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1.
Clin Nucl Med ; 46(2): 153-155, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-32969912

RESUMO

ABSTRACT: Leiomyosarcomas originating from the inferior vena cava are very rare malignant tumors with an extremely poor prognosis. We report FDG PET/CT findings of pathology-proven hepatic metastases from leiomyosarcoma originating from the inferior vena cava in a young woman whose initial presentation was worsening abdominal and chest pain.


Assuntos
Fluordesoxiglucose F18 , Leiomiossarcoma/patologia , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/secundário , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Vasculares/patologia , Veia Cava Inferior/patologia , Feminino , Humanos
2.
Vasa ; 50(1): 2-10, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33138741

RESUMO

Intravascular ultrasound (IVUS) has been used extensively in coronary applications. Its use in venous applications has increased as endovascular therapy has increasingly become the mainstay therapy for central venous diseases. IVUS has been used for both diagnostic and therapeutic purposes in managing venous stenotic disease, venous occlusive disease, and IVC filter placement and removal. IVUS has been proven to be effective in providing detailed measurement of the venous anatomy, which aid in determining the appropriate size and the approach for venous stent placement. In IVC filter placement, IVUS can provide detailed measurement and guide IVC filter placement in emergent and critical care settings. It also has certain utility in filter removal. At any rate, to date there are only a few studies examining its impact on patient outcomes. Prospective randomized controlled trials are warranted in the future.


Assuntos
Ultrassonografia de Intervenção/métodos , Filtros de Veia Cava , Veia Cava Inferior/diagnóstico por imagem , Trombose Venosa/terapia , Idoso , Constrição Patológica , Veia Femoral/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento , Trombose Venosa/diagnóstico por imagem
3.
Ann Vasc Surg ; 70: 567.e13-567.e17, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32795651

RESUMO

BACKGROUND: Leiomyosarcoma of the inferior vena cava (IVC) is a rare smooth muscle neoplasm typically presenting in the fifth to sixth decades of life with both intraluminal and extraluminal growth patterns. Surgical resection remains the gold standard for nonmetastatic disease and often requires vascular reconstruction. We present an atypical case of leiomyosarcoma involving both the IVC and infrarenal abdominal aorta necessitating reconstruction with intraoperative veno-venous bypass. METHODS: A 63-year-old man initially presenting with back pain was found to have a large mass adjacent to the IVC on MRI, subsequently confirmed to be leiomyosarcoma by biopsy. After 6 months of neoadjuvant chemotherapy, the patient was taken for resection. However, intraoperatively the tumor was found to involve the aorta necessitating combined aorto-caval reconstruction. To facilitate en-bloc resection of the tumor, the aorta was reconstructed first followed by the inferior vena cava using veno-venous bypass. RESULTS: Postoperatively, the patient was taken to the intensive care unit for resuscitation and had an uncomplicated hospital course. He was discharged to rehab 6 days postoperatively and at one year remains free of significant tumor burden with patent aorto-caval bypass grafts. CONCLUSIONS: Primary leiomyosarcoma of the IVC is estimated to have aortic involvement in <10% of cases and concurrent aorto-caval reconstruction can be a well-tolerated option in good surgical candidates. Furthermore, veno-venous bypass can be a useful tool for accomplishing successful oncologic resections. With interdisciplinary collaboration between surgical oncologists, urologists, and vascular surgeons, difficult pathologies can be addressed with good patient outcomes.


Assuntos
Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Leiomiossarcoma/cirurgia , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Quimioterapia Adjuvante , Humanos , Leiomiossarcoma/diagnóstico por imagem , Leiomiossarcoma/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Resultado do Tratamento , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/patologia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia
4.
Acta Radiol ; 62(1): 34-41, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32241170

