Vena Cava Obstruction Research Articles

Defecation Syncope Secondary to Functional Inferior Vena Caval Obstruction During a Valsalva Maneuver

This report describes a case of defecation syncope secondary to functional inferior vena cava (IVC) obstruction. Preoperative hemodynamic assessment revealed a marked decrease in blood pressure and IVC obstruction when the patient performed a Valsalva maneuver. The intraoperative approach included continuous hemodynamic monitoring as well as transesophageal ultrasonography to assess IVC patency during surgical mobilization of the IVC. Functional obstruction of the IVC at the diaphragmatic hiatus was identified, and this obstruction was relieved with extensive mobilization of the IVC and right crural myotomy. This report describes an effective surgical approach to a rare functional disorder involving the IVC.

Idiopathic retroperitoneal fibrosis.

Herein is described a case report of urinary tract obstruction due to idiopathic retroperitoneal fibrosis (IRF) in a 43-year-old man. Recent studies suggest that IRF fits into the broader pathologic heading of chronic periaortitis. Although there may be more than one pathophysiologic mechanism, growing evidence suggests that many cases of IRF are due to an autoallergic reaction to lipid material in the atheromatous aorta. Computed tomographic scanning has supplanted excretory and retrograde urography in the diagnosis of this condition. Ureterolysis and steroids remain the mainstays in the treatment of IRF. Even after successful decompression of urinary obstruction, long-term follow-up is required in these patients because of the possibility of other complications such as vena caval or duodenal obstruction.

Stenting in malignant vena caval obstruction

For patients with recurrent vascular obstruction of the vena cava due to tumor regrowth after chemotherapy or radiation therapy and occasionally surgery, no current therapy is available. With the development of intravascular stenting, a new option becomes available in the treatment of a vena caval syndrome. Twenty-two patients were treated for malignant obstruction of the vena cava by single, double, and triple Z-type metal stents. All patients had been pretreated extensively and their disease was not amenable to other therapeutic techniques at the time of stenting. Correct positioning of the stents was achieved in all patients. In 68% of patients (n = 15), the symptoms completely disappeared without recurrence until death as a result of tumor progression. In 18% of patients (n = 4), a remarkable improvement was observed, but there was no complete disappearance of symptoms. In 14% of patients (n = 3), reocclusion of the vena cava occurred. The median survival time was 3.0 months (range, 1 week to 9 months). The application of Z-type metal stents in patients with recurrent malignant obstruction of the vena cava appears to be a useful palliative procedure.

Acute and Late Vascular Complications Following Chemotherapy for Germ Cell Tumors

Side effects of cisplatin-based chemotherapy for germ cell tumors include myelosup-pression, nephro-, neuro- and ototoxicity. These side effects as well as the pulmonary toxicity of bleomycin are dose-dependent. On the contrary, chemotherapy-associated vascular complications are unpredictable. Whereas Raynaud’s phenomenon is observed in a considerable proportion of patients, myocardial infarction, stroke, and pulmonary embolism appear to occur infrequently. The fact that some patients have been in complete remission at the time of myocardial infarction or cerebrovascular accident argues against a tumor-induced complication and is an argument in favor of a possible causative role of chemotherapy. An alteration of the clotting system and vascular smooth muscle tone as well as an endothelial cell damage are discussed to be pathogenetic mechanisms. Pulmonary embolism, on the contrary, seems to be more frequently associated with inferior vena caval obstruction by tumor masses. Presently there is a debate whether, apart from rare acute vascular events, chemotherapy for testicular cancer leads to a long-term alteration of lipid profile and thereby eventually increases cardiovascular risk.

