Inferior Vena Cava Thrombosis Research Articles

Inferior Vena Cava Syndrome: A Rare Complication.

Inferior vena cava syndrome is rare and often difficult to diagnose because of its rarity and consequent low suspicion.We describe the case of a 28-year-old female patient with a history of nephroblastoma of the right kidney, stage IV, with a favourable histology with epidural metastasis (D5–D9), diagnosed at 3 years of age. The patient underwent treatment with surgery, chemotherapy and radiotherapy.The patient suffered from sudden low back pain worsening over 2 weeks, with progressive inability to walk. The pain radiated to the front of the thighs. Concomitantly, oedema of the lower limbs with cephalocaudal progression was observed. At admission to our institution, the physical examination showed peripheral oedema, abdominal wall venous collaterals, an inability to walk due to low back pain in the supine position, with no neurological deficits. Lumbar MRI showed exuberant epidural venous congestion. The hypothesis of inferior vena cava thrombosis (IVCT) was considered and confirmed by angio-CT.IVCT is prevalent in patients with congenital anomalies of the inferior vena cava, occurring in approximately 60–80% of these cases, and most published series on inferior vena cava syndrome refer to thrombotic complications in this subgroup of patients. There are currently no guidelines defined or validated to guide the diagnosis and approach to IVCT. With this case, we would like to draw attention to a rare disease that should be suspected in all patients with inferior vena cava disease, whether resulting from congenital disease or after surgical procedures.LEARNING POINTSDiagnosing IVCT can be challenging and a high index of suspicion is needed in presence of abnormalities of the inferior vena cava.In rare instances, IVCT can present with severe lumbar pain due to epidural venous congestion.

Management of inferior vena cava thrombosis with the FlowTriever and ClotTriever systems

ObjectiveAlthough inferior vena cava (IVC) thrombosis is infrequently encountered, it carries a significant risk of post-thrombotic syndrome and pulmonary embolus. Recent studies show no difference in the incidence of post-thrombotic syndrome in patients with iliofemoral deep venous thrombosis (DVT) treated with pharmacothrombolysis vs anticoagulation alone; however, there is an associated increased risk of bleeding. The treatment of IVC thrombosis is less well-studied and the hemodynamic changes may be more significant with pharmacothrombolysis, although the bleeding risk remains. The ClotTriever and FlowTriever systems remove thrombus from veins without the use of thrombolytics. Our study evaluates outcomes of patients undergoing mechanical thrombectomy for the treatment of IVC thrombosis using the ClotTriever and FlowTriever devices. MethodsA retrospective chart review was performed to identify consecutive patients who underwent mechanical thrombectomy for the treatment of IVC thrombosis using the ClotTriever and/or FlowTriever systems from November 2018 to January 2020 at four data-sharing institutions. The decision of which device(s) to use was at the discretion of the surgeon. Patient demographics, symptomatology, and imaging characteristics were captured at presentation and follow-up. ResultsA total of 15 patients met the inclusion criteria; 10 were male, and the average age was 59 years. The majority of patients were symptomatic at presentation (n = 14), had a prior history of DVT (n = 13), and had a preexisting IVC filter (n = 8). Eleven patients presented with acute onset (<1 week) of symptoms, whereas three patients had subacute (1-4 weeks) symptoms. Most patients had an associated iliofemoral DVT (n = 13) and were treated with both ClotTriever and FlowTriever (n = 8); others were treated with either ClotTriever or FlowTriever alone (n = 5 and n = 2, respectively). Technical success was achieved in all but two patients, one who had a nonocclusive thrombus densely adherent to a preexisting IVC filter and another who had a chronic rubbery clot in the IVC that could not be cleared. No patient required concomitant lytic therapy or a postoperative stay in the intensive care unit. Furthermore, there were no postoperative bleeding events, myocardial infarctions, pulmonary emboli, renal impairments, or deaths. The median length of stay was 3 days (range, 1-37 days). Patients underwent postoperative follow-up (n = 7) as well as extended follow-up (>6 months; n = 8). All patients who achieved technical success were asymptomatic without evidence of reocclusion of the IVC on follow-up imaging. ConclusionsIn our multicenter series of 15 patients, The ClotTriever and FlowTriever showed promise in the treatment of IVC thrombosis without the use of fibrinolytic drugs, with no bleeding events and no requirement for intensive care unit stay.