RESUMO

BACKGROUND: Acute pulmonary embolism (PE) is a common disease with a high mortality. Computed tomographic pulmonary angiography (CTPA) represents the current gold standard for the evaluation of patients with suspected PE. PURPOSE: To search possible CTPA predictors of 24-h and 30-day mortality in PE. MATERIAL AND METHODS: Overall, 224 patients with PE (46.4% women, mean age 64.7 ± 16.7 years) were acquired. CTPA was performed on a multi-slice CT scanner. The following radiological parameters were estimated: thrombotic obstruction index; diameter of the pulmonary trunk (mm); short axis ratio of right ventricle/left ventricle; diameter of the azygos vein (mm); diameter of the superior and inferior vena cava (mm); and reflux of contrast medium into the inferior vena cava (IVC). RESULTS: Patients who died within the first 24 h after admission (n = 32, 14.3%) showed a reflux grade 3 into IVC more often than survivors (odds ratio [OR] 7.6, 95% confidence interval [CI] 3.3-17.7; P < 0.001). Other relevant CTPA parameters were diameter of IVC (OR 1.1, 95% CI 1.01-1.21; P = 0.034) and diameter of the pulmonary trunk (OR 0.91, 95% CI 0.82-1.01, P = 0.074), whereas the Mastora score showed nearly no influence (OR 1.01, 95% CI 0.99-1.02, P = 0.406). Furthermore, 61 (27.2%) patients died within the first 30 days after admission. These patients showed a reflux grade 3 into IVC more often than survivors (OR 3.4, 95% CI 1.7-7.0; P = 0.001). Other CTPA parameters, such as diameter of IVC (OR 1.04, 95% CI 0.97-1.12; P = 0.277) and diameter of the pulmonary trunk (OR 0.96, 95% CI 0.89-1.04; P = 0.291), seem to have no relevant influence, whereas Mastora score did (OR 0.99, 95% CI 0.976-0.999, P = 0.045). CONCLUSION: Subhepatic contrast reflux into IVC is a strong predictor of 24-h and 30-day mortality in patients with acute PE.


Assuntos
Angiografia por Tomografia Computadorizada/métodos , Meios de Contraste/farmacocinética , Embolia Pulmonar/mortalidade , Intensificação de Imagem Radiográfica/métodos , Veia Cava Inferior/diagnóstico por imagem , Doença Aguda , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos , Índice de Gravidade de Doença , Veia Cava Inferior/fisiopatologia
5.
Clin Imaging ; 69: 120-125, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32717539

RESUMO

PURPOSE: The aim of this study was to investigate the effect of the cardiac cycle on the vena cava and determine the phase of measuring maximum diameters. METHODS: A total of 152 patients who underwent cardiac computed tomography (CT) were included. Patients' basic information was collected. The major axis, minor axis, and cross-sectional area (CSA) of the vena cava in 10 phases reconstructed at 10% step from 5% to 95% R-R interval were measured in four planes (SVC1 layer: the bifurcation of the pulmonary artery; SVC2 layer: the superior vena cava (SVC) into the right atrium; IVC1 layer: the intersection of the inferior vena cava (IVC) and the right atrium; IVC2 layer: the IVC into the anterior hepatic plane). The difference in vena cava diameters between cardiac cycles was determined using the linear mixed model. RESULTS: The variations in diameter and CSA of the SVC in cardiac cycles were statistically significant (p < 0.05), while those of the suprahepatic IVC were not. In the SVC1 layer, the maximum value of the SVC major and minor axes was observed in 85% and 45% phases, respectively, while that in the SVC2 layer was observed in 45% phases. The maximum SVC diameters in the SVC1 and SVC2 layers were 19.48 ± 2.57 mm and 17.43 ± 3.09 mm, respectively. The SVC and IVC diameters and CSA were positively correlated with the body surface area in the linear mixed model. CONCLUSION: The maximum SVC diameter and CSA were mostly observed in 45% phase, which provides a reference for selecting the best phase to measure the abnormality of vena cava diameter in the future.


Assuntos
Cardiopatias , Veia Cava Superior , Adulto , Átrios do Coração , Humanos , Tomografia Computadorizada por Raios X , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Superior/diagnóstico por imagem
6.
Vasc Endovascular Surg ; 55(1): 69-72, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32862786

RESUMO

Venous stent placement of symptomatic occlusion of the superior and inferior vena cava is considered the treatment of choice in malignant disease because this technique can restore patency and achieve a relief of symptoms. However, tumor thrombus extension into the right atrium harbors the potential risk of stent migration and perforation. One strategy to avoid this potential life-threatening complication could be the placement of a bridging stent from the superior vena cava-to-inferior vena cava. This case reports describes the superior vena cava-to-inferior vena cava bridging stent technique in 2 patients with malignant occlusion of the superior and inferior vena cava. Special considerations such as technical details of the devices and potential complications are discussed.


