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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 -
European Journal of Vascular and... Oct 2022To evaluate the prevalence of inferior vena cava (IVC) anomalies in an asymptomatic healthy population and symptomatic patients. (Observational Study)
Observational Study
OBJECTIVE
To evaluate the prevalence of inferior vena cava (IVC) anomalies in an asymptomatic healthy population and symptomatic patients.
METHODS
This was a multicentre retrospective observational study This study was conducted by reviewing the computed tomography (CT) images of 1 000 individuals from South Korea taken for a general medical check up (group A) and 1 000 patients from the USA who visited with various symptoms for which CT was required (group B). A third group of 800 patients with deep vein thrombosis (DVT) and CT from two US centres were used for comparison (group C). Twenty-eight patients with anatomical changes in the IVC due to intervention, extrinsic compression, trauma, other rare conditions, and poor image quality were excluded.
RESULTS
The mean age ± standard deviation of each group was 50 ± 6, 54 ± 11, and 54 ± 15 years in groups A, B, and C, respectively. In group A, duplication was the most common anomaly (10 cases, 1.0%), followed by left sided IVC (four cases, 0.4%), hypoplasia (three cases, 0.3%), and megacava (one case, 0.1%). In group B, the most common IVC anomaly was hypoplasia in six cases (0.6%); duplication in three patients, left sided IVC in three patients, aplasia in two patients, web formation in two patients, and megacava in two patients. In group C, hypoplasia was the most common type (32 cases, 4.0%). The prevalence of hypoplasia in patients younger than 50 years of age was significantly higher compared with older patients (12.7% [14/110] vs. 5.3% [10/190]; p = .027). The risk of hypoplasia or aplasia was significantly higher in patients with DVT (odds ratio [OR] 17.032, 95% confidence interval [CI] 5.243 - 55.321), especially in patients with iliofemoral DVT (OR 34.211, 95% CI 10.323 - 113.378).
CONCLUSION
In the normal group, IVC duplication was the most common variation, while hypoplasia was most common in patients with iliofemoral DVT, especially in younger ones.
Topics: Humans; Vena Cava, Inferior; Prevalence; Venous Thrombosis; Vascular Malformations; Tomography, X-Ray Computed
PubMed: 35671937
DOI: 10.1016/j.ejvs.2022.05.045 -
Journal of Vascular Surgery. Venous and... Sep 2019The primary aim of this article was to establish the actual prevalence of transposition and duplication of the inferior vena cava and to increase awareness about them. (Meta-Analysis)
Meta-Analysis
OBJECTIVE
The primary aim of this article was to establish the actual prevalence of transposition and duplication of the inferior vena cava and to increase awareness about them.
METHODS
A meta-analysis of prevalence was conducted of cases obtained from PubMed, Web of Science, and Scopus databases.
RESULTS
A total of 48 studies contained data that allowed us to estimate the prevalence of these variants (39 for duplication and 32 for transposition). The overall prevalence of duplication was 0.7%, with a 95% confidence interval between 0.5% and 0.9%; for transposition, the prevalence was 0.3%, with a 95% confidence interval between 0.2% and 0.5%. The publication bias was minimal. Duplication prevalence was significantly higher in anatomy studies compared with imaging and surgery studies; for transposition, there were no statistically significant differences by detection technique.
CONCLUSIONS
The overall prevalence of duplication of the inferior vena cava is 0.7%; for transposition, it is 0.3%. Even if they are obviously rare conditions, their presence must be suspected by practitioners as they can have important clinical consequences, may require changes in the surgery protocol, or can be associated with other congenital abnormalities.
Topics: Humans; Prevalence; Vascular Malformations; Vena Cava, Inferior
PubMed: 31068277
DOI: 10.1016/j.jvsv.2019.01.063 -
Journal of Digital Imaging Dec 2023Two data-driven algorithms were developed for detecting and characterizing Inferior Vena Cava (IVC) filters on abdominal computed tomography to assist healthcare...
