Inferior Vena Cava Thrombosis Research Articles

Prognosis of patients operated on for renal cell carcinoma and tumor venous thrombosis: experience of the Urology Clinics, N.N. Blokhin National Medical Research Center of Oncology

Objective: to identify independent risk factors affecting survival of patients with renal cell carcinoma (RCC) and tumor venous thrombosis who have undergone nephrectomy and thrombectomy.Materials and methods. This study included 768 patients with RCC complicated by tumor venous thrombosis who have undergone nephrectomy and thrombectomy. Median age was 58 years (range: 16-82 years); the male to female ratio was 2.3:1. The symptoms of tumor venous thrombosis were identified in 232 patients (30.2 %); laboratory abnormalities at baseline were observed in 456 patients (59.3 %). Grade I and II tumor thrombosis was diagnosed in 456 (59.3 %) and 201 (26.2 %) patients, respectively; grade III and IV thrombosis was found in 171 (22.3 %) and 177 (23.0 %) patients, respectively. One hundred and twenty-nine participants (16.8 %) had infrarenal inferior vena cava thrombosis. Regional metastases were detected in 188 individuals (24.4 %), distant metastases were registered in 274 patients (35.7 %). All patients have undergone surgery: either radical (n = 555; 72.3 %) or cytoreductive (n = 213; 27.7 %). All primary tumors were histologically classified as RCC (G3-4 in 337 cases; 43.9 %). A total of 719 patients (93.6 %) survived the perioperative period; 183 patients with metastasis (23.8 %) received systemic antitumor therapy.Results. The median follow-up was 24 months (range: 1-200 months). The 24-month overall and cancer-specific survival of all patients were 96.9 and 99.7 %, respectively; recurrence-free survival of patients after radical surgery reached 92.9 %. Progression-free survival among those patients who underwent cytoreductive surgery and received first-line therapy/follow-up was 41.7 %. Negative predictive factors of overall survival included hepatomegaly (p = 0.024), ascites (p = 0.033), level IV tumor thrombosis (p <0.0001), infrarenal inferior vena cava thrombosis (p = 0.002), regional metastases (p <0.0001), and cytoreductive surgery (p = 0.012). Depending on the number of risk factors, we have identified 3 prognostic groups: favorable (0 factors), intermediate (1-2 factors), and poor (3-6 factors). Median overall survival differed significantly between the groups and was 128.6 ± 11.8; 40.9 ± 6.7 and 12.3 ± 2.2 months, respectively (p <0.0001 for all).Conclusion. Stratification of patients operated on for RCC and venous tumor thrombosis with their allocation to prognostic groups will ensure the choice of an optimal management strategy.

Effect of thrombolytic therapy and influencing factors of Budd-Chiari syndrome with inferior vena cava thrombosis

Objective: To examine the effect of thrombolytic therapy of Budd-Chiari syndrome (B-CS) with inferior vena cava (IVC) thrombosis, and the prognosis factors of it. Methods: The clinical data of 67 patients of B-CS with IVC thrombosis treated in the Department of Hepatopancreatobiliary Surgery, the First Affiliated Hospital of Zhengzhou University from January 2013 to August 2020 were analyzed retrospectively. There were 30 males and 37 females. The age was (47.7±11.1) years(range: 18 to 72 years). All patients received catheter directed thrombolysis, and the thrombolysis process, complications and outcomes were analyzed. All patients received IVC balloon angioplasty after thrombolytic therapy. The t test, χ2 test, Mann-Whitney U test were used for univariate analysis of the prognosis factors of thrombolysis effects, while unconditional Logistic regression model were used for multivariate analysis. Results: In the 67 patients, 47 cases succerssed in thrombolytic therapy. The successful rates of thrombolysis at 1-, 2-, 3- and 4-week were 9.0%, 29.9%, 64.2% and 70.1%, respectively. The rates of thrombolytic catheter-related infection at 1-, 2-, 3- and 4-week were 1.5%, 4.5%, 14.9% and 31.3%, respectively. No serious complications such as symptomatic and acute pulmonary embolism occurred during perioperative period of IVC balloon angioplasty. Univariate analysis showed that differences in thrombus length ((36.7±18.1) mm vs. (52.0±16.4) mm, t=-3.234, P=0.002), Child-Pugh classification (class A/B/C: 37/8/2 vs. 10/8/2, Z=-2.310, P=0.021) and pre-opening IVC proportion (68.1% (32/47) vs. 35.0% (7/20), χ²=6.313, P=0.012) were statistically significant. The thrombus length (OR=0.948, 95%CI: 0.913 to 0.984, P=0.005), pre-opening IVC (OR=5.451, 95%CI: 1.469 to 20.228, P=0.011) were independent prognosis factors of thrombolytic effect. Conclusions: Thrombolytic therapy for B-CS with IVC thrombosis were satisfactory, and the thrombolysis duration should be confined within 3 weeks. IVC balloon angioplasty is safe and effective for patients failing in thrombolysis, and pre-opening IVC is an important method to improve the thrombolytic effect.