Assuntos
Procedimentos Endovasculares/instrumentação , Átrios do Coração , Neoplasias/complicações , Stents , Síndrome da Veia Cava Superior/terapia , Veia Cava Inferior , Veia Cava Superior , Trombose Venosa/terapia , Idoso , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/patologia , Humanos , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias/diagnóstico por imagem , Neoplasias/patologia , Síndrome da Veia Cava Superior/diagnóstico por imagem , Síndrome da Veia Cava Superior/etiologia , Síndrome da Veia Cava Superior/patologia , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/patologia , Veia Cava Superior/diagnóstico por imagem , Veia Cava Superior/patologia , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/patologia
7.
Angiol Sosud Khir ; 26(4): 63-69, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332307

RESUMO

Described in the article is a clinical case report regarding successful surgical treatment of a female patient with total floating thrombosis of the inferior vena cava and thrombosis of the right atrium, complicated by pulmonary embolism. Our patient was a 42-year-old woman presenting with a clinical pattern of iliofemoral thrombosis. The examination revealed floating thrombosis of the inferior venal cava, right atrial thrombosis, and massive pulmonary embolism. Given the presence of absolute contraindications to systemic thrombolysis, it was decided to carry out surgical treatment by means of a hybrid-operation procedure. The woman underwent successful direct thrombectomy from the right-atrium cavity and branches of the pulmonary artery in conditions of artificial blood circulation, simultaneously accompanied by removing the floating thrombus from the inferior vena cava with the help of the 'Track' system, as well as by placement of a cava filter. Also presented herein is a review of the world experience gained in treating this pathology, followed by substantiation of using a hybrid approach for achieving an optimal clinical outcome.


Assuntos
Embolia Pulmonar , Trombose , Filtros de Veia Cava , Adulto , Feminino , Humanos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirurgia , Trombectomia , Trombose/diagnóstico , Trombose/etiologia , Trombose/cirurgia , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
8.
Angiol Sosud Khir ; 26(4): 149-154, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33332317

RESUMO

Despite the fact that prevention and treatment of venous thromboembolic complications are based on anticoagulant therapy in cases where there are contraindications, complications, as well as in case of inefficiency of the carried out anticoagulant therapy, installation of a cava filter is indicated. The necessity of subsequent retrieval of this device from the inferior vena cava is associated with a potential risk of the development of complications. Analysed herein is a case series concerning management of 4 patients undergoing treatment from February 2015 to March 2017. Attempts of endovascular retrieval of the cava filter turned out unsuccessful. The patients were therefore subjected to total laparoscopic retrieval of the cava filter. The time required for phlebotomy, retrieval of the filter, and suturing of the phlebectomy zone ranged from 32 to 45 min. The maximal blood loss amounted to 300 ml, not requiring transfusion of blood preparations. Neither was required conversion to laparotomy in any case. No significant systemic or wound complications in the postoperative period were observed. A conclusion drawn is that in case of failed attempts at endovascular retrieval, given that a surgical team has broad experience in performing laparoscopic and angiosurgical operations, total laparoscopic retrieval of a cava filter may be considered a relatively safe minimally invasive method of managing the patient cohort concerned.


Assuntos
Laparoscopia , Embolia Pulmonar , Filtros de Veia Cava , Remoção de Dispositivo , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/cirurgia
9.
BMC Surg ; 20(1): 272, 2020 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-33160340

RESUMO

BACKGROUND: Metastatic germ cell cancer of the testis is characterized by favorable prognosis since effective treatment methods are available even in cases of extensive disease. Retroperitoneal masses frequently encroach major blood vessels requiring a vascular intervention usually performed in association with the post-chemotherapy retroperitoneal lymph node dissection (RPLND). Reported clinical case describes a successful pre-treatment endovascular surgery for abdominal aortic rupture allowing for full-dose systemic chemotherapy administration, and subsequent radical surgical intervention at primary tumor site as well as metastatic retroperitoneal lymph node dissection including the reconstruction of inferior caval vein. CASE PRESENTATION: Patient presented with left-sided testicular tumor and voluminous retroperitoneal mass with vascular involvement. Soon after the patient had been admitted for the first cycle of cisplatin-based chemotherapy, computed tomographic angiography (CTA) revealed a dorsal aortic wall rupture with active extravasation and irregular pseudoaneurysmatic dilatation of the aorta below the leak area. Retroperitoneal intratumoral hemorrhage associated with the bilateral iliac venous thrombosis required an endovascular repair procedure of infrarenal abdominal aorta. CONCLUSIONS: Following the successful endovascular aortic repair 3 cycles of BEP (bleomycin, etoposide, cisplatin) regimen were administered with subsequent delayed left radical orchiectomy and RPLND associated with vena cava inferior (VCI) resection. Reconstruction of VCI was originally not deemed necessary as collateral blood flow appeared sufficient, however, intraoperative complications resulted in the need for unilateral VCI reconstruction, using the interposed bypass between right common iliac vein and infrarenal segment of VCI. Histopathologic examination of the attained specimen detected no vital cancer structures. The patient remains disease-free 18 months after the RPLND.


