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Advances in Chronic Kidney Disease May 2021Accurate assessment of relative intravascular volume is critical to guide volume management of patients with acute or chronic kidney disorders, particularly those with... (Meta-Analysis)
Meta-Analysis Review
Accurate assessment of relative intravascular volume is critical to guide volume management of patients with acute or chronic kidney disorders, particularly those with complex comorbidities requiring hospitalization or intensive care. Inferior vena cava (IVC) diameter variability with respiration measured by ultrasound provides a dynamic noninvasive point-of-care estimate of relative intravascular volume. We present details of image acquisition, interpretation, and clinical scenarios to which IVC ultrasound can be applied. The variation in IVC diameter over the respiratory or ventilatory cycle is greater in patients who are volume responsive than those who are not volume responsive. When 2 recent prospective studies of spontaneously breathing patients (n = 214) are added to a prior meta-analysis of 181 patients, for a total of 7 studies of 395 spontaneously breathing patients, IVC collapsibility index (CI) had a pooled sensitivity of 71% and specificity of 81% for predicting volume responsiveness, which is similar to a pooled sensitivity of 75% and specificity of 82% for 9 studies of 284 mechanically ventilated patients. IVC maximum diameter <2.1 cm, that collapses >50% with or without a sniff is inconsistent with intravascular volume overload and suggests normal right atrial pressure (0-5 mmHg). Inferior vena cava collapsibility (IVC CI) < 20% with no sniff suggests increased right atrial pressure and is inconsistent with overt hypovolemia in spontaneously breathing or ventilated patients. These IVC CI cutoffs do not appear to vary greatly depending on whether patients are breathing spontaneously or are mechanically ventilated. Patients with lower IVC CI are more likely to tolerate ultrafiltration with hemodialysis or improve cardiac output with ultrafiltration. Our goal for IVC CI generally ranges from 20% to 50%, respecting potential biases to interpretation and overriding clinical considerations. IVC ultrasound may be limited by factors that affect IVC diameter or collapsibility, clinical interpretation, or optimal visualization, and must be interpreted in the context of the entire clinical situation.
Topics: Critical Care; Critical Illness; Humans; Prospective Studies; Ultrasonography; Vena Cava, Inferior
PubMed: 34906306
DOI: 10.1053/j.ackd.2021.02.003 -
European Journal of Heart Failure May 2021Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important... (Review)
Review
Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important therapeutic target. While symptoms and physical signs of fluid overload are required to make a clinical diagnosis of heart failure, they lack both sensitivity and specificity, which might lead to diagnostic delay and uncertainty. Over the last decades, new ultrasound methods for the detection of elevated intracardiac pressures and/or fluid overload have been developed that are more sensitive and specific, thereby enabling earlier and more accurate diagnosis and facilitating treatment strategies. Accordingly, we considered that a state-of-the-art review of ultrasound methods for the detection and quantification of congestion was timely, including imaging of the heart, lungs (B-lines), kidneys (intrarenal venous flow), and venous system (inferior vena cava and internal jugular vein diameter).
Topics: Delayed Diagnosis; Heart Failure; Humans; Jugular Veins; Ultrasonography; Vena Cava, Inferior
PubMed: 33118672
DOI: 10.1002/ejhf.2032 -
Critical Care (London, England) May 2023Venous congestion is an under-recognized contributor to mortality in critically ill patients. Unfortunately, venous congestion is difficult to measure, and right heart... (Observational Study)
Observational Study
Venous congestion is an under-recognized contributor to mortality in critically ill patients. Unfortunately, venous congestion is difficult to measure, and right heart catheterization (RHC) has been considered the most readily available means for measuring venous filling pressure. Recently, a novel "Venous Excess Ultrasound (VExUS)" score was developed to noninvasively quantify venous congestion using inferior vena cava (IVC) diameter and Doppler flow through the hepatic, portal, and renal veins. A preliminary retrospective study of post-cardiac surgery patients showed promising results, including a high positive-likelihood ratio of high VExUS grade for acute kidney injury. However, studies have not been reported in broader patient populations, and the relationship between VExUS and conventional measures of venous congestion is unknown. To address these gaps, we prospectively assessed the correlation of VExUS with right atrial pressure (RAP), with comparison to inferior vena cava (IVC) diameter. Patients undergoing RHC at Denver Health Medical Center underwent VExUS examination before their procedure. VExUS grades were assigned before RHC, blinding ultrasonographers to RHC outcomes. After controlling for age, sex, and common comorbidities, we observed a significant positive association between RAP and VExUS grade (P < 0.001, R = .68). VExUS had a favorable AUC for prediction of a RAP ≥ 12 mmHg (0.99, 95% CI 0.96-1) compared to IVC diameter (0.79, 95% CI 0.65-0.92). These results suggest a strong correlation between VExUS and RAP in a diverse patient population, and support future studies of VExUS as a tool to assess venous congestion and guide management in a spectrum of critical illnesses.