Endothelial progenitor cells overexpressing platelet derived growth factor-D facilitate deep vein thrombosis resolution.

To assess the therapeutic efficacy of PDGF-D-overexpressing endothelial progenitor cells (EPCs) in deep vein thrombosis. Inferior vena cava thrombosis was induced in female Sprague Dawley (SD) rats. Animals were injected via the distal vena cava with EPCs overexpressing PDGF-D after transfection with a lentiviral vector containing the PDGF-D gene. The effect on thrombosis in animals who received EPCs was evaluated using MSB staining, immunohistochemistry, immunofluorescence, and venography; the steady-state mRNA and protein levels of PDGF-D and its receptor (PDGF-Rβ) were determined by RT-PCR and Western blotting, respectively; and the PDGF-D-induced mobilization of circulating EPCs was estimated by flow cytology. Compared with controls, injection of EPCs overexpressing PDGF-D was associated with increased thrombosis resolution; recanalization; PDGF-D and PDGF-Rβ expression; induction of monocyte homing; and mobilization of EPCs to the venous circulation. In a rat model, transplantation of PDGF-D-overexpressing EPCs facilitated the resolution of deep vein thrombosis.

Inferior vena cava thrombosis during extracorporeal membrane oxygenation: a case report and review of the\xa0literature

BackgroundExtracorporeal membrane oxygenation (ECMO) is an effective cardiopulmonary support therapy, which can provide temporary cardiopulmonary support for critically ill patients whose condition cannot be reversed by conventional therapy. However, there are many complications in the use of ECMO, such as bleeding, thrombosis, and so on. Among them, inferior vena cava (IVC) thrombosis which can cause pulmonary embolism is a rare complication, which may be life-threatening.Case presentationA 75-year-old female patient (Han Chinese ethnicity) with acute heart failure due to acute myocardial infarction in our department was retrospectively analyzed. After regular treatment was unsuccessful, she was treated with venoarterial ECMO (VA-ECMO). After her condition improved, she was withdrawn from ECMO and experienced a complication of IVC thrombosis. Enoxaparin was given immediately for 1 mg/kg every 12 hours hypodermic injection. The thrombus disappeared after anticoagulant therapy. She was discharged on the 60th day. Her level of consciousness returned to normal without residual central nervous system-related complications.ConclusionsIVC thrombosis is one of the possible serious complications in the process of ECMO therapy. Prevention of thrombosis and optimization of the anticoagulant regimen are the main preventive measures. Anticoagulant therapy is still the main treatment of IVC thrombosis in the process of ECMO therapy. Other interventional strategies need to accumulate clinical experience.

Thrombolytic and anticoagulant effects of a recombinant staphylokinase-hirudin fusion protein

A pure recombinant staphylokinase-hirudin fusion protein (SFH) was obtained by recombinant genetic engineering and purification techniques. The thrombolytic and anticoagulant activities of SFH were investigated using in vitro coagulation models and chromogenic assays. The results showed that intact SFH had targeted thrombolytic activity, and gained anticoagulant activity when cleaved by FXa. In addition, we investigated the pharmacodynamics of SFH in vivo using a variety of animal models, including a rat inferior vena cava thrombosis model, a rat coronary thrombosis model, a rabbit carotid artery thrombosis model and a canine coronary thrombosis model. We found that SFH had an obvious thrombolytic effect and could prevent and reduce re-embolization after thrombolysis and reduce the serious bleeding side effects caused by the combination of thrombolytic and anticoagulant drugs. The results suggest that SFH can be used for thrombolytic therapy in thromboembolic diseases.

Safety and Efficacy of Rivaroxaban for Inferior Vena Cava Thrombosis after Successful Catheter-Directed Thrombolysis.