Assuntos
Ruptura Aórtica/cirurgia , Procedimentos Endovasculares/métodos , Hemorragia/cirurgia , Neoplasias Embrionárias de Células Germinativas , Neoplasias Retroperitoneais , Neoplasias Testiculares , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Aorta Abdominal/diagnóstico por imagem , Aorta Abdominal/patologia , Aorta Abdominal/cirurgia , Ruptura Aórtica/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/patologia , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Angiografia por Tomografia Computadorizada , Etoposídeo/administração & dosagem , Hemorragia/diagnóstico por imagem , Hemorragia/etiologia , Humanos , Veia Ilíaca , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Embrionárias de Células Germinativas/tratamento farmacológico , Neoplasias Embrionárias de Células Germinativas/secundário , Neoplasias Embrionárias de Células Germinativas/cirurgia , Orquiectomia , Neoplasias Retroperitoneais/diagnóstico por imagem , Neoplasias Retroperitoneais/tratamento farmacológico , Neoplasias Retroperitoneais/secundário , Neoplasias Retroperitoneais/cirurgia , Neoplasias Testiculares/diagnóstico por imagem , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologia , Neoplasias Testiculares/cirurgia , Neoplasias Vasculares/diagnóstico por imagem , Neoplasias Vasculares/tratamento farmacológico , Neoplasias Vasculares/secundário , Neoplasias Vasculares/cirurgia , Veia Cava Inferior/cirurgia , Trombose Venosa/cirurgia
10.
J Vasc Interv Radiol ; 31(12): 2060-2065, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33153863

RESUMO

PURPOSE: To report safety and efficacy of a skip stent technique using nitinol stents in patients with chronic bilateral iliocaval venous occlusions. MATERIALS AND METHODS: A retrospective analysis of 48 consecutive patients (32 men; mean age, 40.7 years; age range, 18-68 years) with chronic bilateral iliocaval obstructions treated using a nonoverlapping stent technique was conducted at a single center. None of the patients had May-Thurner syndrome. Iliocaval confluence was treated by deploying a nitinol stent in inferior vena cava (IVC) and a nitinol stent in each common iliac vein close to the caval stent. Patency of stents was assessed by duplex US at 2 weeks, 3 months, and 6 months and yearly thereafter. RESULTS: Recanalization and stent reconstruction was technically successful in 47 (98%) patients. The sinus-XL venous stent was used to treat IVC (95 [100%]). Common iliac and external iliac veins were treated with sinus-Venous and VENOVO stents (80 [83%] and 16 [17%] limbs, respectively). External iliac and common femoral veins were treated with sinus-Venous and VENOVO stents (83 [92%] and 7 [18%] limbs, respectively). Early thrombosis (< 30 days) of the iliac vein with stent occurred in 2 limbs. Cumulative primary, assisted primary, and secondary patency rates at 30 months were 74%, 83%, and 97%. CONCLUSIONS: Findings of this study suggest that leaving a skipped lesion at the level of iliocaval confluence may not adversely affect stent patency. Patency rates were comparable with other reported techniques of stent reconstruction at the level of iliocaval confluence.