S1925 A Case of Acute Esophageal Necrosis (Black Esophagus) Managed With Fully Covered Self-Expandable Stent

INTRODUCTION: Acute esophageal necrosis (AEN) is a rare but serious endoscopic finding characterized by diffuse inflammation and black appearance of the esophageal mucosa. It mainly affects the distal esophagus and discontinues at the gastroesophageal junction (GEJ). We report a case of AEN presenting in the setting of extensive inferior vena cava thrombosis and alcohol intoxication. CASE DESCRIPTION/METHODS: 58-year-old male with history of alcohol abuse presented with 4 days of constant, severe, epigastric pain. The patient was sedentary for approximately four months following a fall from second floor. CT scan revealed inferior vena cava thrombosis at the level of the renal veins extending to the left iliac vein. Anticoagulation with IV heparin was initiated; however, it was discontinued when the patient developed hematemesis. Emergent upper endoscopy demonstrated diffuse necrosis and black discoloration in the entire lower and middle third of the esophagus to the GEJ. Additionally, actively oozing mucosa was found in the middle esophagus. The decision was made to immediately place a fully covered self-expandable esophageal stent to tamponade the bleeding and prevent complications. The patient was then transferred to interventional radiology. On left gastric arteriogram, he was found to have faint arterial extravasation in the distal esophageal area. This was successfully embolized. The patient stabilized and was later discharged on oral anticoagulation and acid suppression therapy. Repeat endoscopy three months later for stent removal showed complete healing of the esophagus with normal appearing mucosa. DISCUSSION: While the exact etiology of AEN is unknown, it is suspected to be multifactorial. It carries poor prognosis thus initial management includes aggressive resuscitation, correction of underlying medical conditions, and aggressive acid suppression and monitoring for signs of infection or perforation. We present a case managed with fully covered self-expandable stent at the time of diagnosis which prevented complications, allowed early feeding and ultimately complete healing.Figure 1.: Acute Necrotizing Esophagitis (Black Esophagus).Figure 2.: Fully Covered Self-Expandable Esophageal Stent Placed In The Distal Esophagus.Figure 3.: Healed Esophagus On Three Month Follow-Up.

Renal Cancer with Tumor Thrombus of the Inferior Vena Cava and the Right Atrium

ntroduction. A distinctive feature of kidney cancer is a frequent, compared with other tumors, spread of the tumor through the venous collectors (in the renal and inferior vena cava up to the right atrium), along the path of least resistance to invasive growth.The aim of the study was to present a clinical case of radical treatment of kidney cancer involving extensive IVC thrombosis.Materials and methods. The study describes a clinical case of radical treatment of patient M. with kidney cancer involving extensive IVC thrombosis, extending to the right atrium (written informed consent for patient information and images to be published was obtained prior to the study). During preoperative examination, the patient was diagnosed with renal cell carcinoma with non-occlusive hypervascular tumor thrombus of the renal vein, the inferior vena cava and the right atrium based on the findings of ultrasound examination (transabdominal and transthoracic, and transesophageal), multislice computed tomography (MSCT) and magnetic resonance imaging (MRI).Results and discussion. Surgical treatment remains the main method of treatment of renal cell cancer, moreover, the inferior vena cava thrombosis cannot serve as a cause for refusing surgical treatment. The thrombus spreading along the venous collectors is an important factor in determining the tactics of surgical treatment. The length of the tumor thrombus, as well as the degree of its fixation and ingrowth into the vein wall is of great significance for planning surgical techniques and predicting clinical outcomes. Based on various methods of radiological examination, patient M. was diagnosed with cancer of the right kidney, 3 stage T3cNxM0, IVC tumor thrombus, paraneoplastic syndrome (hyperthermia), right-sided nephrectomy with aortocaval lymphadenectomy, thrombectomy from the IVC, vascular isolation of the liver, resection of the IVC, thrombectomy from the right atrium combined with cardiopulmonary bypass.Conclusion. Despite the technical complexity of nephrectomy with thrombectomy from the IVC, especially in the presence of a massive supradiaphragmatic thrombus, these interventions have no alternatives if a radical treatment is to be achieved. Step-by-step support using radiological methods of investigation is an important aspect of patients preparation; this allowing determining the exact volume of the damage and non-invasively assessing clinical outcomes of surgical treatment.

