The bridge occlusion balloon for venous angioplasty in superior vena cava occlusion

Abstract The Bridge Occlusion Balloon is a compliant balloon, specifically designed for temporary Superior vena cava occlusion in case of Superior Vena Cava laceration during lead extraction procedures. We here report the first case, using Bridge Occlusion Ballon for a venous angioplasty in a patient with dysfunctional pacemaker leads and symptomatic Superior Vena Cava occlusion. After successful lead extraction, venography was showing a narrow venous canal. Therefore, venous angioplasty using the Bridge balloon was performed. Especially for high-risk lead extraction cases in patients with Superior Vena Cava stenosis, the Bridge Occlusion Ballon might be used as a combination of a safety-net in case of Superior Vena Cava perforation and for Superior Vena Cava angioplasty.

Estudo da técnica de venografia dos dígitos de vacas / Study of Venography technique in digits of cows

O objetivo deste estudo foi descrever a técnica de venografia retrógrada podal em vacas, comparando os acessos da veia digital dorsal comum III com a digital comum II ou IV, nos membros torácicos e pélvicos, mediante a administração de dois diferentes volumes de contraste. Foram utilizados 53 membros torácicos e pélvicos de 14 vacas, com o torniquete de borracha posicionado a 5cm proximal aosparadígitos. Administraram-se 10mL do diatrizoato de meglumina em 24 membros (grupo 1), sendo 13 na veia digital dorsal comum III pelo acesso 1 (A1) e 11 na digital II ou IV no acesso 2 (A2). No grupo 2, administraram-se 20mL em 29 membros, sendo 15 pelo A1 e 19 pelo A2. Após a administração do contraste, as radiografias foram repetidas a cada 20 segundos até 120 segundos. O grau de preenchimento vascular foi maior no grupo 2, não diferindo entre membros e acessos venosos. Conclui-se que a administração de 20mL de contraste apresentou melhor preenchimento vascular e radiopacidade, não havendo diferença entre 20 e 120 segundos após a administração do contraste na qualidade radiográfica, independentemente do acesso venoso.(AU)

The aim of this study was to describe the technique of retrograde venography foot in cows, comparing the approaches of the dorsal common digital vein III with the digital commons II or IV, thoracic and pelvic by administering two different volumes of contrast members. Fifty three fore and hindlimbs of 14 cows were used, a rubber tourniquet was placed at 5cm above accessory digit. Diatrizoatemeglumine was administered at 10mL to 24 members (group 1), 13 dorsal common digital vein III for access 1 (A1), and 11 digital II or IV access 2 (A2). In group 2 20mL was administered to 29 members, 15 by 19 in A1 and A2. After contrast administration, the radiographs were repeated every 20 seconds until 120 seconds. The degree of vascular filling was greater in group 2, independent of venous access, member or moment. There was no significant difference in the degree of radiopacity of radiographic images when compared to the venous access, time and a member of both groups. We conclude that administration of 20mL of contrast showed better vascular filling and radiopacity, with no difference between 20 and 120 seconds after contrast administration in independent radiographic quality venous access.(AU)

Tratamento endovascular da síndrome de quebra-nozes: relato de caso / Endovascular treatment of Nutcracker syndrome: case report

A dor pélvica crônica é uma doença debilitante, com impacto na qualidade de vida e custos para os serviços de saúde. A síndrome de quebra-nozes é uma importante causa dessa dor, e se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta. Seu tratamento ainda permanece controverso e varia de acordo com a gravidade clínica do paciente. Contudo, a técnica endovascular com implante de stent em veia renal tem obtido excelentes resultados. Relatamos um caso de uma paciente de 59 anos submetida a correção endovascular com stent autoexpansível de nitinol. São apresentados dados clínicos, detalhes do procedimento e resultados do acompanhamento dessa paciente. O sucesso técnico foi obtido e não houve relato de complicações pós-operatórias. Pôde-se observar alívio dos sintomas e melhora nos exames de imagem realizados no acompanhamento de curto prazo