Assuntos
Procedimentos Endovasculares/instrumentação , Veia Ilíaca , Stents Metálicos Autoexpansíveis , Doenças Vasculares/terapia , Veia Cava Inferior , Adolescente , Adulto , Idoso , Ligas , Doença Crônica , Constrição Patológica , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Veia Ilíaca/diagnóstico por imagem , Veia Ilíaca/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Doenças Vasculares/diagnóstico por imagem , Doenças Vasculares/fisiopatologia , Grau de Desobstrução Vascular , Veia Cava Inferior/diagnóstico por imagem , Veia Cava Inferior/fisiopatologia , Adulto Jovem
11.
J Vasc Interv Radiol ; 31(12): 2073-2080, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33189540

RESUMO

PURPOSE: To examine spinal interaction types and prevalence of inferior vena cava (IVC) filters in patients presenting for complex filter removal. MATERIALS AND METHODS: The records of 447 patients presenting for complex removal of IVC filters were reviewed, including patient demographics, IVC filter dwell time, filter fracture status, and computed tomography (CT) evidence of filter interaction with the spine. Spinal interaction was defined as a filter strut touching or penetrating into the vertebral body or disc. Patients with evidence of filter penetration and spinal interaction had abdominal CT that preceded filter removal assessed by 2 interventional radiologists to categorize the type of spinal interaction, including bony reaction and osteophyte formation. RESULTS: CT evidence of spinal interaction by the filter was found in 18% of patients (80/447). Interaction with the spine was more common in single point of fixation filters than filters with rails (P = .007) and was more likely in filters with round wires than flat wires (P = .0007). Patients with interaction had longer dwell times (mean [SD] 5.7 [4.46] y) compared with patients without interaction (mean [SD] 3.2 [3.85] y); this relationship was significant (P < .0001). Women were more likely than men to experience filter/spine interaction (P = .04). Filters with spinal interaction were more likely to be fractured (P = .001). Filter interaction was found in 38% (30/78) of patients with symptoms, including chest and back pain, compared with 14% (50/369) of patients without symptoms (P < .0001, odds ratio 3.99). CONCLUSIONS: Retrievable IVC filters may interact with the spine. These interactions are associated with longer filter dwell times, female sex, and round wire filter construction.


Assuntos
Remoção de Dispositivo , Migração de Corpo Estranho/cirurgia , Disco Intervertebral , Falha de Prótese , Filtros de Veia Cava , Veia Cava Inferior , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/efeitos adversos , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/epidemiologia , Humanos , Disco Intervertebral/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Philadelphia/epidemiologia , Prevalência , Desenho de Prótese , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Adulto Jovem
12.
J Assoc Physicians India ; 68(11): 74-76, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33187045

RESUMO

Leiyomyosarcoma of vascular origin is rarely seen occurring in the Inferior Vena Cava. We report a rare case of a young male with giant retroperitoneal leiyomyosarcoma which extended into the right atrium.


Assuntos
Fibrilação Atrial , Leiomiossarcoma , Neoplasias Vasculares , Átrios do Coração/diagnóstico por imagem , Humanos , Leiomiossarcoma/diagnóstico por imagem , Masculino , Veia Cava Inferior/diagnóstico por imagem
13.
Kyobu Geka ; 73(11): 910-913, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33130712

RESUMO

Cardiac metastasis from renal cell carcinoma (RCC) is relatively rare. It generally initiates from the right atrium with or without involvement of the inferior vena cava (IVC). Here, we report a case of metastasis of isolated clear cell RCC to the left ventricular( LV) papillary muscle. An 84-year-old male who had undergone renal resection due to RCC 19 years before, presented to our hospital with suspected LV tumor by echocardiography. The tumor was located near the posterior papillary muscle, with a size of 15×12 mm. The patient underwent resection of the LV tumor. Pathologically, the tumor was diagnosed as clear cell RCC. The postoperative course was stable, and he did not require any chemotherapy. Although there is no definite evidence of the mechanisms of metastasis, the tumor was supposed to metastasize lymphogeneously.


Assuntos
Carcinoma de Células Renais , Neoplasias Cardíacas , Neoplasias Renais , Idoso de 80 Anos ou mais , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/cirurgia , Neoplasias Cardíacas/diagnóstico por imagem , Neoplasias Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/cirurgia , Masculino , Veia Cava Inferior
14.
Zhonghua Yi Xue Za Zhi ; 100(43): 3425-3430, 2020 Nov 24.
Artigo em Chinês | MEDLINE | ID: mdl-33238673