Clinical manifestation of mediastinal fibrosis and histoplasmosis

We treated 20 patients thought to have mediastinal fibrosis secondary to Histoplasma capsulatum. All but 1 were symptomatic. The most common symptoms were dyspnea (8), hemoptysis (6), postobstructive pneumonia (5), and superior vena caval obstruction (2). Nine patients had severe stenosis of the trachea, carina, or main bronchus. Special stains identified Histoplasma capsulatum in surgical specimens in 9 patients. Surgical procedures were done for 18 of 20 patients (resection of subcarinal mass, 6; right middle and lower lobectomy, 5; carinal pneumonectomy, 4; esophagoplasty, 4; sleeve resection, 3 (with right main bronchus in 1, right lower and middle lobectomy in 1, and carina in 1); right upper lobectomy, 1; middle lobectomy, 1; and bronchoplasty of left main bronchus, 1. There were 4 deaths, 3 after complications of carinal pneumonectomy and 1 in a patient with tracheobronchial obstruction that could not be dilated. Two patients were treated with amphotericin and 4 with ketoconazole. Sclerosing mediastinitis secondary to histoplasmosis presents tremendous surgical challenges because of the intense fibrosis encountered. Bronchoplastic procedures are possible in spite of the intense fibrosis. High mortality rates after carinal resection may be encountered. The exact role of antifungal therapy is as yet undefined.

Chronic fibrosing mediastinitis and superior vena caval obstruction from blastomycosis

Chronic fibrosing mediastinitis is most commonly a complication of granulomatous disease caused by histoplasmosis. We report a case of Blastomyces dermatitidis causing superior vena caval obstruction from fibrosing mediastinitis.

Fast Magnetic Resonance Imaging in the Evaluation of Tumoral Obstructions of the Inferior Vena Cava

A prospective study was conducted on 9 patients with suspected obstruction of the inferior vena cava on ultrasonography, dynamic computerized tomography and/or inferior venacavography during the course of a retroperitonal tumor to assess the value of magnetic resonance imaging with gradient echo sequences. The findings on gradient echo magnetic resonance imaging were compared with the other imaging modalities and surgical or necropsy results. Our results suggest that gradient echo magnetic resonance imaging is the most appropriate imaging modality to diagnose and delineate the extent of inferior vena caval obstruction.

Right-sided hydrothorax and central venous catheters in extremely low birthweight infants.

Central venous catheters (CVCs) have become more common in the care of very low birthweight newborns. Nutrition is enhanced, fluid delivery is more secure, and stress from the intervention of starting new IVs is reduced. Complications of these devices include infection, thrombus or embolus, damage to vessels and organs, and extravascular collections of fluid. Pleural fluid collections can occur due to superior vena caval obstruction with obstruction of lymphatic drainage, and erosion or perforation of the catheter through the vein into the pleural space. Three infants weighing less than 1000 gm had CVCs placed in an antecubital vein. Severe respiratory compromise developed in 1 at 5, 1 at 6, and 1 at 40 hours after line placement, and chest radiograph suggested fluid in the right pleural space. Milky fluid was found in two cases in which the infants received lipid emulsion and parenteral nutrition fluid (PNF). Bright yellow fluid, resembling PNF, was found in the third, not receiving lipids. None of the patients was enterally fed. The tips of the CVCs were adjusted to a more peripheral location and there was no recurrence of pleural fluid, nor were signs of superior vena cava syndrome seen. Etiologies for the unilateral hydrothorax include vein perforation and erosion, but another cause is discussed. A right pleural fluid collection in a patient with a CVC tip in the right subclavian vein is a serious problem, which may be solved with repositioning of the CVC instead of removal.

Diagnosis of Superior Vena Caval Obstruction by Transesophageal Echocardiography

Superior vena caval (SVC) syndrome may be caused by extravascular compression or intravascular obstruction. Knowing the mechanism of SVC syndrome enables the physician to choose appropriate treatment. Transesophageal echocardiography (TEE) is a safe bedside procedure that is excellent for evaluating the SVC and its surrounding structures. We report the valuable role of TEE in demonstrating the mechanism of SVC syndrome.

