Retrieval of a Gunther tulip vena cava filter implanted in a patient with inferior vena cava and right common iliac vein thrombosis was attempted by the standard method. Because the filter was tilted, the hook became attached to the vena cava wall and could not be snared. During attempts at removal by an alternative method, the filter migrated toward the right atrium. However, it was finally successfully removed.
Embolism; pulmonary; extremities; thrombosis; interventional procedures; vena cava; filters
To retrospectively evaluate the frequency and risk factors for developing thrombus in a systemic vein such as the infrarenal inferior vena cava or the iliac vein, in which a balloon-occluded retrograde transvenous obliteration (B-RTO) catheter was indwelled.
Materials and Methods
Forty-nine patients who underwent B-RTO for gastric varices were included in this study. The B-RTO procedure was performed from the right femoral vein, and the B-RTO catheter was retained overnight in all patients. Pre- and post-procedural CT scans were retrospectively compared in order to evaluate the development of thrombus in the systemic vein in which the catheter was indwelled. Additionally, several variables were analyzed to assess risk factors for thrombus in a systemic vein.
In all 49 patients (100%), B-RTO was technically successful, and in 46 patients (94%), complete thrombosis of the gastric varices was achieved. In 6 patients (12%), thrombus developed in the infrarenal inferior vena cava or the right common-external iliac vein. All thrombi lay longitudinally on the right side of the inferior vena cava or the right iliac vein. One of the aforementioned 6 patients required anticoagulation therapy. No symptoms suggestive of pulmonary embolism were observed. Prothrombin time-international normalized ratio and the addition of 5% ethanolamine oleate iopamidol, on the second day, were related to the development of thrombus.
Development of a thrombus in a systemic vein such as the inferior vena cava or iliac vein, caused by indwelling of the B-RTO catheter, is relatively frequent. Physicians should be aware of the possibility of pulmonary embolism due to iliocaval thrombosis.
Interventional radiology; Balloon-occluded retrograde transvenous obliteration; Gastric varices; Complications
Congenital systemic-pulmonary collateral vein (i.e. levoatriocardinal vein) is an uncommon cardiac anomaly. We report a rare case of congenital systemic-pulmonary collateral vein incidentally noticed after accidental migration of a central venous catheter. Cardiac CT showed the vertical vein connected to the left upper pulmonary vein (LUPV) and another thin abnormal vessel was shown running caudally from the LUPV, connecting to the coronary sinus. Furthermore, the normal connection between the LUPV and the left atrium remained. There were two levoatriocardinal veins from the LUPV without atrial egress failure. To our knowledge, this might be the first report of such a case.
central venous catheter; migration; congenital systemic-pulmonary collateral vein
A persistent left superior vena cava (PLSVC) is the most common thoracic venous anomaly,
and we should be aware of its existence. We encountered a case of significant left arm
swelling due to recurrent left subclavian venous stenosis in a hemodialysis patient with a
PLSVC. Endovascular stent placement was performed safely and effectively for the stenosis
employing the pull-through technique, in which a guidewire was passed from the left
internal jugular vein to the access vein. On the following day, left arm swelling had
improved. 3 months after stent placement the left arm swelling has not recurred.
stent; pull-through technique; persistent left superior vena cava
Individuals with type 2 diabetes are at high risk for cardiovascular events. We evaluated the prognostic value of gated myocardial perfusion single-photon computed tomography (SPECT) for asymptomatic diabetic patients in a Japanese population.
RESEARCH DESIGN AND METHODS
Asymptomatic patients (n = 485) aged ≥50 years with either a maximal carotid artery intima-media thickness of ≥1.1 mm, or a urinary albumin ≥30 mg/g creatinine or who had at least two of the following, abdominal obesity, low HDL cholesterol, high triglyceride levels, and hypertension, were enrolled at 50 institutions. The patients were evaluated using gated SPECT with the stress-rest protocol and followed up for 3 years.
During the follow-up period, 62 (13%) events occurred, including 5 cardiac deaths and 57 cardiovascular events. Patients with summed stress scores (SSS) of ≥9 had a significantly higher incidence (of either death or cardiovascular events) than those with SSS scores of <9 (23 vs. 12%; P = 0.009). Multivariate Cox regression analysis showed that significant variables were SSS ≥9, a low estimated glomerular filtration rate, and being a current smoker. Univariate Cox regression analysis showed that ticlopidine and insulin use are potent medical modulators of cardiovascular events.
The incidences of cardiovascular events and death were significantly high in a select population of type 2 diabetic patients with SPECT abnormalities. A targeted treatment strategy is required for asymptomatic but potentially high-risk patients with type 2 diabetes.
We report a case of a life-threatening massive hemothorax caused by iatrogenic injury of
the right subclavian artery. The patient was successfully treated with placement of a
covered stent. During the procedure, occlusion balloon catheters rapidly controlled the
hemorrhage; minimally invasive therapy; subclavian artery injury
Patients with deep venous thrombosis (DVT) of the lower extremities have an increased
risk of pulmonary emboli and post-thrombotic syndrome. Traditionally, they are treated
medicinally, with anticoagulation therapy. Currently, endovascular therapies, with their
higher efficiency, have replaced previously attempted systemic fibrinolytic therapies.