RESUMO

Objective: To evaluate the influence of preoperative fasting duration on blood volume status of pediatric patients during induction based on ultrasonic technique. Methods: One hundred and ten pediatric patients, scheduled for elective operation in the Second Affiliated Hospital & Yuying Children's Hospital, were recruited during January and October in 2018. After sedation by inhalation of sevoflurane, the maximum (expiratory) and minimum (inspiratory) diameter of inferior vena cava (IVC(max), IVC(min)) and aorta velocity-time integral (VTI) in apical five-chamber cardiac view were measured with an ultrasound machine. Respiratory variabilities of these parameters were further calculated. Furthermore, passive leg raising (PLR) test was performed and above measurements/calculations were repeated. The correlation between the duration of fasting and IVC respiratory variations index (IVC(RVI)) or aortic VTI variability (ΔVTI) was then analyzed. Results: Before PLR, IVC(max), IVC(min) and IVC(RVI) were (0.78±0.19), (0.43±0.15) cm and 0.45±0.12, respectively. After PLR, IVC(max) and IVC(min) increased to (0.94±0.20), (0.55±0.18) cm, while IVC(RVI) decreased to 0.42±0.13, the differences were statistically significant (t=15.66, 10.85, 3.14, all P<0.05). However, IVC(max), IVC(min) and IVC(RVI) were not significantly correlated with the duration of fasting analyzed by linear regression (before PLR: r=0.052, 0.163, 0.171; after PLR, r=0.062, 0.169, 0.165, all P>0.05). Before PLR, expiratory aortic VTI (VTI(max)), inspiratory aortic VTI (VTI(min)) and ΔVTI were 21±5, 17±4 and 17±8, respectively. After PLR, the VTI(max) and VTI(min) significantly increased to 23±5 and 19±4 (t=13.60, 10.43, all P<0.05), but ΔVTI was not changed significantly, which was 17±8(t=0.34, P>0.05). Linear regression analysis showed that VTI(max), VTI(min) and ΔVTI were not significantly correlated with the duration of fasting (before PLR: r=0.111, 0.100, 0.047; after PLR: r=0.003, 0.033, 0.073, all P>0.05). Further multiple linear regression analysis indicated that, age and body weight were independent factors influencing IVC(RVI) and ΔVTI before and after PLR (IVC(RVI): ß=-0.441, 0.515, -0.451, 0.507; ΔVTI: ß=-0.442, 0.545, -2.422, 2.850; all P<0.05). However, the duration of fasting was not correlated with IVC(RVI) and ΔVTI after adjusting the age and weight (IVC(RVI): ß=0.177, 0.160; ΔVTI: ß=0.037, 0.054; all P>0.05). Conclusion: Age and weight, but not preoperative fasting duration, are correlated with respiratory variabilities of inferior vena cava diameter and aortic VTI in pediatric patients.


Assuntos
Jejum , Ultrassom , Volume Sanguíneo , Criança , Humanos , Ultrassonografia , Veia Cava Inferior/diagnóstico por imagem
15.
Chirurgia (Bucur) ; 115(5): 665-669, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33138904

RESUMO

Duplication of inferior vena cava (DIVC) is a rare congenital malformation of extreme importance for vascular and urology surgeons, interventional radiologists. Oftentimes it goes unnoticed and is diagnosed incidentally at a routine or emergency CT-scan when complications occur due to associated congenital malformations. We present a case of a 70-year-old male patient who was admitted into the emergency room (ER) accusing abdominal pain. He was diagnosed with an intestinal obstruction due to a left paraduodenal hernia (LPDH), associated with a DIVC. The reviewing the literature led to concluding that DIVC is not the cause of LPDH.


Assuntos
/etiologia , Obstrução Intestinal , Malformações Vasculares/complicações , Veia Cava Inferior/anormalidades , Dor Abdominal/etiologia , Idoso , Humanos , Obstrução Intestinal/etiologia , Masculino , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(43): e22880, 2020 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-33120831

RESUMO

The collapsibility and diameter of the inferior vena cava (IVC) are known to predict the volume state in critically ill patients. However, no study has examined the prognostic value of the IVC diameter ratio measured on computed tomography (CT) in patients with septic shock. A retrospective observational study was conducted on adult septic shock patients visiting the emergency department at a university hospital in Korea. The IVC diameter ratio was calculated by dividing the maximal transverse and anteroposterior diameters. Multivariable logistic regression analysis was conducted to investigate whether the IVC diameter ratio predicted in-hospital mortality. The area under the curve (AUC) was calculated, and the sensitivity, specificity, positive predictive value, and negative predictive value with the cut-off values were computed. A total of 423 adult septic shock patients were included, and the in-hospital mortality rate was 17%. The median IVC diameter ratio in non-survivors was significantly greater than in survivors (1.56 cm vs 1.4 cm, P = .004). The IVC diameter ratio was found to be significantly associated with in-hospital mortality on multivariate logistic regression analysis after adjustment for confounding variables (odds ratio = 1.48, confidence interval: 1.097-1.998, P = 0.01). The AUC for IVC diameter ratio was 0.607. A cut-off IVC diameter ratio of ≥1.31 cm had 75% sensitivity and 42% specificity for predicting in-hospital mortality. The IVC diameter ratio measured on CT may to be helpful in predicting the prognosis of septic shock patients. However, due to its low diagnostic performance and sensitivity, further research is warranted.