Two data-driven algorithms were developed for detecting and characterizing Inferior Vena Cava (IVC) filters on abdominal computed tomography to assist healthcare providers with the appropriate management of these devices to decrease complications: one based on 2-dimensional data and transfer learning (2D + TL) and an augmented version of the same algorithm which accounts for the 3-dimensional information leveraging recurrent convolutional neural networks (3D + RCNN). The study contains 2048 abdominal computed tomography studies obtained from 439 patients who underwent IVC filter placement during the 10-year period from January 1st, 2009, to January 1st, 2019. Among these, 399 patients had retrievable filters, and 40 had non-retrievable filter types. The reference annotations for the filter location were obtained through a custom-developed interface. The ground truth annotations for the filter types were determined based on the electronic medical record and physician review of imaging. The initial stage of the framework returns a list of locations containing metallic objects based on the density of the structure. The second stage processes the candidate locations and determines which one contains an IVC filter. The final stage of the pipeline classifies the filter types as retrievable vs. non-retrievable. The computational models are trained using Tensorflow Keras API on an Nvidia Quadro GV100 system. We utilized a fine-tuning supervised training strategy to conduct our experiments. We find that the system achieves high sensitivity on detecting the filter locations with a high confidence value. The 2D + TL model achieved a sensitivity of 0.911 and a precision of 0.804, and the 3D + RCNN model achieved a sensitivity of 0.923 and a precision of 0.853 for filter detection. The system confidence for the IVC location predictions is high: 0.993 for 2D + TL and 0.996 for 3D + RCNN. The filter type prediction component of the system achieved 0.945 sensitivity, 0.882 specificity, and 0.97 AUC score with 2D + TL and 0. 940 sensitivity, 0.927 specificity, and 0.975 AUC score with 3D + RCNN. With the intent to create tools to improve patient outcomes, this study describes the initial phase of a computational framework to support healthcare providers in detecting patients with retained IVC filters, so an individualized decision can be made to remove these devices when appropriate, to decrease complications. To our knowledge, this is the first study that curates abdominal computed tomography (CT) scans and presents an algorithm for automated detection and characterization of IVC filters.
Topics: Humans; Vena Cava Filters; Device Removal; Vena Cava, Inferior; Retrospective Studies; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 37770730
DOI: 10.1007/s10278-023-00882-1 -
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 -
BMC Anesthesiology May 2022The volume status of patients after major abdominal surgery constantly varies owing to postoperative diverse issues comprising fluid loss or capillary leakage secondary...
Comparison of superior and inferior vena cava diameter variation measured with transthoracic echocardiography to predict fluid responsiveness in mechanically ventilated patients after abdominal surgery.
BACKGROUND
The volume status of patients after major abdominal surgery constantly varies owing to postoperative diverse issues comprising fluid loss or capillary leakage secondary to systemic inflammatory reaction syndrome, et.al, the precise fluid responsiveness assessment is crucial for those patients. The purpose of this study is to validate the transthoracic ultrasonographic measurement of superior and inferior vena cava variation in predicting fluid responsiveness of mechanically ventilated patients after surgery.
METHODS
A total of 70 patients undergoing the scheduled major abdominal surgeries in the anesthesia ICU ward were included. The superior vena cava (SVC) collapsibility index (SVCCI), the inferior vena cava distensibility index (dIVC), SVC variation over the cardiac cycle (SVCV), and cardiac output (CO) were measured by transthoracic ultrasonography were recorded before and after fluid challenge test of 5 ml/kg crystalloid within 15 min. The responders were defined as a 15% or more increment in CO.
RESULTS
Thirty patients (42.9%) responded to fluid challenge, while the remnant forty patients (57.1%) did not. The areas under the ROC curve (AUC) of SVCCI, dIVC and SVCV were 0.885 (95% CI, 0.786-0.949; P < 0.0001) and 0.727 (95% CI, 0.608-0.827; P < 0.001) and 0.751 (95% CI, 0.633-0.847; P < 0.0001), respectively. AUC and AUC were significantly lower when compared with AUC (P < 0.05). The optimal cutoff values were 19% for SVCCI, 14% for dIVC, and 15% for SVCV. The gray zone for SVCCI was 20%-25% and included 15.7% of patients, while 7%-27% for dIVC including 62.9% of patients and 9%-21% for SVCV including 50% of patients.