A Nationwide Analysis of Budd–Chiari Syndrome in the United States

The Budd-Chiari Syndrome (BCS) is a rare disorder characterized by hepatic venous outflow obstruction. The primary objectives of our study were to assess temporal trends in the prevalence of BCS among hospitalized patients in the United States using the National Inpatient Sample (NIS) database and to evaluate demographics, risk factors, and common presentation of BCS. Data were extracted from the NIS to identify patients >18 years of age using all listed diagnosis of BCS from 1998 to 2017 and analyzed. Between 1998 and 2017, we identified a total of 8435 hospitalizations related to BCS. Over the 19-year period, the hospitalization rate for BCS increased consistently from 4.96 per 1,000,000 US population in 1998 to 10.44 per 1,000,000 in 2017, with an annual percentage change increase of 4.41% (95% confidence interval [CI]: 4.23%-4.59%, P < 0.0001). The most common risk factor (7.75%) was myeloproliferative disorder (essential thrombocythemia, polycythemia vera, myelofibrosis, chronic myeloid leukemia) followed (7.32%) by a hypercoagulable state (primary thrombophilia, protein C deficiency, factor V Leiden mutation, antiphospholipid antibody syndrome or prothrombin gene mutation) and paroxysmal nocturnal hemoglobinuria (1.63%). Cirrhosis was present in 18.7%, Portal vein thrombosis in 7.9%, and inferior vena cava thrombosis in 6.4%. The most common manifestations of BCS were ascites (29.9%) or acute kidney injury (18.8%) followed by hepatic encephalopathy (9.6%) and acute liver failure (5.6%). This large population-based study from the United States showed increasing hospitalizations related to BCS. Common presentation was ascites and acute kidney injury.

VenaTech Convertible Vena Cava Filter 6 Months after Conversion Follow-up

PurposeTo report device-related adverse events 6 months after placement or conversion of the VenaTech convertible vena cava filter (VTCF). Materials and MethodsA review of 6-month follow-up data of an investigational device exemption multicenter, prospective, single-arm study was performed. The VTCF was implanted in 149 patients. Conversion was attempted in 64.4% of those patients (n = 96) and successfully in 96.9% of the patients (n = 93). A total of 76 patients completed imaging evaluation at 6 months after filter conversion. Patients who required continued venous thromboembolism prophylaxis at 6 months did not undergo a conversion attempt and were designated as nonconverted filter subjects. A total of 28 nonconverted filter subjects completed imaging evaluation at 6 months after implantation. ResultsEvaluation of patients at 6 months after conversion demonstrated 1 of 76 (1.3%) inferior vena cava (IVC) perforations with a filter strut greater than 3 mm outside of the caval lumen. No cases of recurrent PE, clinically significant filter migration, filter fracture, or IVC thrombosis were reported in the converted subjects. In the nonconverted filter subjects, there was a 14.3% (4 of 28) complete or nearly complete rate of IVC thromboses. There were no cases of recurrent pulmonary embolism, penetration, fracture, or spontaneous conversion in the nonconverted filter subjects. There was a significant reduction in the rate of IVC thrombosis and migration in the converted cohort compared to that in the nonconverted cohort. ConclusionsAt 6 months, the VTCF demonstrated low adverse event rates in the converted configuration, whereas a minority of patients with the nonconverted configuration demonstrated a high risk of IVC thrombosis.