Chronic pelvic pain is a debilitating disease that directly impacts on quality of life and generates costs for health services. Nutcracker Syndrome is an important cause of pelvic pain and consists of a set of signs secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta. Treatment remains controversial and varies depending on the patient's clinical severity. However, endovascular treatment with renal vein stenting has achieved excellent results. We report the case of a 59 year-old female treated by endovascular repair with a self-expanding nitinol stent. Clinical data, details of the procedure, and follow-up results are presented. Technical success was achieved and there patient reported no postoperative complications. Short-term, there was relief from symptoms and follow-up imaging tests showed improvement

Análise do grau de recanalização da trombose venosa profunda: estudo comparativo de pacientes tratados com varfarina versus rivaroxabana / Analysis of recanalization of deep venous thrombosis: a comparative study of patients treated with warfarin vs. rivaroxaban

Contexto A trombose venosa profunda (TVP) afeta anualmente cerca de dez milhões de pessoas no mundo e tem como principais complicações a embolia pulmonar e a síndrome pós-trombótica. O tratamento padrão é a anticoagulação, que pode ser realizada com heparinas, antagonistas da vitamina K, fondaparinux ou, mais recentemente, com anticoagulantes orais diretos (direct oral anticoagulants, DOACs). Os anticoagulantes diminuem a progressão do trombo e facilitam os mecanismos trombolíticos naturais, fato conhecido como recanalização, que pode ocorrer em graus e tempos variados, influenciados por diversos fatores, dentre eles o tipo de anticoagulação utilizado. Objetivos Avaliar o grau e o tempo de recanalização através da análise de laudos de eco-Doppler colorido (EDC) de pacientes com TVP tratados com DOACs ou com heparina + varfarina. Métodos Foram avaliados retrospectivamente os dados demográficos e os laudos dos EDC dos pacientes com TVP, tratados entre janeiro de 2009 a dezembro de 2016. Os pacientes foram divididos em dois grupos, de acordo com a terapêutica utilizada: Grupo I (heparina + varfarina): 26 pacientes; Grupo II (rivaroxabana): 51 pacientes. Os principais itens observados foram o grau e o tempo para a recanalização. Resultados Foram observadas taxas de recanalização aos 30, 90 e 180 dias de 10%, 52,5% e 78,9%, respectivamente, no Grupo I, e de 55,3%, 83,5% e 92,4%, respectivamente, no Grupo II, com diferença estatisticamente significativa (p = 0,041). Conclusões Ambos os tratamentos promoveram recanalização. Houve recanalização mais precoce no grupo de pacientes que utilizaram a rivaroxabana

Deep venous thrombosis (DVT) strikes around ten million people worldwide every year and is associated with major complications including pulmonary embolism and post-thrombotic syndrome. Anticoagulation is the standard treatment, with administration of heparins, vitamin K antagonists, fondaparinux, or, more recently, direct oral anticoagulants (DOACs). Anticoagulants reduce thrombus progression and facilitate natural thrombolytic mechanisms, leading to a phenomenon known as recanalization, which can occur in varying degrees and over variable periods of time, under influence from many different factors, including the type of anticoagulation employed. Objectives To evaluate the degree of recanalization and the time taken, by analysis of color Doppler ultrasonography (CDU) reports from patients with DVT treated with DOACs or with heparin + warfarin. Methods A retrospective analysis was conducted of demographic data and CDU reports from patients with DVT who had been treated from January 2009 to December 2016. These patients were classified into two groups, according to the treatment given: Group I (heparin + warfarin): 26 patients; or Group II (rivaroxaban): 51 patients. The primary outcomes assessed were degree of recanalization and time taken. Results Recanalization rates at 30, 90, and 180 days were 10%, 52.5%, and 78.9%, respectively, in Group I, and 55.3%, 83.5%, and 92.4%, respectively, in Group II, with statistically significant difference (p = 0.041). Conclusions Both treatments led to recanalization. Recanalization occurred earlier among patients treated with rivaroxaban

Dolor pélvico crónico secundario a síndrome de congestión pélvica: resultados del tratamiento endovascular de la insuficiencia venosa pelviana y várices genitales / Embolization of insufficient pelvic veins for pelvic congestion syndrome: analysis of 17 cases