Assuntos
Choque Séptico/mortalidade , Tomografia Computadorizada por Raios X/métodos , Veia Cava Inferior/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estado Terminal/mortalidade , Serviço Hospitalar de Emergência , Feminino , Mortalidade Hospitalar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Valor Preditivo dos Testes , Prognóstico , República da Coreia/epidemiologia , Estudos Retrospectivos , Sensibilidade e Especificidade , Choque Séptico/epidemiologia , Veia Cava Inferior/anatomia & histologia
18.
J Cancer Res Ther ; 16(5): 1186-1190, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004769

RESUMO

This study was designed to propose a classification of inferior vena cava tumor thrombus (IVCTT) and retrospectively evaluate the safety and efficacy of the combination therapy of transcatheter arterial chemoembolization (TACE) and sequential percutaneous ablation for hepatocellular carcinoma (HCC) with IVCTT. All HCC patients with IVCTT who underwent the combination therapies of TACE and sequential percutaneous ablation therapy between January 2015 and December 2017 in Beijing Youan Hospital were included in the study. The demographic, clinical, and pathological data were recorded. The response rate and overall survival (OS) rate were statistically analyzed. A classification system of IVCTT types was proposed based on the anatomical structure and ablation technique, which contained five types of IVCTT. Different types of IVCTT require different ablation strategies. For the response rate of IVCTT, complete response was achieved in all six patients. The 1- and 2-year OS rates were 88.3% and 55.6%, respectively. The new classification system and corresponding ablation strategies proposed in this study provided guidance for the use of ablation therapy for IVCTT. The combination therapy of TACE and ablation is effective and safe for treating HCC with IVCTT.


Assuntos
Carcinoma Hepatocelular/terapia , Ablação por Cateter/mortalidade , Quimioembolização Terapêutica/mortalidade , Terapia Combinada/métodos , Neoplasias Hepáticas/terapia , Veia Cava Inferior/patologia , Trombose Venosa/terapia , Idoso , Carcinoma Hepatocelular/patologia , Feminino , Humanos , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Segurança do Paciente , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento , Trombose Venosa/patologia
19.
Cochrane Database Syst Rev ; 10: CD006212, 2020 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-33027844