Topics: Humans; Atrial Pressure; Retrospective Studies; Hyperemia; Atrial Function, Right; Ultrasonography; Vena Cava, Inferior
PubMed: 37237315
DOI: 10.1186/s13054-023-04471-0 -
Wiener Medizinische Wochenschrift (1946) May 2023Congenital heart disease comprises one of the largest groups of congenital defects, affecting approximately 1% of births. Advances in pre- and postoperative critical...
Congenital heart disease comprises one of the largest groups of congenital defects, affecting approximately 1% of births. Advances in pre- and postoperative critical care treatment as well as surgery and interventional procedures have improved survival rates, but treatment and long-term care of children with complex congenital heart disease remains challenging, and is associated with a number of complications.Here, we report on a 17-month-old infant with congenital univentricular heart disease who devloped post-operatively inferior vena cava (IVC) thrombosis. IVC thrombosis was confirmed by a bedside contrast media study (X-ray) demonstrating collateral paravertebral circulation along the paravertebral sinuses bilaterally into the azygos and hemiazygos vein ("rope ladder sign"), with no contrast media detected in the IVC. The infant was subsequently started on aspirin and clopidogrel.
Topics: Child; Infant; Humans; Vena Cava, Inferior; Venous Thrombosis; Azygos Vein; Heart Defects, Congenital; Collateral Circulation
PubMed: 34613517
DOI: 10.1007/s10354-021-00886-y -
Ugeskrift For Laeger Jan 2024Renal cell carcinomas (RCCs) represent 2-3% of cancer cases in Denmark, with increasing incidence. RCCs invading the inferior vena cava (IVC) with tumour thrombus (TT)... (Review)
Review
Renal cell carcinomas (RCCs) represent 2-3% of cancer cases in Denmark, with increasing incidence. RCCs invading the inferior vena cava (IVC) with tumour thrombus (TT) are associated with poor prognosis. Classification is based on tumour extent in the IVC. Surgical treatment involves radical nephrectomy and thrombectomy, with different approaches depending on TT level. Complications are significant, with a mortality rate of 2-13%. Additional therapies may improve outcomes. This review finds that all patients with RCC and IVC TT should be considered for surgery.
Topics: Humans; Carcinoma, Renal Cell; Kidney Neoplasms; Thrombosis; Thrombectomy; Vena Cava, Inferior; Nephrectomy; Retrospective Studies
PubMed: 38235778
DOI: 10.61409/V06230354 -
Methodist DeBakey Cardiovascular Journal 2024For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However,... (Review)
Review
For patients with existing venous thromboembolisms (VTEs), anticoagulation remains the standard of care recommended across multiple professional organizations. However, for patients who developed a deep venous thrombosis (DVT) and/or a pulmonary embolism and cannot tolerate anticoagulation, inferior vena cava (IVC) filters must be considered among other alternative treatments. Although placement of a filter is considered a low-risk intervention, there are important factors and techniques that surgeons and interventionalists should be aware of and prepared to discuss. This overview covers the basics regarding the history of filters, indications for placement, associated risks, and techniques for difficult removal.
Topics: Vena Cava Filters; Humans; Pulmonary Embolism; Venous Thrombosis; Risk Factors; Device Removal; Prosthesis Implantation; Prosthesis Design; Treatment Outcome; Venous Thromboembolism; Vena Cava, Inferior; Risk Assessment; Anticoagulants
PubMed: 38765211
DOI: 10.14797/mdcvj.1346 -
JPMA. the Journal of the Pakistan... Jun 2020Inferior vena caval (IVC) injuries are uncommon and challenging to treat. Less than 5% of patients with penetrating abdominal trauma and less than 0.5% of patients with... (Review)
Review
Inferior vena caval (IVC) injuries are uncommon and challenging to treat. Less than 5% of patients with penetrating abdominal trauma and less than 0.5% of patients with blunt abdominal trauma have this injury. Patient can present with intraperitoneal haemorrhage or with a contained retroperitoneal haematoma. Mostly it is associated with other abdominal structures injuries. Most commonly injured segment is infrarenal IVC. Operative strategy is different for each segment of injured vein. Infrahepatic injuries are exposed by medial visceral rotation. Retrohepatic and suprahepatic injuries need infrequent exposures. Mortality remains high and range between 31-51% for the patient brought alive to the operative room. Glasgow coma scale, level of injury, haemodynamic status at presentation and free blood in the peritoneal cavity are some of the predictive factors for mortality in these patients.