Rivaroxaban use for inferior vena cava (IVC) thrombosis after successful catheter-directed thrombolysis (CDT) is rarely reported. This study aimed at investigating the safety and efficacy of rivaroxaban for IVC thrombosis after CDT. The clinical data on 38 consecutive patients with IVC thrombosis (68% male; mean age, 51.5 ± 16.5), who received rivaroxaban after CDT between July 2017 and January 2020, were retrospectively analyzed in this study. Safety and efficacy of rivaroxaban (bleedings and recurrent venous thromboembolism), cumulative prevalence of post-thrombotic syndrome (PTS), primary patency, clinically driven target lesion revascularization rate, and other adverse events including all-cause mortality and vascular events (systemic embolism, acute coronary syndrome, ischemic stroke, and transient ischemic attack) were retrospectively analyzed. Of the 38 patients who received rivaroxaban for IVC thrombosis after CDT, 27 (71%) had an anticoagulant duration of 6 months and 11 patients (29%) of more than 6 months. Four patients (10%) suffered recurrent thrombosis. No patient suffered major bleeding, while clinically relevant nonmajor bleeding occurred in two (5%) patients. The cumulative prevalence of PTS was 18% (7/38) during the 12 months follow-up period. Primary patency at 1, 3, 6, and 12 months was 97, 92, 90, and 90%, respectively. According to follow-up data, the clinically driven target lesion revascularization of this study was 10%. Cardiovascular events and mortality did not occur in any patient during the study period. Rivaroxaban for IVC thrombosis after successful CDT can be safe and effective.

Inferior vena cava and right atrial thrombosis in children with embryonal tumors

Tumor thrombosis of the central venous system in children with embryonal tumors is a rare complication, requiring a comprehensive treatment approach, with chemotherapy and the intervention of a multidisciplinary team of oncologists and cardiac surgeons. The article describes the medical history of a 9-month-old patient with bilateral nephroblastoma and tumor thrombosis of inferior vena cava and right atrium, as well as provides a brief review of the literature. The patient's parents gave their consent to the use of their child's data, including photographs, for research purposes and in publications.

Inferior vena cava thrombosis-rope ladder sign.

Congenital heart disease comprises one of the largest groups of congenital defects, affecting approximately 1% of births. Advances in pre- and postoperative critical care treatment as well as surgery and interventional procedures have improved survival rates, but treatment and long-term care of children with complex congenital heart disease remains challenging, and is associated with anumber of complications.Here, we report on a17-month-old infant with congenital univentricular heart disease who devloped post-operatively inferior vena cava (IVC) thrombosis. IVC thrombosis was confirmed by abedside contrast media study (X-ray) demonstrating collateral paravertebral circulation along the paravertebral sinuses bilaterally into the azygos and hemiazygos vein ("rope ladder sign"), with no contrast media detected in the IVC. The infant was subsequently started on aspirin and clopidogrel.

Endothelium-protective, histone-neutralizing properties of the polyanionic agent defibrotide.

Neutrophil-mediated activation and injury of the endothelium play roles in the pathogenesis of diverse disease states ranging from autoimmunity to cancer to COVID-19. Neutralization of cationic proteins (such as neutrophil extracellular trap–derived [NET-derived] histones) with polyanionic compounds has been suggested as a potential strategy for protecting the endothelium from such insults. Here, we report that the US Food and Drug Administration–approved polyanionic agent defibrotide (a pleiotropic mixture of oligonucleotides) directly engages histones and thereby blocks their pathological effects on endothelium. In vitro, defibrotide counteracted endothelial cell activation and pyroptosis-mediated cell death, whether triggered by purified NETs or recombinant histone H4. In vivo, defibrotide stabilized the endothelium and protected against histone-accelerated inferior vena cava thrombosis in mice. Mechanistically, defibrotide demonstrated direct and tight binding to histone H4 as detected by both electrophoretic mobility shift assay and surface plasmon resonance. Taken together, these data provide insights into the potential role of polyanionic compounds in protecting the endothelium from thromboinflammation with potential implications for myriad NET- and histone-accelerated disease states.

