CT angiography was taken to find bleeding focus. Second CT demonstrated massive contrast extravasation to pericardial space due to rupture of IVC. Patient expired due to multi-organ failure.

Successful salvage of inferior vena cava rupture during reoperative repair for ascending aortic aneurysm

A 44-year-old man underwent reoperative repair for ascending aortic aneurysm at our hospital. He had received aortic valve replacement due to severe aortic regurgitation 4 years previously. The cardiopulmonary bypass was set up through the femoral arterial and venous cannula. An unusual experience of rupture of the abdominal inferior vena cava was encountered after total-body retrograde perfusion. The tragic situation was successfully salvaged by recannulation into the intrapericardial inferior vena cava and repair of the several perforations on abdominal inferior vena cava. The patient recovered smoothly except for mild pancreatitis. The causes of rupture of the inferior vena cava are discussed here.