Bleeding Duodenal Varices in a Patient with Behcet's Disease: A Case Report

Bleeding Duodenal Varices in a Patient with Behcet's Disease: A Case Report

Thrombose de la veine cave supérieure après cathétérisation prolongée. Traitement par retrait progressif du cathéter et association urokinase-héparine

A retrospective study of 13 cases of complete superior vena cava thrombosis due to prolonged catheterization is reported. All the polyurethane catheters had been inserted by anaesthetists in theatre between January 1985 and December 1989, using Seldinger's technique. On the 10th day after the first catheter had been placed, the catheter was replaced by using a guide wire. Superior vena cava obstruction was diagnosed clinically (eyelid, neck, facial and upper limb oedema, cyanosis, collateral venous circulation, lack of blood reflux in the catheter). The clinical diagnosis was confirmed by phlebography. Treatment consisted in administration of urokinase (1 500 IU · kg −1 · h −1), together with 10 000 to 25 000 IU · day −1 of heparin, both being injected via the catheter. The catheter was removed progressively (1 cm every 2 to 4 h). As soon as a venous pressure curve was obtained, the catheter was completely removed. Overall 8 784 catheters were inserted during that period. The incidence of superior vena caval obstruction may therefore be estimated to be 1.48 per 1 000 catheters. The catheters remained in place up to a mean of 14.75 ± 9.6 days before the obstruction occurred. Treatment with urokinase and heparin lasted a mean of 2.53 ± 1 days. The clinical picture returned to normal in all 13 patients. Phlebography carried out in three of them, after treatment, showed an excellent degree of venous repermeability. Thrombolysis was confirmed by the increase in the concentration of D-dimers, without any decrease in fibrinogen concentration. There were five haemorrhagic complications, including two haematomas of the psoas muscle, one of which required surgical drainage. This treatment with small doses of urokinase combined with heparin and the progressive removal of the catheter was therefore efficient in freeing the superior vena cava from iatrogenic thrombosis.

Superior Vena Caval Obstruction: King Khalid University Hospital Experience

A five year experience in 21 patients with superior vena caval obstruction (SVCO) was reviwed. SVCO was due to benign conditions in four patients (19%) and malignant tumors in 17 patients (81%). Lymphoma and lung cancer were the most common causes encountered. The most common symptoms and signs were facial swelling, shortness of breath, jugular venous distention, swelling of face and arms, and engorgement of thoracic veins. Benign disorders had a longer duration of symptoms before presentation and required longer time to make the diagnosis than in malignant disorders. No serious complications resulted from the superior vena cava obstruction itself or the investigate procedures leading to the diagnosis. Prognosis and response to treatment were dependent on the underlying cause of SVCO. Chemotherapy was effective in induction of complete regression of SVCO in the majority of patients with underlying malignant disorders. We conclude that SVCO should be approached invasively for diagnosis and tissue diagnosis of the underlying disorder should dictate the appropriate therapy.

Angioimmunoblastic Lymphadenopathy Presenting as Superior Vena Caval Obstruction

A 60-year-old man presented with features of superior vena cava (SVC) obstruction. On evaluation, he was diagnosed as having angioimmunoblastic lymphadenopathy with dysproteinemia (AILD). SVC obstruction due to AILD, to our knowledge, has not been described.

Collateral pathways observed by radionuclide superior cavography in 70 patients with superior vena caval obstruction : Muramatsu T, Miyamae T, Dohi Y. Second Department of Internal Medicine, Saitama Medical School, 38 Moroyama, Iruma-gun, Saitama, 350-04. Clin Nucl Med 1991;16:332-6

Collateral pathways observed by radionuclide superior cavography in 70 patients with superior vena caval obstruction : Muramatsu T, Miyamae T, Dohi Y. Second Department of Internal Medicine, Saitama Medical School, 38 Moroyama, Iruma-gun, Saitama, 350-04. Clin Nucl Med 1991;16:332-6

Diffuse uptake of osteotropic radionuclide in the breast secondary to superior vena caval obstruction : Swayne LC, Bajakian RL. Department of Diagnostic Radiology, Morristown Memorial Hospital, 100 Madison Avenue, Morristown, NJ 07960. Clin Nucl Med 1990;15:110–111

Diffuse uptake of osteotropic radionuclide in the breast secondary to superior vena caval obstruction : Swayne LC, Bajakian RL. Department of Diagnostic Radiology, Morristown Memorial Hospital, 100 Madison Avenue, Morristown, NJ 07960. Clin Nucl Med 1990;15:110–111

Collateral pathways observed by radionuclide superior cavography in 70 patients with superior vena caval obstruction.