Endovascular Treatment (Stenting) of Total IVC Obstruction with Collaterals in Young Adult with Crohn’s Disease Maharishi Markandeshwar (Deemed to Be University)

We present a case of clinically extensive bilateral DVTs associated with chronic total inferior vena cava thrombosis with underlying crohn’s disease and who is on steroid therapy. 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. Treatment options in the case of IVC thrombus without anatomical variance include anticoagulation, mechanical thrombectomy, systemic thrombolytic therapy, transcatheter regional thrombolysis, and angioplasty

Delayed presentation of blunt inferior vena cava injury following high-speed motor vehicle collision

This is a report of a case of acute-on-chronic inferior vena cava thrombosis 10 years following blunt abdominal trauma from a motor vehicle collision. Although more common risk factors for this pathology include anatomical variation or the long-standing presence of an inferior vena cava filter, history of blunt abdominal trauma serves as a rare etiology. Fewer than 20 cases of inferior vena cava thrombosis following blunt abdominal trauma have been reported in the literature, and most describe a presentation within weeks of inciting trauma. The lengthy time to diagnosis and acute-on-chronic presentation given substantial reconstitution of circulation by collateral veins make this case unique in the literature.

Sequential interventional therapy for Budd-Chiari syndrome associated with fresh inferior vena cava thrombosis

ObjectiveOur study aimed to evaluate the safety and efficacy of sequential interventional therapy for Budd-Chiari syndrome (BCS) caused by obstruction of the inferior vena cava (IVC) with fresh thrombus in the IVC. MethodsFull medical records were obtained for 20 patients with BCS associated with fresh IVC thrombus who received sequential interventional therapy from 2014 to 2019 at our hospital. All patients underwent small-diameter percutaneous transluminal angioplasty (PTA) balloon catheter predilation combined with sequential catheter-directed thrombolysis and large-diameter PTA balloon dilation. Ultrasound examinations were performed at 1 week, 1 month, 3 months, and every 6 months thereafter. Therapeutic effects and perioperative and postoperative adverse effects were recorded to assess the safety of the treatment. ResultsAll 20 patients were treated with small PTA balloon catheters (diameter, 10-14 mm) to predilate the occlusive segment of the IVC. Urokinase 400,000 to 600,000 (465,000 ± 93,000) units was administered to patients through the catheter for 6 to 20 (9.7 ± 4.2) consecutive days postoperatively. Ultrasound re-examination showed that the IVC thrombus disappeared completely in 14 patients (70.0%), and a small amount of the old thrombus remained in 6 patients (30.0%). After thrombolysis, all 20 patients received PTA balloon dilation (diameter, 26-30 mm) in the stenosed IVC segment, and blood flow recovered subsequently. No pulmonary embolism or death occurred in the perioperative course. The perioperative survival rate was 100.0%. ConclusionsSequential interventional therapy for BCS associated with fresh IVC thrombus is safe and effective.

Perioperative Outcome of Suprarenal Resection of Vena Cava Without Reconstruction in Urologic Malignancies: A Case Series and Review of the Literature

To describe the feasibility and perioperative outcome of suprarenal resection of inferior vena cava (IVC) in urologic neoplasms without reconstruction. We retrospectively reviewed the patients who underwent suprarenal resection of IVC without reconstruction for urologic neoplasms in our institution between September 2010 and October 2019. Patients' demographic, clinical, radiologic, and 90-day perioperative complications were recorded. Twenty-eight (79% male) patients with a median age of 59 (25-75) years were included in the study. Twenty-five (89%) of patients had renal cell carcinoma, 1 had renal leiomyosarcoma, and 2 had metastatic testicular teratoma. Twenty-two patients had Mayo level 3 thrombus, 3 had level 2, and 3 had level 4. The mean radiologic thrombus length was 12.6 cm. Eleven patients had radiologic bland thrombosis in the infrarenal IVC. Twenty-seven patients underwent open, and 1 robotic surgery. The median operating time was 411 (range 240-808) minutes, median blood loss was 3750 cc, and all but 1 patient received perioperative transfusion (median 11 units of packed red blood cells). Median hospital stay was 5 (3-50) days. Ninety-day complication rate was 35% (Clavien-Dindo grade I/II and III/IV were 21% and 14%, respectively). Four patients (14%) developed transient nondisabling leg edema. The 90-day mortality rate was 7%. Suprarenal inferior vena cava resection without reconstruction is feasible, yet high-risk operation that should be performed in experienced centers in selected patients with urologic malignancies.