Robotic surgery for renal cell carcinoma with inferior vena cava thrombosis: balancing feasibility and safety toward individualized decision-making

article: Robotic surgery for renal cell carcinoma with inferior vena cava thrombosis: balancing feasibility and safety toward individualized decision-making - Minerva Urology and Nephrology 2021 August;73(4):544-8 - Minerva Medica - Journals

V11-04 ROBOTIC-ASSISTED LAPAROSCOPIC RIGHT RADICAL NEPHRECTOMY WITH RIGHT IVC THROMBECTOMY AND REPAIR WITH BOVINE GRAFT

You have accessJournal of UrologyRenal Oncology II (V11)1 Sep 2021V11-04 ROBOTIC-ASSISTED LAPAROSCOPIC RIGHT RADICAL NEPHRECTOMY WITH RIGHT IVC THROMBECTOMY AND REPAIR WITH BOVINE GRAFT Rohan Sawhney, Mubashir Billah, Mutahar Ahmed, and Michael Stifelman Rohan SawhneyRohan Sawhney More articles by this author , Mubashir BillahMubashir Billah More articles by this author , Mutahar AhmedMutahar Ahmed More articles by this author , and Michael StifelmanMichael Stifelman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002073.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Extension of renal cell carcinoma (RCC) into the inferior vena cava (IVC) has been reported in 3-7% of patients. Definitive treatment is surgical resection with a 5-year cancer-specific survival of 32%. Various treatment choices exist including open radical nephrectomy with IVC thrombectomy, hybrid robot-assisted laparoscopic (RAL) radical nephrectomy with limited subcostal for IVC thrombectomy and complete RAL radical nephrectomy with IVC thrombectomy. In all cases one must be prepared to reconstruct the vena cava to prevent narrowing. We present a unique case of RCC with subhepatic IVC thrombosis that was treated entirely robotically and utilized a bovine patch to reconstruct the vena cava. METHODS: A 77-year-old male presented with gross hematuria, an eGFR of 42 and MRI revealing a heterogenous ill-defined mass in the upper pole of the right kidney, level 2 IVC thrombosis, and numerous pulmonary parenchymal metastases. CT guided renal biopsy confirmed clear cell RCC and the patient was treated pre-operatively with immunotherapy. This video will review pertinent steps to performing a robotic IVC thrombectomy with bovine patch. In addition, we will review our single institution experience with complete RAL radical nephrectomy with IVC thrombectomy. RESULTS: The video outlines our technique for robotic radical nephrectomy, IVC thrombectomy and placement of bovine graft. Reviewing our retrospective and prospective data renal cancer databases, we completed 18 IVC thrombectomies, of which 3 were done completely robotically. Of the 9 requiring a bovine patch, 4 were done open, 4 were done as a hybrid technique and 1 was done robotically. Our data for complete robotic IVC thrombectomy is summarized in Table 1. CONCLUSIONS: Management of Level 1 and 2 IVC thrombus can be safely performed through a hybrid technique or completely robotically technique. No matter the technique, one must be prepared for IVC reconstruction. Our experience suggests that complete robotic IVC thrombectomy and reconstruction with bovine graft is feasible in select patients. We recommend having a vascular surgeon close by and anesthesia ready with blood products if necessary. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e858-e859 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Rohan Sawhney More articles by this author Mubashir Billah More articles by this author Mutahar Ahmed More articles by this author Michael Stifelman More articles by this author Expand All Advertisement Loading ...

A young woman presented with massive pulmonary embolism with inferior vena cava thrombus as a complication of nephrotic syndrome: a case report

Nephrotic syndrome (NS) was first described in 1827 as the presence of proteinuria of ≥ 3.5 g/24 h, hypoalbuminemia < 3.0 g/dl, peripheral edema, hyperlipidemia, lipiduria, and increased thrombotic risk. Nephrotic syndrome has an incidence of three cases per 100,000 each year in adults. Nephrotic syndrome also has serious complications due to hypercoagulable state in both various venous and arteries which could lead thromboembolic events. The pathophysiology of hypercoagulability in the nephrotic syndrome is due to an imbalance of prothrombotic and antithrombotic factors, as well as impaired thrombolytic activities.Here, we will present a 19-year-old woman who presented to the emergency department complaining of chest pain and shortness of breath for 3 days. The patient was quickly diagnosed with pulmonary embolism and inferior vena cava thrombosis as a complication of nephrotic syndrome, allowing prompt initiation of anticoagulant therapy. After 2 weeks of admission, the patient’s condition resolved, her laboratory results returned to almost normal and the patient was discharged with oral prednisolone, coumadin, atorvastatin, and ramipril. We aim to determine which is the likely cause of pulmonary embolism in patients with nephrotic syndrome.