RESUMO

BACKGROUND: Pulmonary emboli (PE), or blood clots in the lungs,can be potentially fatal. Anticoagulation is the first line therapy to prevent PE. In some instances anticoagulation fails to prevent more emboli, or cannot be given because the person has a high risk of bleeding. Inferior vena caval filters (VCFs) are metal alloy devices that mechanically trap fragmented emboli from the deep leg veins en route to the pulmonary circulation. Retrievable filters are designed to be introduced and removed percutaneously. Although their deployment seems of theoretical benefit, their clinical efficacy and adverse event profile is unclear. This is the third update of a Cochrane Review first published in 2007. OBJECTIVES: To assess the evidence for the effectiveness and safety of vena caval filters (VCFs) in preventing pulmonary embolism (PE). SEARCH METHODS: For this review update, the Cochrane Vascular Information Specialist (CIS) searched the Specialised Register (last searched 10 September 2019) and the Cochrane Register of Controlled Trials (CENTRAL) (2019, Issue 8) via the Cochrane Register of Studies Online. The CIS also searched MEDLINE Ovid, EMBASE Ovid, CINAHL, and AMED (1 January 2017 to 10 September 2019) and trials registries to 10 September 2019. SELECTION CRITERIA: We included randomised controlled trials (RCTs) and controlled clinical trials (CCTs) that examined the efficacy of VCFs in preventing PE. DATA COLLECTION AND ANALYSIS: For this update, studies were assessed and data extracted independently. We assessed study quality with Cochrane's 'Risk of bias' tool and used the GRADE approach to assess the overall certainty of the evidence. The outcomes of interest were PE, mortality, lower limb venous thrombosis, filter-related complications and major bleeding. MAIN RESULTS: We identified four new studies for this update, bringing the total to six included studies involving 1388 participants. The six studies were clinically heterogeneous and we were unable to carry out meta-analysis. Only two studies were considered to be both applicable in current clinical settings and of good methodological quality. One was a randomised open-label trial studying the effect of a retrievable inferior vena caval filter plus anticoagulation versus anticoagulation alone on risk of recurrent pulmonary embolism (PE) in 399 participants over three months. There was no evidence of a difference in the rates of PE, death, lower extremity deep vein thrombosis (DVT), or bleeding at three and six months after the intervention (moderate-certainty evidence). A filter was inserted in 193 people, but could only be successfully retrieved from 153. Minor filter complications were noted at six months. The second clinically relevant study was a randomised open-label trial of 240 participants who had sustained multiple traumatic injuries, allocated to a filter or no filter, three days after injury, in conjunction with anticoagulation and intermittent pneumatic compression. Prophylactic anticoagulation was initiated in both groups when it was thought safe to do so. There was no evidence of a difference in symptomatic PE, death, or lower limb venous thrombosis rates (moderate-certainty evidence). The only major filter complication was that one person required surgical removal of the filter. We are unable to draw any conclusions from the remaining four included studies. One study showed an increased incidence of long-term lower extremity DVT at eight years. Three studies are no longer clinically applicable because they utilised permanent filters which are seldom used now, or they did not use routine prophylactic anticoagulation which is current standard practice. The fourth study compared two filter types and was terminated prematurely as one filter group had a higher rate of thrombosis compared to the other filter type. AUTHORS' CONCLUSIONS: Two of the six identified studies were relevant for current clinical settings. One showed no evidence of a benefit of retrievable filters in acute PE for the outcomes of PE, death, DVT and bleeding during the initial three months in people who can receive anticoagulation (moderate-certainty evidence). The other study did not show any benefit for prophylactic filter insertion in people who sustained multiple traumatic injuries, with respect to symptomatic PE, mortality, or lower extremity venous thrombosis (moderate-certainty evidence). We can draw no firm conclusions regarding filter efficacy in the prevention of PE from the remaining four RCTs identified in this review. Further trials are needed to assess vena caval filter effectiveness and safety, and clinical differences between various filter types.


Assuntos
Embolia Pulmonar/prevenção & controle , Filtros de Veia Cava , Anticoagulantes/uso terapêutico , Terapia Combinada/métodos , Humanos , Dispositivos de Compressão Pneumática Intermitente , Traumatismo Múltiplo/complicações , Embolia Pulmonar/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Recidiva , Filtros de Veia Cava/efeitos adversos , Veia Cava Inferior , Trombose Venosa/complicações
20.
J Small Anim Pract ; 61(11): 659-668, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33035379

RESUMO

OBJECTIVE: To re-evaluate the anatomy and classification of congenital extrahepatic portosystemic shunts entering the caudal vena cava at the level of the omental foramen. MATERIAL AND METHODS: A retrospective review of a consecutive series of dogs undergoing CT angiography as part of the diagnostic work-up for a congenital extrahepatic portosystemic shunt. RESULTS: In total, 53 dogs met the inclusion criteria revealing four anatomically distinct omental foramen shunt types; one of which (32 of 53 dogs) showed no shunting blood flow through the right gastric vein and three of which (21 of 53 dogs) involved shunting flow through this vessel. The anatomy of these four distinct shunt types, as defined by CT angiography, was found to be highly consistent. In all cases, regardless of the tributary vessels, the left gastric vein was the final vessel that communicated with the caudal vena cava. Using these findings, a more accurate naming classification for congenital portosystemic shunts entering the caudal vena cava at the level of the omental foramen was proposed. CLINICAL SIGNIFICANCE: A precise pre-treatment anatomical classification of congenital extrahepatic portosystemic shunts entering the caudal vena cava at the level of the omental foramen is important for a more complete understanding of the severity of clinical signs and prognosis, and for the better communication between clinicians and researchers in this clinical field.


Assuntos
Doenças do Cão , Animais , Doenças do Cão/diagnóstico por imagem , Cães , Sistema Porta/diagnóstico por imagem , Veia Porta , Derivação Portossistêmica Cirúrgica/veterinária , Estudos Retrospectivos , Veia Cava Inferior/diagnóstico por imagem
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