Background: Pelvic venous insufficiency may cause pelvic congestion syndrome that is characterized by chronic pelvic pain exacerbated by prolonged standing, sexual activity or menstrual cycle. It may be treated by embolizing the dysfunctional pelvic venous drainage and sometimes resecting vulvar, perineal and thigh varices. Aim: To assess the results of embolization of insufficient pelvic or ovarian veins on pelvic congestion syndrome. Material and Methods: Analysis of 17 female patients aged 32 to 53 years, who underwent subjected to a selective coil embolization of insufficient pelvic and/or ovarian veins through the jugular, basilic or cephalic veins. In the preoperative period, all patients had a lower extremity venous duplex pelvic ultrasound examination and some had an abdominal and pelvic CT angiogram. Results: The technical success of the procedure was 100% and no complications were registered. During a 32 month follow up, no patient had symptoms of pelvic venous insufficiency or relapse of vulvar or thigh varices. Conclusions: Embolization of insufficient pelvic and ovarian veins is a safe and successful procedure for the treatment of pelvic venous insufficiency or vulvar varices.

Síndrome renal del cascanueces / Nutcracker syndrome

El síndrome renal del cascanueces es una enfermedad rara, más frecuente en mujeres entre la tercera y cuarta décadas de la vida. Consiste en la compresión de la vena renal izquierda, entre la arteria mesentérica superior y la aorta abdominal, que provoca un aumento en el gradiente presión de la vena renal izquierda y produce hematuria renal unilateral izquierda. Se presenta una paciente de 55 años de edad con antecedentes patológicos personales de hipertensión arterial hace 15 años, que comienza con cuadro de dolor lumbar izquierdo, asociado a hematuria microscópica y leucocituria. Se interpreta como infección del tracto urinario, recibió tratamiento antibiótico por 10 días, aunque con persistencia de la hematuria, sin otra manifestación clínica. Se le realizó angio-TAC (fase simple, arterial, venosa, excretora) que mostró arterias únicas y normales. Existe ligera compresión de la vena renal izquierda, por disminución del ángulo aorto mesentérico (ángulo 25°), compatible con síndrome renal del cascanueces. Se presenta este caso, dado lo poco frecuente del reporte de este síndrome en Cuba(AU)

Nutcracker syndrome is a rare disease, more frequent in in women between the third and fourth decades of life. It consists of the compression of the left renal vein between the superior mesenteric artery and the abdominal aorta, causing an increase in the pressure gradient of the left renal vein and producing left unilateral renal hematuria. We present a 55-year-old patient with a personal pathological history of arterial hypertension for 15 years, who began with left lumbar pain, associated with microscopic hematuria and leukocyturia. It was interpreted as a urinary tract infection, the patient received antibiotic treatment for 10 days , although hematuria continued, until now, with no other clinical manifestation. The patient underwent a angio-CT (simple, arterial, venous, excretory phase) that showed single and normal arteries. There is slight compression of the left renal vein, due to reduction of the mesenteric aorto angle (angle 25°), compatible with renal nutcracker syndrome. We present this case since this syndrome is rare in Cuba(AU)

Usefulness of preoperative venography in patients with cardiac implantable electronic devices submitted to lead replacement or device upgrade procedures / Utilidade da Venografia Pré-Operatória em Procedimentos de Troca de Cabos-Eletrodos ou Mudança do Modo de Estimulação

Abstract Background: Venous obstructions are common in patients with transvenous cardiac implantable electronic devices, but they rarely cause immediate clinical problems. The main consequence of these lesions is the difficulty in obtaining venous access for additional leads implantation. Objectives: We aimed to assess the prevalence and predictor factors of venous lesions in patients referred to lead reoperations, and to define the role of preoperative venography in the planning of these procedures. Methods: From April 2013 to July 2016, contrast venography was performed in 100 patients referred to device upgrade, revision and lead extraction. Venous lesions were classified as non-significant (< 50%), moderate stenosis (51-70%), severe stenosis (71-99%) or occlusion (100%). Collateral circulation was classified as absent, discrete, moderate or accentuated. The surgical strategy was defined according to the result of the preoperative venography. Univariate analysis was used to investigate predictor factors related to the occurrence of these lesions, with 5% of significance level. Results: Moderate venous stenosis was observed in 23%, severe in 13% and occlusions in 11%. There were no significant differences in relation to the device side or the venous segment. The usefulness of the preoperative venography to define the operative tactic was proven, and in 99% of the cases, the established surgical strategy could be performed according to plan. Conclusions: The prevalence of venous obstruction is high in CIED recipients referred to reoperations. Venography is highly indicated as a preoperative examination for allowing the adequate surgical planning of procedures involving previous transvenous leads.