An unusual presentation of Behçet’s disease with inferior vena cava thrombosis and pulmonary embolism

No abstract available

High penetrance of inferior vena cava system atresia in severe thrombophilia caused by homozygous antithrombin Budapest 3 variant: Description of a new syndrome

Atresia of inferior vena cava (IVC) is a rare congenital malformation associated with high risk of venous thrombosis that still has unknown etiology, although intrauterine IVC thrombosis has been suggested to be involved. The identification of IVC atresia in a case with early idiopathic venous thrombosis and antithrombin deficiency caused by the homozygous SERPINC1 c.391C > T variant (p.Leu131Phe; antithrombin Budapest 3) encouraged us to evaluate the role of this severe thrombophilia in this vascular abnormality. We have done a cross-sectional study in previously identified cohorts of patients homozygous for the Budapest 3 variant (N=61) selected from 1118 patients with congenital antithrombin deficiency identified in two different populations: Spain (N=692) and Hungary (N=426). Image analysis included computed tomography and phlebography. Atresia of the IVC system was observed in 17/24 cases (70.8%, 95% confidence interval [CI]: 48.9%-87.3%) homozygous for antithrombin Budapest 3 with available computed tomography (5/8 and 12/16 in the Spanish and Hungarian cohorts, respectively), 16 had an absence of infrarenal IVC and one had atresia of the left common iliac vein. All cases with vascular defects had compensatory mechanisms, azygos-hemiazygos continuation or double IVC, and seven also had other congenital anomalies. Short tandem repeat analysis supported the specific association of the IVC system atresia with SERPINC1. We show the first evidence of the association of a severe thrombophilia with IVC system atresia, supporting the possibility that a thrombosis in the developing fetal vessels is the reason for this anomaly. Our hypothesis-generating results encourage further studies to investigate severe thrombophilic states in patients with atresia of IVC.

Budd-Chiari syndrome in Behçet's disease: a retrospective multicenter study.

To compare the clinical features, laboratory findings, and prognosis of Behçet's disease (BD) patients with and without Budd-Chiari syndrome (BCS). This multicenter retrospective study investigated 61 (M/F: 41/20) patients with BD, having coexistent BCS, and 169 (M/F:100/69) BD patients as the control group without BCS from 22 different centers of Turkey diagnosed between 1990 and 2017. Of the total 61 BD patients with BCS, the onset of the first symptom and the median age of diagnosis were earlier in contrast to BD patients without BCS (p = 0.005 and p = 0.007). Lower extremity deep vein and inferior vena cava (IVC) thrombosis were more common in patients with BCS (all; p < 0.01) compared to the control group. Mortality was significantly higher in BD-BCS patients with IVC thrombosis than in the controls (p = 0.004). Since most of the cases in our cohort had chronic and silent form of BCS, mortality rate was 14.8%, which was on the lower range of mortality rate reported in literature (14-47%). While all BD-BCS patients received immunosuppressive (IS) agents, only half of them received additional anticoagulant treatments. Among IS agents, interferon treatment was more frequently used in this cohort (19%), compared to other series reported in literature (2.3%). To our knowledge, this is the largest series of BD patients with BCS. Our patients had earlier disease onset and diagnosis, higher frequency of IVC thrombosis, and higher mortality rate, compared to BD patients without BCS. Mortality was significantly higher in BD-BCS patients with IVC thrombosis compared to controls. Key Points • Mortality rate is higher in BD-associated BCS patients with IVC involvement. • Chronic and silent form of BD-associated BCS has a better prognosis. • The main treatment options are corticosteroids and immunosuppressive agents, whereas anticoagulant treatment remains controversial.

Catheter directed thrombolysis for acute deep vein and arterial thrombosis in COVID-19: report of two cases from Sulaymaniyah, Kurdistan-Iraq

Abstract &#x0D; As one year elapsed since COVID-19 outbreak, venous and arterial thromboses are increasingly reported in different vascular territories. Once accessed by the virus, the endothelial cells, abundant in angiotensin converting enzyme-2 (ACE-2) protein, will be activated by the inflammatory process leading to coagulopathy and vascular lesions. Herein, we describe a case of extensive thrombosis of the infra-renal inferior vena cava and iliac femoral vein in a man of 62 and a case of acute superficial femoral artery thrombosis in a lady of 55. Both were COVID-19 confirmed cases with severe pneumonia, high D-Dimer levels and risk factors for severe disease or death. Despite presentation 1-2 weeks after the onset of thromboses, they were successfully managed by catheter directed thrombolysis (CDT) using tissue plasminogen activator (tPA). Owing to the increased morbidity and mortality of vascular thrombosis, there is a need to identify COVID-19 patients who need prophylaxis and prescribe them the right prophylactic drug (s). The excellent outcome of CDT in these two patients, from Sulaymaniyah/Iraq, supports the use of this treatment modality as a valid, safe and effective option for acute arterial and venous thromboses.&#x0D;