Results of surgical treatment of inferior vena cava tumor thrombi in renal cell carcinoma.

Thrombosis of inferior vena cava (IVC) is an important complication amongst oncological patients. Tumor thrombus of IVC is characteristic for patients with renal cell carcinoma, occurring in 1018%. The aim of the work is to analyze of surgical treatment in patients with cancer thrombosis of inferior vena cava in kidney cancer. Between 2010 and 2019 we treated 32 patients with kidney cancer complicated by thrombotic infiltration of the inferior vena cava. According to Nesbitt classification the levels of thrombotic infiltration of the inferior vena cava were: I-8 (25%), II-14 (43.8%), III-6 (18.8%), and IV-4 (12.5%). Nephrectomy with thrombectomy of the cancer thrombus in the inferior vena cava was performed in all patients. In addition to laparotomy, sternotomy was approached in 4 patients with Nesbitt IV and in 2 patients with Nesbitt III. Primary suture of IVC was performed in 26 patients; angioplasty of IVC was performed in 4 patients; and resection of IVC with replacement using apolytetrafluoroethylene interposition graft was done in 2 patients. Radical surgical treatment was performed in 27 (84.3%) patients, and palliative in 5 (15.6%) patients. In the postoperative period, 1 (3.1%) patient (Nesbitt IV) died of cardiac failure during hospitalisation. Two-year survival was observed in 75% of the cases. Tumorous infiltration of IVC is associated with ahigh potential for tumour embolisation to the lungs, leading to the formation of multiple metastases and spreading of the underlying disease. Postoperative comfort is improved considerably after nephrectomy of the affected kidney and removal of the tumour thrombus, including IVC resection as appropriate, and when combined with oncological treatment, the survival rate is increased significantly, as well.

