RESUMO
Imaging of the vena vava prior to the insertion of an inferior vena vava (IVC) filter is mandatory to assess IVC diameter and patency, delineate anatomy and venous anomalies, and to direct filter placement for appropriate deployment and avoidance of complications. The standard imaging technique is vena cavography, although alternative methods to evaluate the inferior vena cava include carbon dioxide venography, transabdominal duplex ultrasound, and intravascular ultrasound. This manuscript will review the anatomical features, technique, and complications of pre-insertion inferior vena cava imaging and discuss alternative methods to evaluate the inferior vena cave prior to filter insertion.
Assuntos
Filtros de Veia Cava , Veia Cava Inferior/diagnóstico por imagem , Angiografia Digital , Dióxido de Carbono , Meios de Contraste , Humanos , Flebografia/métodos , Veia Cava Inferior/anatomia & histologiaRESUMO
OBJECTIVE: To evaluate the possible role of a novel, minimally invasive approach to the management of abdominal pregnancy. METHODS: We hypothesized that sonographically guided feticide without subsequent laparotomy for removal of the fetus and placenta could minimize potential blood loss and would be a reasonable approach in the care of a patient who had a viable 14.5-week abdominal pregnancy with placental implantation directly over the bifurcation of the left common iliac artery. An extensive MEDLINE literature review revealed 1 case of sonographically guided feticide followed 10 days later by uneventful laparotomy for removal of the fetus and placenta. Thus, we used sonographically guided feticide without subsequent laparotomy for removal of the products of conception. RESULTS: The sonographically guided feticide was uneventful, and the patient had no major postprocedure morbidity; a mild ileus was treated conservatively without the need for nasogastric suctioning. No major postprocedure bleeding was encountered. Human chorionic gonadotropin levels dropped precipitously. During the 1.5 years of postprocedure follow-up, the patient reported no major complications. The gestational sac involuted very slowly; amniotic fluid volume appeared normal at 6 months after the procedure but was diminished at the 9-month postprocedure examination. CONCLUSIONS: In cases of previable intra-abdominal pregnancy, sonographically guided feticide may lessen the risk of extensive hemorrhage that can be associated with exploratory laparotomy. Sonographically guided feticide without subsequent exploratory laparotomy can result in a gradual resorption of the products of conception and an uncomplicated recovery. This treatment option should be considered in the management of this potentially life-threatening condition.
Assuntos
Aborto Induzido , Gravidez Abdominal/terapia , Adulto , Feminino , Humanos , Metotrexato/administração & dosagem , Procedimentos Cirúrgicos Minimamente Invasivos , Cloreto de Potássio/administração & dosagem , Gravidez , Gravidez Abdominal/diagnóstico por imagem , Ultrassonografia de Intervenção , Ultrassonografia Pré-NatalRESUMO
Portal vein thrombosis is a relatively rare clinical entity that can result in substantial morbidity and mortality. Because of the risk of intestinal infarction, acute symptomatic portal vein thrombosis requires prompt intervention. Traditional treatment has included anticoagulation and/or systemic thrombolytic therapy. We report the successful management of acute portal vein thrombosis with percutaneous transphepatic thrombolytic therapy. In addition to the potential for improving regional clot lysis through direct infusion of the thrombolytic agent, this method may result in fewer systemic side effects than occur with other available treatment modalities.