Single-Session Mechanical Thrombectomy of Lower Extremity Deep Venous Thrombosis Using the ClotTriever System: A Single-Institution Experience

Abstract Purpose The aim of this study was to provide a single-center experience in utilization of the ClotTriever mechanical thrombectomy system in acute and subacute deep vein thrombosis (DVT). Methods Retrospective review was performed for all patients who underwent DVT thrombectomy using the ClotTriever system at a single academic medical center. Data recorded included age, gender, etiology, laterality of DVT, fluoroscopy time, perioperative parameters, type of anesthesia, concomitant usage of thrombolytics and/or stents. Follow-up Doppler ultrasounds or diagnostic venograms were reviewed, and time of reintervention (if performed) and Villalta scores were recorded. Results Ten patients were included in the study, with 6/10 female (60%), mean age 54.6 years (range: 24–80). Eight patients presented with acute iliofemoral DVT, one patient with subacute iliofemoral DVT, and one patient with subacute inferior vena cava thrombosis. Only one patient required concomitant intraprocedural thrombolytic administration, and four patients underwent same-session venous stent placement. Technical success was achieved in 90% patients and no procedure-related adverse events were observed. Reintervention within 30 days was required in two (20%) patients at 12 and 13 days. No patient required intensive care unit (ICU) stay, and mean postprocedure hospital length of stay was 2.3 days. On follow-up (mean: 214 days), five patients had no evidence of DVT and four patients showed chronic postthrombotic changes in femoropopliteal veins not requiring intervention. Conclusion The ClotTriever mechanical venous thrombectomy system demonstrates high efficacy in removal of thrombus from lower extremities in a single session, often obviating the need for thrombolytic therapy with low reintervention rates and short postprocedure hospital stay.

The outcomes of interventional treatment for Budd-Chiari Syndrome complicated by inferior vena cava thrombosis: Systematic review and meta-analysis

The aim of this study was to perform a systematic review and meta-analysis to assess the safety and efficacy of interventional treatment for Budd-Chiari syndrome (BCS) complicated by Inferior Vena Cava thrombosis (IVCT) patients. We evaluated the published studies on interventional treatment for BCS complicated by IVCT. Meta-analysis was used to calculate the combined effect size and their 95% confidence intervals (CI) based on random effect. The publication bias was assessed by Begg's test. Sixteen studies on interventional treatment for BCS complicated by IVCT patient were selected for meta-analysis, a total of 767 BCS complicated by IVCT patients were included. The combined effect size (95% CI) were 99% (98–100%) for the total successful rate of IVC recanalization, 15% (11–21%) for the rate of IVC restenosis after initial operation, 92.0% (86–97%) for the rate of clinical improvement, 76% (68–84%) for the rate of thrombus clearance and 0.00% (0–1%) for the incidence of pulmonary embolism (PE). Through subgroup meta-analysis about the rate of thrombus clearance, we got the pooled results (95% CI) of individualized treatment strategy (ITS) group and non-individualized treatment strategy (non-ITS) group, were 81% (71–92%) and 73% (63–83%), respectively. The interventional treatment for BCS complicated by IVCT patients is safe and effective with low incidence of PE, high thrombus clearance rate, high technically successful rate, good patency, and high clinical improvement rate. Moreover, subgroup analysis indicated that management based on the type and extent of the thrombus is proposed. El objetivo de este estudio fue realizar una revisión y un metaanálisis sistemáticos para evaluar la seguridad y la eficacia del tratamiento intervencionista en los pacientes con el síndrome de Budd-Chiari (SBC), agravado por trombosis de la vena cava inferior (TVCI). Evaluamos los estudios publicados sobre el tratamiento intervencionista del SBC agravado por TVCI. Se utilizó el metaanálisis para calcular el tamaño del efecto combinado y los intervalos de confianza (IC) del 95%, basados en el efecto aleatorio. El sesgo de publicación se evaluó con la prueba de Begg. Para el metaanálisis se seleccionaron 16 estudios sobre el tratamiento intervencionista de pacientes con SBC agravado por TVCI; se incluyó un total de 767 pacientes con SBC agravado por TVCI. El tamaño del efecto combinado (IC del 95%) fue del 99% (98-100%) para la tasa de éxito global de la recanalización de la vena cava inferior (VCI), un 15% (11-21%) para la tasa de reestenosis de la VCI después de la operación inicial, un 92% (86-97%) para la tasa de mejora clínica, un 76% (68-84%) para la tasa de eliminación de trombos y un 0% (0-1%) para la incidencia de embolia pulmonar. En el metaanálisis de subgrupos de la tasa de eliminación de trombos, los resultados combinados (IC del 95%) para el grupo de estrategia de tratamiento individualizado y el grupo de estrategia de tratamiento no individualizado fueron del 81% (71-92%) y del 73% (63-83%), respectivamente. El tratamiento intervencionista de pacientes con SBC agravado por TVCI es seguro y eficaz, con una baja incidencia de embolia pulmonar, una alta tasa de eliminación de trombos, una alta tasa de éxito técnico, una buena permeabilidad y una tasa elevada de mejora clínica. Además, el análisis de subgrupos reveló que el mejor enfoque es el tratamiento basado en el tipo y la extensión del trombo.