V01-12 ROBOTIC SUPRARENAL CAVECTOMY IN A PATIENT WITH KIDNEY TUMOR AND LEVEL III TUMOR THROMBOSIS

You have accessJournal of UrologyKidney Cancer I: Partial Nephrectomy & Kidney Preservation Strategies (V01)1 Apr 2020V01-12 ROBOTIC SUPRARENAL CAVECTOMY IN A PATIENT WITH KIDNEY TUMOR AND LEVEL III TUMOR THROMBOSIS Luis G Medina*, Alireza Ghoreifi, Hatim Thaker, Vinay Duddalwar, and Hooman Djaladat Luis G Medina*Luis G Medina* More articles by this author , Alireza GhoreifiAlireza Ghoreifi More articles by this author , Hatim ThakerHatim Thaker More articles by this author , Vinay DuddalwarVinay Duddalwar More articles by this author , and Hooman DjaladatHooman Djaladat More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000826.012AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Inferior vena cava (IVC) thrombosis occurs in less than 10% of patients with renal cell carcinoma (RCC). Up to 25% of these cases will require IVC interruption or resection, yet caval replacement is controversial. Our aim is to present the first reported case of robotic suprarenal cavectomy without reconstruction in a patient with RCC. METHODS: A 50-year-old male was found to have 9-cm right renal mass and level III thrombosis during his workup for pulmonary embolism. The length of IVC thrombus was 112 mm, terminating 3.6 cm below the level of hepatic veins and occluded 100% of the IVC without distal bland thrombosis. CT scan showed suspicious lesion in liver and contralateral adrenal, though supplementary imaging ruled out liver metastasis. He underwent robotic right radical nephrectomy, retroperitoneal lymph node dissection, IVC thrombectomy, and suprarenal cavectomy, using 6-port da Vinci Xi surgical system. Intraoperative ultrasound and Trans-Esophageal Echocardiography were employed to ensure the proper IVC controls and endo-GIA was used for cavectomy. RESULTS: The surgery was completed successfully without intraoperative complication. Operating time was 6 hours and estimated blood loss was 300 cc. Intraoperative ultrasound showed the tip of the thrombus and helped to secure rommel control just above it. After securing/cinching down all controls, IVC was opened and thrombus was removed. Cavectomy was deemed necessary due to multiple areas of tumor adhesions to inner part of IVC. Nephrectomy was completed and all specimens removed through pfannstiel incision. Postoperative course was uneventful and discharged home in 4 days. Baseline GFR was 44 and at discharge was 49 mL/min/1.73m2. Pathology endorsed clear cell RCC (pT3bN0) with negative margins as well as multiple adherent tumors in middle section of IVC (non-invasive). No complication including lower limb edema was reported within 90-day, postoperatively. He is without evidence of disease (NED), 9-month after surgery. CONCLUSIONS: Herein, we are reporting a case of right RCC with level III IVC thrombosis that underwent robotic right radical nephrectomy and suprarenal cavectomy, due to possible infiltration of tumor thrombosis to IVC wall. Source of Funding: none © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e93-e94 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Luis G Medina* More articles by this author Alireza Ghoreifi More articles by this author Hatim Thaker More articles by this author Vinay Duddalwar More articles by this author Hooman Djaladat More articles by this author Expand All Advertisement PDF downloadLoading ...

Factors Affecting Recurrent Deep Vein Thrombosis after Pharmacomechanical Thrombolysis and Left Iliac Vein Stent Placement in Patients with Iliac Vein Compression Syndrome

PurposeThis study evaluated the factors affecting contralateral and ipsilateral recurrent deep vein thrombosis (DVT) after iliac vein stent placement in patients with iliac vein compression syndrome (IVCS). Materials and MethodsData from 130 patients (95 female patients) who underwent catheter-directed thrombolysis and stent placement for IVCS with left lower leg thrombosis at a single institution were retrospectively analyzed. Mean patient age was 69.0 ± 14.0 years old. Median follow-up was 14 months (range, 3–164 months). Anticoagulation therapy was prescribed for 6 months, followed by lifelong antiplatelet therapy. Multivariate logistic regression analysis was performed to evaluate the factors affecting the development of contralateral and ipsilateral recurrent DVT. ResultsSeven patients (5.4%) developed contralateral DVT (median, 26 months; range, 2–61 months), and 11 patients (8.5%) developed ipsilateral DVT (median, 1 month; range, 0–53 months). Stent location (odds ratio [OR], 11.564; 95% confidence interval [CI], 1.159–115.417) and in-stent thrombosis during follow-up (OR, 15.142; 95% CI, 1.406–163.119) were predictors of recurrent contralateral DVT. Thrombophilia (OR, 47.560; 95% CI, 2.369–954.711), remaining inferior vena cava filter (OR, 30.552; 95% CI, 3.495–267.122), and in-stent thrombosis during follow-up (OR, 82.057; 95% CI, 2.915–2309.848) were predictors of ipsilateral DVT. ConclusionsContralateral DVT occurs late and is associated with extension of the iliac vein stent to the inferior vena cava and in-stent thrombosis. Ipsilateral DVT occurs relatively early and is associated with thrombophilia, remaining inferior vena cava filter, and in-stent thrombosis.

Early diagnosis and precision treatment of right ovarian vein and inferior vena cava thrombosis following caesarean section: A case report.