Resumo Fundamento: Obstruções venosas são frequentes em portadores de dispositivos cardíacos eletrônicos implantáveis (DCEI) endocárdicos, mas raramente causam problemas clínicos imediatos. A principal consequência destas lesões é a dificuldade para obtenção de via de acesso para o implante de novos cabos-eletrodos. Objetivos: Determinar a prevalência de lesões venosas em candidatos a reoperações envolvendo o manuseio de cabos-eletrodos, e definir o papel da venografia pré-operatória no planejamento desses procedimentos. Métodos: De abril de 2013 a julho de 2016, 100 pacientes com indicação de troca de cabos-eletrodos, ou mudança no modo de estimulação, realizaram venografia com subtração digital no período pré-operatório. As lesões venosas foram classificadas em: não significativas (< 50%), moderadas (51-70%), graves (71-99%) ou oclusivas (100%), e a circulação colateral, em ausente, discreta, moderada ou acentuada. A estratégia cirúrgica foi definida a partir do resultado deste exame. Empregou-se análise univariada para a pesquisa de fatores de risco relacionados à ocorrência dessas lesões, com nível de significância de 5%. Resultados: Obstruções venosas moderadas foram observadas em 23%, graves em 13% e oclusões em 11% dos pacientes estudados, não sendo identificadas diferenças significativas em sua distribuição em relação ao lado do implante, ou do segmento venoso. A utilidade do exame para definição da tática operatória foi comprovada, sendo que em 99% dos casos, a estratégia cirúrgica estabelecida pode ser executada. Conclusões: A prevalência de obstruções venosas é elevada em portadores de DCEI que serão submetidos a reoperações. A venografia é altamente indicada como exame pré-operatório para o adequado planejamento cirúrgico de procedimentos envolvendo cabos-eletrodos transvenosos previamente implantados.

Taxa de sucesso de posicionamento de cabo-eletrodo ventricular esquerdo em região-alvo sem utilização de bainha e/ou venografia durante procedimento de implante de marcapasso biventricular / Success rate of left ventricular lead positioning in target region without a sheath and/or venography during biventricular pacemaker implantation procedure

Introdução: Este trabalho teve por objetivo avaliar a taxa de sucesso de implante de cabo-eletrodo ventricular em região lateral sem uso de venografia. Método: Foram analisados 100 casos de implante de cabo-eletrodo ventricular esquerdo ao longo de 30 meses, em um único centro, quanto a sua localização e calculada a taxa de implantes em parede lateral (ântero-lateral, lateral e póstero-lateral). Todos os procedimentos foram realizados sem uso de bainha e sem realização de venografia, por meio de técnica de cateterização do seio coronário baseada no componente atrial do eletrograma endocavitário. Resultados: Em 83% dos casos foi conseguido implante em parede lateral, predominantemente em paredes póstero-lateral e lateral, com tempo de radioscopia médio de 5,97 minutos. Em 10% houve insucesso, com necessidade de implante de cabo-eletrodo epicárdico. Conclusão: O implante de cabo-eletrodo ventricular esquerdo em região lateral sem uso de venografia baseado no componente atrial do eletrograma endocavitário constitui técnica segura e eficaz, apresentando ainda redução do tempo de radioscopia

Background: This study was aimed at evaluating left ventricular pacing implant success rate in the lateral region without the use of venography. Method: We analyzed 100 cases of left ventricular lead implants over 30 months in a single center as to the location of the left ventricular lead and calculated the rate of implants in the lateral wall (anterolateral, lateral and posterolateral). All procedures were carried out without the use of a sheath and without performing venography using the coronary sinus catheter technique based on the atrial endocardial electrogram component. Results: In 83% of cases it was successfully implanted in the lateral wall, predominantly in the posterolateral and lateral walls, with a mean radioscopy time of 5.97 minutes. It failed in 10% of the cases and we had to use an epicardial lead. Conclusion: Left ventricular lead implantation in the lateral region without venography based on atrial component of the endocavitary electrogram is a safe and effective technique, which also reduces radioscopy time