Long-term outcomes of individualized interventional treatment for primary Budd-Chiari syndrome complicated by inferior vena cava thrombosis.

Various endovascular treatments were used for Budd-Chiari syndrome (BCS) patients complicated by inferior vena cava (IVC) thrombosis. The best treatment for this disease remains unknown. To evaluate safety and efficacy of individualized interventional treatment for primary BCS with IVC thrombosis. Forty-seven consecutive patients with IVC involvement BCS complicated by IVC thrombosis between June 2002 and August 2020 were analyzed retrospectively. They were treated with individualized interventional treatment based on thrombus type and size. Agitation thrombolysis, transcatheter thrombus aspiration, and catheter-directed thrombolysis were initially used for fresh and mixed thrombus (n = 20), then stent implantation for compressing thrombus and IVC recanalization were performed according to the size of the residual thrombus. Direct balloon angioplasty was used for old thrombus (n = 27). Median follow-up duration was 109 (5-223) months (average 114 ± 60 months). IVC recanalization were attempted in forty patients and failed in one. The technical successful rate of IVC recanalization was 97.5%. Thrombus was completely lysed in eight patients with fresh thrombus (40%, 8/20), partially lysed in 11 patients with mixed thrombus (55%, 11/20), and no response in one patient with mixed thrombus (5%, 1/20). Thrombolytic-related complications occurred in one patient (5%, 1/20). No symptomatic pulmonary embolism occurred. Among the 11 patients with thrombus partially lysed, five patients underwent stent implantation for compressing thrombus, six patients received conservative treatment. Old thrombus was completely lysed in 15 patients (55.6%, 15/27) during follow-up. Restenosis occurred in six patients (15.4%, 6/39). Primary patency rates at 1, 5, 10 and 15 years were 92, 92, 86 and 80%, respectively. Hepatocellular carcinoma (HCC) occurred in four patients (8.5%, 4/47). One patient died of HCC. The survival rate was 97.9%. The individualized interventional treatment based on thrombus type and size for primary BCS complicated by IVC thrombosis patients is safe and effective with long-term patency and survival.

Complicated HCC - A Case of IVC Thrombosis

Hepatocellular cancer (HCC) is known to be among one of the commonest primary liver tumors globally with rising incidence and it is often implicated as a frequent cause of cancer-related death. It usually carries a poor prognosis because it is not often diagnosed early until the advanced stages of the disease with distant metastatic spread, vascular invasion, and thrombus formation. The pathophysiologic evolution of HCC is complicated involving prolonged inflammatory damage with sequelae of hepatocyte necrosis, regeneration, and fibrosis. Involvement of the vasculature portends a dismal outcome (less than 6 month survival) although inferior vena cava (IVC) tumor thrombus occur far less commonly than portal and hepatic veins. This can present a significant challenge in patient management despite advances in diagnostic and therapeutic modalities, due to late clinical presentation and lack of consensus regarding treatment. We report a 71-year old man who presented with syncope with incidental finding of large hepatocellular cancer with IVC thrombosis. Following extensive workup, the patient was ineligible for surgical intervention and was referred for chemoembolization with possible immunotherapy. This case highlights vigilance for occult malignant processes in patients that may present atypically.