Ovarian vein thrombosis (OVT) is a rare medical complication that is most often diagnosed in the post-partum period. OVT can lead to conditions, including sepsis, inferior vena cava (IVC), pulmonary emboli and mortality. The current study outlines a case of a patient who experienced pain in the lower abdomen and waist without fever postpartum following caesarean section (CS). Plasma FDP, D-Dimer and fibrinogen levels were markedly increased following CS and this was an indicator of the rapid progression of blood coagulation and fibrinolysis. Increased maternal lipid may be one of the risk factors for thrombosis. Based on the clinical presentation, a CT scan demonstrated thrombosis of the right ovarian vein and inferior vena cava, and a diagnosis of OVT and IVC thrombosis was subsequently made. In the current case, an anticoagulant therapy was started with a subcutaneous injection low molecular weight heparin calcium, an intravenous urokinase drip as a thrombolytic agent and implantation of inferior vena cava filters as a novel method of treatment for thrombosis. The patient was discharged from hospital 20 days following treatment in a good condition. The current study reports a case of OVT associated with IVC that was successfully managed without complication.

An Atypical Presentation of IVC Thrombosis

Inferior vena cava (IVC) thrombosis is commonly caused by either a congenital anomaly or an IVC filter that was not previously removed. Other causes include inherited thrombophilia or acquired. It is found in 2.6% - 4% of patients with lower extremity deep vein thrombosis (DVT). The mortality rate of IVC thrombosis is twice as high as that of DVT. Morbidities include post-thrombotic syndrome (PTS), disabling venous claudication, pulmonary embolism, and venous ulceration. In one study the rate of recurrent DVT in iliocaval thrombosis was 73% in those with untreated residual outflow stenosis versus 13% in those who had stenting of residual stenosis. Here we present an atypical case of IVC thrombosis in a young male without any inherited or acquired risk factors.

VENOUS BLOOD INDICES AFTER CAVAPLICATION IN PATIENTS WITH THROMBOSIS OF THE VENA CAVA INFERIOR

Summary. Despite reports of plication with inferior vena cava thrombosis, the venous hemodynamics before and after hardware cavaplication has been not evaluated.&#x0D; The aim of research. Estimate the changes of the venous blood flow indices after complication in patients with vena cava inferior thrombosis.&#x0D; Materials and methods. Quantitative assessment of venous blood flow was performed in 34 patients with inferior vena cava thrombosis before and after incomplete hardware cavaplication. Cavaplication was performed in 11 (32.4 %) patients with non-tumor and in 23 (67.6 %) patients with tumors of the vena cava inferior. For selecting the site of cavaplication, the infrarenal branch of the vena cava inferior directly below the renal veins was prevailed – in 29 (85.3 %) patients, the plication of vena cava inferior lower or higher hepatic veins in 4 (11.8 %) and 1 (2.9 %) patients were performed respectively.&#x0D; Results. Increases of following indices of central and regional hemodynamics after hardware cavaplication were observed, in particular, volume (by 56.5 %) and the linear rate of blood flow (by 40.4 %), minute volume of blood flow (by 16.2 %), cardiac index (by 8.8 %), systolic volume (by 6 %), end-systolic volume index (by 4.5 %), end-diastolic volume index (by 3.9 %) and ejection fraction (by 2.1 %). Instead, the pressure in the inferior vena cava (by 18.2 %) and stroke volume (by 8.9 %) decreased, which, however, was also considered as a positive result of thrombectomy from the vena cava inferior and hardware cavaplication.&#x0D; Conclusions. Within a year after inferior vena plication, indicators of central and peripheral hemodynamics were within the physiological norm and collateral pathways during radioisotope phleboscintigraphy weren`t determined. At the same time, the lumen of the vena cava inferior was completely restored, after 12-18 months, in all cases after plication.

Venous thrombosis and segmental hypoperfusion in amebic liver abscess: MDCT demonstration and its implications.