CONCLUSION
Superior vena cava-related parameters measured by transthoracic ultrasound are reliable indices to predict fluid responsiveness. The accuracy of SVCCI in mechanically ventilated patients after abdominal surgery is better than that of dIVC and SVCV.
TRIAL REGISTRATION
ChiCTR-INR-17013093 . The initial registration date was 24/10/2017.
Topics: Echocardiography; Fluid Therapy; Humans; Respiration, Artificial; Ultrasonography; Vena Cava, Inferior; Vena Cava, Superior
PubMed: 35581547
DOI: 10.1186/s12871-022-01692-8 -
The Journal of Invasive Cardiology Feb 2017Double inferior vena cava (DIVC) is present in 0.2%-3.0% of the general population. Its presence can be detected by computed tomographic angiography or magnetic... (Review)
Review
Double inferior vena cava (DIVC) is present in 0.2%-3.0% of the general population. Its presence can be detected by computed tomographic angiography or magnetic resonance imaging. Identifying the presence of DIVC is important to define its relationship with the renal vein, its size when IVC filters are planned, the location of the left renal vein in relationship to the aorta, and for planning of IVC filter placement in the setting of deep vein thrombosis and pulmonary embolism. Finally, this entity should not be mistaken for lymphadenopathy and its course should be well understood before abdominal and pelvic/retroperitoneal surgical interventions.
Topics: Endovascular Procedures; Humans; Magnetic Resonance Imaging; Tomography, X-Ray Computed; Vascular Malformations; Vena Cava, Inferior
PubMed: 28145872
DOI: No ID Found -
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 -
European Journal of Vascular and... Feb 2023Inferior vena cava (IVC) stenting may provide benefit to patients with symptomatic obstruction; however, there are no devices currently licensed for use in the IVC and... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Inferior vena cava (IVC) stenting may provide benefit to patients with symptomatic obstruction; however, there are no devices currently licensed for use in the IVC and systematic reviews on the topic are lacking. The aim of this study was to carry out a systematic review of the literature and meta-analysis to investigate the safety and efficacy of IVC stenting in all adult patient groups.
DATA SOURCES
The Medline and Embase databases were searched for studies reporting outcomes for safety and effectiveness of IVC stenting for any indication in series of 10 or more patients.
REVIEW METHODS
A systematic review of the literature was carried out according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
RESULTS
Thirty-three studies were included describing 1 575 patients. Indications for stenting were malignant IVC syndrome (229 patients), thrombotic disease (807 patients), Budd-Chiari syndrome (501 patients), and IVC stenosis post liver transplantation (47 patients). The male:female ratio was 2:1 and the median age ranged from 30 to 61 years. The studies included were not suitable for formal meta-analysis as 30/33 were single centre retrospective studies with no control groups and there was considerable inconsistency in outcome reporting. There was significant risk of bias in 94% of studies. Median reported technical success was 100% (range 78 - 100%), primary patency was 75% (38 - 98%), and secondary patency was 91.5% (77 - 100%). Major complications were pulmonary embolism (three cases), stent migration (12 cases), and major bleeding (15 cases), and there were three deaths in the immediate post-operative period. Most studies reported improvement in clinical symptoms but formal reporting tools were not used consistently.
CONCLUSION
The evidence base for IVC stenting consists of predominantly single centre, retrospective, observational studies that have a high risk of bias. Nonetheless the procedure appears safe with few major adverse events, and studies that reported clinical outcomes demonstrate improvement in symptoms and quality of life. Randomised controlled trials and prospective registry based studies with larger patient numbers and standardised outcome are required to improve the evidence base for this procedure.
Topics: Adult; Humans; Male; Female; Middle Aged; Vena Cava, Inferior; Retrospective Studies; Quality of Life; Treatment Outcome; Budd-Chiari Syndrome; Stents
PubMed: 36334902
DOI: 10.1016/j.ejvs.2022.11.006 -
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