Topics: Abdominal Injuries; Glasgow Coma Scale; Hematoma; Humans; Vena Cava, Inferior; Wounds, Nonpenetrating
PubMed: 32810108
DOI: 10.5455/JPMA.21107 -
Romanian Journal of Morphology and... 2020Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignant tumor, accounting for 2% of all LMSs. Less than 400 cases have been reported in literature.... (Review)
Review
Leiomyosarcoma (LMS) of the inferior vena cava (IVC) is a rare malignant tumor, accounting for 2% of all LMSs. Less than 400 cases have been reported in literature. Computed tomography (CT) is the most accurate imaging method in assessing the location of the tumor within the IVC and magnetic resonance imaging (MRI) accurately identifies its extent and the potential for surgical resection. We present the case of a patient with inferior vena cava leiomyosarcoma (IVCL), for whom the pathological diagnosis was different from the initially expected one, the tumor appearance on pre-operative imaging mimicking renal cell carcinoma. The intraoperative difficulty of approaching renal hilum and IVC was a factor suggesting the vascular origin of the tumor, which was confirmed at pathological analysis. The extensive defect in the IVC after tumor excision led to the decision of complete transverse suturing of IVC, as significant collateral venous circulation was already present. Because IVCL is a rare disease, there is scarce data regarding the prognosis and treatment options. Long-term survival depends on the extent of the surgery. The need of vascular reconstruction is not always mandatory. Despite high recurrence rates, no consensus regarding adjuvant treatment exists yet. A multidisciplinary approach including surgical oncologists and vascular surgeons is mandatory to achieve the best patient outcomes. Perioperative planning, coordination and adherence to oncological techniques are critical.
Topics: Female; Humans; Leiomyosarcoma; Middle Aged; Prognosis; Survival Analysis; Vena Cava, Inferior
PubMed: 32747914
DOI: 10.47162/RJME.61.1.25 -
Journal of Healthcare Engineering 2022In this paper, clinical manifestations of inferior vena cava injuries and the progress of emergency treatment are presented. Inferior vena cava (IVC) is the large vein... (Review)
Review
In this paper, clinical manifestations of inferior vena cava injuries and the progress of emergency treatment are presented. Inferior vena cava (IVC) is the large vein returning venous blood from the lower limbs and pelvic and abdominal cavities to the right atrium of the heart. The clinical manifestations of IVC injuries include shock, progressive hemorrhage, air embolism, retroperitoneal hematoma, active bleeding, and hemoperitoneum. The patients may be combined or not combined with injuries to other organs or even die. Routine examination methods for IVC injuries include general examination, color Doppler ultrasound, abdominal contrast-enhanced CT, magnetic resonance spectroscopic imaging (MRSI), and IVC angiography. These examinations are usually performed to confirm the diagnosis. Surgical treatment is the primary emergency treatment for this condition. Increasing the blood volume and symptomatic treatment are auxiliary treatments. The surgeries and repairs for IVC injuries are currently under investigation. Experimental results have verified the exceptional performance of the proposed scheme.
Topics: Angiography; Emergency Treatment; Humans; Ultrasonography, Doppler, Color; Vena Cava Filters; Vena Cava, Inferior
PubMed: 35136539
DOI: 10.1155/2022/9475522 -
The Journal of International Medical... May 2022The inferior vena cava (IVC) may develop abnormally because of its complex embryogenesis. An understanding of congenital variants such as duplication of the IVC is...
The inferior vena cava (IVC) may develop abnormally because of its complex embryogenesis. An understanding of congenital variants such as duplication of the IVC is essential for clinical interventions, particularly those performed by surgeons and radiologists. We herein describe five patients who were diagnosed with duplication of the IVC by computed tomography or angiography and summarize their imaging and clinical features. All five patients were men aged 46 to 78 years. Two of the patients had pulmonary embolism and deep vein thrombosis and were treated by placement of an IVC filter and catheter-directed thrombolysis. The IVC in all patients ascended on either side of the abdominal aorta. All left IVCs terminated in the left renal vein, which crossed the aorta and joined the right IVC. The average follow-up time was 29 months (range, 14-46 months), and no patients developed venous thromboembolism or recurrence of thrombosis. Duplication of the IVC can be diagnosed by computed tomography and angiography. Its course and relationship with the renal vein must be identified for accurate planning of IVC filter placement in the setting of deep vein thrombosis and pulmonary embolism.
Topics: Female; Humans; Male; Pulmonary Embolism; Renal Veins; Treatment Outcome; Vena Cava Filters; Vena Cava, Inferior; Venous Thrombosis
PubMed: 35607249
DOI: 10.1177/03000605221100771