To report venous thrombosis and associated perfusion defect in amebic liver abscess (ALA) using MDCT. MDCT images of 62 patients with ALA were reviewed for venous thrombosis and associated perfusion abnormalities. The study found 43 (69%) patients with venous thrombosis: portal vein thrombosis (PVT) occurred in 39, hepatic vein thrombosis (HVT) in 37 and inferior vena cava (IVC) thrombosis in 4. Combined PVT and HVT occurred in 33 (77%) patients. The portal vein thrombi remained localized in subsegmental branches in 25 patients and extended to segmental branches in 14. The hepatic vein thrombi were confined to peripheral branches in 18 patients; they progressed to the main trunk in 19 and to the IVC in 4. A wedge-shaped hypoattenuating zone suggesting ischemia was identified in 33 (77%) patients in portal phase: 31 had combined PVT and HVT, 2 had HVT alone, but none had PVT alone. It occurred significantly more often with combined PVT and HVT than HVT alone (p = 0.05). Arterial phase enhancement occurred in 2 of 13 patients with multiphasic CT. All patients were symptomatic despite medical therapy and therefore required percutaneous drainage. About half of the patients were identified with ruptured abscesses. Segmental atrophy was observed in seven of nine patients who underwent follow-up CT. Combined PVT and HVT commonly occur with ALA and often manifests as segmental hypoperfusion in portal venous phase, indicating ischemia. The detection of such events by CT may be indicative of severe disease that requires aggressive management involving percutaneous drainage.

A Case Report and a Descriptive Retrospective Study of Cases of Inferior Vena Cava Thrombosis Diagnosed over a 10-Year Period in a Third Level Hospital

Inferior vena cava thrombosis is an under-recognized entity associated with significant morbidity and mortality. This is the reason why, although the diagnosis is challenging, a high index of suspicion is required. Regarding this condition, we present the case of a 63-year-old man who had repeatedly visited the emergency room suffering from abdominal and back pain and painful lower limb edema. After several tests, including magnetic resonance imaging (MRI), he was diagnosed to have agenesis of left renal vein and inferior vena cava thrombosis, from hypercoagulable state secondary to Antiphospholipid Syndrome. He had anticoagulation treatment with low-molecular-weight heparin with good subsequent evolution. This study sets out a descriptive retrospective study of fifty cases of inferior vena cava thrombosis diagnosed in a third-level hospital in the north of Spain over a ten-year period (2010-2018). The aim of this article is to identify the epidemiology, predisposing factors and symptoms that characterize this entity, in order to be able to achieve an early diagnosis that allows us to initiate immediate treatment, minimizing acute and chronic complications of this disease.

Combined surgical treatment of a patient with kidney cancer stage 4 and coronary artery disease

We report 3 patients with coronary artery disease and kidney cancer followed by thrombosis of inferior vena cava and right cardiac chambers undergoing simultaneous surgery.

Inferior vena cava filter thrombosis: An overview

The leading long term and undervalued impediment associated with inferior vena cava (IVC) filter placement is said to be increased risk of venous thrombosis within and below the IVC. Anticoagulation remains the mainstay treatment preference for the management of deep-vein thrombosis (DVT) and pulmonary embolism (PE). Now and then, it is not viable due to bleeding complications or, occasionally, breakthrough PE associated with this treatment method. In these patients, the development of vena cava filters was a significant advancement in their management. Patients with IVC filters predominantly the ones placed with permanent filters are considered to be at a greater risk for the development of recurrent DVT. Cautious applications of IVC filters, along with retrieval of temporary IVC filters in good time, significantly diminishe the risk of IVC thrombosis. The proof of connection of IVC thrombosis with each of the following factors is known: Population demographics, history of or preexisting hypercoagulable states/anticoagulation, the manner in which the thrombus is assessed, and the duration since the filter employment. Most cases of IVC filter thrombosis are asymptomatic. Contrast-enhanced computed tomography is a preferred imaging modality compared to Doppler sonography. Here in this article, we attempt to discuss briefly the present ideas concerned with the indications of IVC filters along with the prevalence, risks, and management of IVC filter thrombosis.