Schematic representations of collateral pathways that have developed in association with superior vena caval obstruction have been established in studies using radionuclide superior cavography (RNSC). However, these were hampered by the poor resolution of earlier scintillation cameras. Using a modern scintillation camera, we performed RNSC in 70 patients with obstruction of the superior vena caval system, and examined the differences in collateral pathways in the presence or absence of obstruction of the azygos vein. RNSC visualized the site of obstruction and collateral pathways far more readily than in prior studies. When the orifice of the azygos vein was not obstructed, collateral flow drained into the azygos system. When it was obstructed, however, the collaterals drained into the inferior vena caval system. An important collateral pathway comprising the contralateral brachiocephalic vein and the jugular venous arch was also found, which has not previously been reported. Our diagrams of collateral circulation may provide a means of determining the site of obstruction in the superior vena caval system by RNSC.

Angiographic Findings of Great Vessel Involvement in Behçet's Disease

Behçet's disease (BD) is a systemic disorder and vasculitis is a common pathologic finding that may give clues in the understanding of the vascular involvement. During the period between 1968 and 1988, 30 patients with BD had vascular complications that were diagnosed by conventional venography (indud ing cavography) (in 15 patients prior to 1985) and then by computed tomography, digital subtraction angiography (DSA), and sonography in the remaining 15 patients for the last four years . The group included 13 patients with superior vena caval obstruction (SVCO), 3 with inferior vena caval obstruction (IVCO), 4 with both SVCO and IVCO, 2 with IVCO and hepatic veins obstruction (Budd-Chiari syndrome, BCS), 1 patient with SVCO, IVCO, and BCS, 1 with BCS, 1 with portal vein and IVCO, 4 patients pulmonary artery occlusion (1 of them also had pulmonary artery aneurysm), and finally, 1 patient with right illiac artery aneurysm. In many cases, classical clinical features of BD were not evident when great vessels were involved. The authors concluded that DSA and sonography are the preferred method in demonstrating vascular complications of BD and that BD should be taken into consideration when a patient presents with a great vessel involvement due to unknown cause.

Intermittent inferior vena caval obstruction: an unusual cause demonstrated by ultrasound

The syndrome of inferior vena caval obstruction may result from a number of diverse causes (Missal et al, 1965; Siqueira-Filho et al, 1976), and the clinical presentation and course depend, with some exceptions, upon the aetiology and level of obstruction. Thrombosis within the inferior vena cava (IVC) is one of the more common causes and may be primary or secondary to abdominal infection, abdominal trauma or surgery, hypercoagulable states or extension from femoral or iliac thrombophlebitis.

Malignant thymoma presenting as intracardiac tumor and superior vena caval obstruction

A case of malignant thymoma with intracardiac infiltration and intrinsic superior vena caval obstruction due to the tumor is reported. Intracardiac invasion by a thymoma is rare and for this reason is believed worthy of a report.

Superior Vena Caval Obstruction in Patients with Gut Failure Receiving Home Parenteral Nutrition

Clinical suspicion and venographic conformation were used to diagnose 15 cases of superior vena caval obstruction (SVCO) in 107 home parenteral nutrition (HPN) patients over 379 cumulative years of HPN (3.9 cases/100 patient-years). Patients with SVCO had been on HPN a mean of 51.5 months and had used 6.2 (range 1-50) central catheters, including short- and long-term, before SVCO was diagnosed. The frequency of inflammatory bowel disease (IBD) with SVCO was approximately the same as that in our general HPN population. Positive blood cultures were present immediately preceding the diagnosis of SVCO in 40% (six of 15) of cases. Atypical line placements were noted in two cases. The most common management strategies employed were conversion to enteral feedings in five patients and placement of a new catheter directly into the right atrium by thoracotomy in another five patients. Two of the five with right atrial catheters experienced a postpericardiotomy syndrome (fever, pericardial rub, and pulmonary infiltrates) that responded promptly to indomethacin. The most significant long-term sequela of SVCO was the need for a left jugular vein to right atrial appendage bypass in one patient with chronic venous congestion from her SVCO. Once the SVCO is confirmed, systemic heparinization provides immediate antithrombotic effect and minimizes the risk of pulmonary embolism. The use of streptokinase may result in rapid thrombolysis.