There is a continuing controversy in the temporary use of filters in the inferior vena
cava during these endovascular therapies, which may include catheter-directed
thrombolysis, manual aspiration, mechanical thrombectomy, percutaneous transluminal
angioplasty and placement of self-expandable metallic stents. Here, we present an overview
of the literature and analysis on the application of prophylactic implantation of an
inferior vena cava filter during endovascular therapy for DVT of the lower
embolism; pulmonary; endovascular therapies; extremities; thrombosis; vena cava; filters
To examine the role of brachytherapy for aged patients 80 or more in the trend of rapidly increasing number.
We examined the outcomes for elderly patients with node negative oral tongue cancer (T1-3N0M0) treated with brachytherapy. The 21 patients (2 T1, 14 T2, and 5 T3 cases) ranged in age from 80 to 89 years (median 81), and their cancer was pathologically confirmed. All patients underwent definitive radiation therapy, with low dose rate (LDR) Ra-226 brachytherapy (n = 4; median 70Gy), with Ir-192 (n = 12; 70Gy), with Au-198 (n = 1) or with high dose rate (HDR) Ir-192 brachytherapy (n = 4; 60 Gy). Eight patients also underwent external radiotherapy (median 30 Gy). The period of observation ranged from 13 months to 14 years (median 2.5 years). We selected 226 population matched younger counterpart from our medical chart.
Definitive radiation therapy was completed for all 21 patients (100%), and acute grade 2-3 mucositis related to the therapy was tolerable. Local control (initial complete response) was attained in 19 of 21 patients (90%). The 2-year and 5-year local control rates were 91%, (100% for T1, 83% for T2 and 80% for T3 tumors after 2 years). These figures was not inferior to that of younger counterpart (82% at 5-year, n.s.). The cause-specific survival rate was 83% and the regional control rate 84% at the 2-years follow-up. However, 12 patients died because of intercurrent diseases or senility, resulting in overall survival rates of 55% at 2 years and 34% at 5 years.
Age is not a limiting factor for brachytherapy for appropriately selected elderly patients, and brachytherapy achieved good local control with acceptable morbidity.
We sought to investigate the optimum b value for resolving crossing fiber using high-angular resolution diffusion imaging (HARDI)-based multi-tensor tractography. The study tested the standard b values that are commonly used in the routine clinical setting.
Ten normal volunteers (five men and five women) with a mean age of 26.3 years (range, 22–32 years) were scanned using a 1.5-T clinical magnetic resonance unit. Single-shot echo-planar imaging was used for diffusion-weighted imaging with a diffusion-sensitizing gradient in 32 orientations. The b values of 700, 1,400, 2,100, and 2,800 s/m2 were used. Data postprocessing was performed using multi-tensor methods. The depiction of the optic nerves, optic tracts, and decussation of superior cerebellar peduncles were assessed.
The depictions of the nerve fibers were independent of the b values tested.
The depiction of crossing fibers by HARDI-based multi-tensor tractography is not substantially influenced by b values ranging from 700 to 2,800 s/m2. Thus, the optimum b value within this range may be the lowest one considering the higher signal to noise ratio.
MRI; Diffusion-tensor imaging; Fiber tracking; Crossing fiber
The purpose of this study was to examine the incidence of new or recurrent venous thromboembolism (VTE) after retrieval of inferior vena cava (IVC) filters and risk factors associated with such recurrence. Between March 2001 and September 2008, at our institution, implanted retrievable vena cava filters were retrieved in 76 patients. The incidence of new or recurrent VTE after retrieval was reviewed and numerous variables were analyzed to assess risk factors for redevelopment of VTE after filter retrieval. In 5 (6.6%) of the 76 patients, redevelopment or worsening of VTE was seen after retrieval of the filter. Three patients (4.0%) had recurrent deep venous thrombosis (DVT) in the lower extremities and 2 (2.6%) had development of pulmonary embolism, resulting in death. Although there was no significant difference in the incidence of new or recurrent VTE related to any risk factor investigated, a tendency for development of VTE after filter retrieval was higher in patients in whom DVT in the lower extremities had been so severe during filter implantation that interventional radiological therapies in addition to traditional anticoagulation therapies were required (40% in patients with recurrent VTE vs. 23% in those without VTE; p = 0.5866 according to Fisher’s exact probability test) and in patients in whom DVT remained at the time of filter retrieval (60% in patients with recurrent VTE vs. 37% in those without VTE; p = 0.3637). In conclusion, new or recurrent VTE was rare after retrieval of IVC filters but was most likely to occur in patients who had severe DVT during filter implantation and/or in patients with a DVT that remained at the time of filter retrieval. We must point out that the fatality rate from PE after filter removal was high (2.6%).
Pulmonary embolism; Thrombosis of extremities; Interventional procedures; Vena cava filters
A Gunther tulip vena cava filter was implanted in a patient with pulmonary embolism from deep venous thrombosis. The filter became unnecessary after therapy. However, retrieval by the standard method employing a vascular sheath placed via the transjugular approach in combination with a snare device was impossible. A thrombus occupying the apical hook made it difficult to snare the hook, also one filter leg was incorporated into the inferior vena cava wall. Therefore we modified an existing method to withdraw the filter. As the first step, the filter cone was snared using the snare-over-guide wire loop technique, and the cephalad site of the filter was introduced into the sheath. Then, a 12-French sheath was advanced from the femoral vein and, using a pusher, the distal legs of the filter were pushed, which resulted the filter leg that was incorporated into the inferior vena cava wall became detached. Finally the filter was successfully retrieved.
embolism; pulmonary; interventional procedures; vena cava; filters