Graft Calcification Caused by a Torsion of the Hepatic Vein after a Living-Related Donor Liver Transplantation

Abstract: The torsion of vessels after liver transplantation rarely occurs. Likewise, calcification of a liver graft has seldom been reported. This report details a case which had torsion of the left hepatic vein on the seventh day after living-related donor liver transplantation. The torsion was reduced soon after re-exploration; however, congestion with partial necrosis of the graft occurred. On the follow-up imaging studies, some resolution of necrosis and graft regeneration were found, yet geographic calcification of the liver graft appeared. The patient died of pneumonia after 13 weeks, post-operation. The avoidance such torsion of vessels is necessary and important.(AU)

Variação anatômica venosa rara em membros inferiores / A rare venous anatomic variation of the lower limb

Resumo A anatomia do sistema venoso dos membros inferiores é uma das mais complexas no corpo humano. Devido a essa condição, é de extrema importância saber identificar variações que possam acometê-la, como as malformações congênitas. Em casos de agenesia de veias profundas, como uma malformação vascular rara, o quadro clínico pode manifestar-se com insuficiência venosa crônica, que pode evoluir com edema, hiperpigmentação e úlcera de membro inferior. Assim, em muitos casos, torna-se uma doença incapacitante e de difícil tratamento. Apresenta-se um caso de agenesia de segmento venoso femoropoplíteo no membro inferior direito em paciente de 36 anos de idade, que cursou com edema e varizes de grosso calibre no membro acometido.

Abstract The anatomy of the venous system of the lower limbs is among the most complex in the human body. In view of this, it is extremely important to know how to identify variations that can affect it, such as congenital malformations, for example. In cases of a rare vascular malformation such as agenesis of deep veins, clinical status may manifest with chronic venous insufficiency, which can progress with edema, hyperpigmentation, and lower limb ulcers. This is very often therefore an incapacitating disease that is difficult to treat. This article describes a case of agenesis of a segment of femoropopliteal vein in the right lower limb of a 36-year-old patient who had edema and large caliber varicose veins in the affected limb.

Double inferior vena cava detected by CT venography and confirmed by magnetic resonance venography: embryogenesis and literature review / Doble vena cava inferior detectada a través de venografía por tomografía computada y confirmada con venografía por resonancia magnética: embriogénesis y revisión de la literatura

A hospital based prospective study was conducted from July 2001 to July 2015 at the Department of Radiology, Jordan University Hospital, Amman, Jordan. During that period, five cases of double inferior vena cava (DIVC) were discovered among a cohort of 7722 patients (3861 men and 3861 women, 49.5±16.9 years, range 16­78 years). Cases were diagnosed by contrast-enhanced Spiral CT venography (CTV) and confirmed by turbo three-dimensional (3D) time-of-flight contrast-enhanced MR venography. The majority of patients 3166 (41 %) were referred for staging and follow-up of malignancy, postoperative complications 1777 (23 %), non-specific abdominal pain 1467 (19 %), preoperative assessment 849 (11 %) and trauma 463 (6 %). Magnetic resonance venography showed higher sensitivity, diagnostic accuracy and noninvasive modality for assessment of IVC map. MRV is a more useful, noninvasive modality for assessment of IVC map. DIVC is a common anomaly, its incidence in our study found to be 0.064 %. The incidence, literature review, embryogenesis, and importance of this anomaly are discussed. In addition, sample figures of relevant cases are provided.

En el Departamento de Radiología del Hospital de la Universidad de Jordania, Amman, Jordania, se llevó a cabo un estudio prospectivo entre el mes de julio de 2001 al mes de julio del 2015. Durante ese período se descubrieron cinco casos de vena cava inferior doble (VCID) en una cohorte de 7722 pacientes (3861 hombres y mujeres 3861, de 49,5 ± 16,9 años, con un rango de edad de 16-78 años). Los casos fueron diagnosticados por medio de venografía por tomografía computada espiral con contraste (TCV) y confirmados por medio de venografía por estudio tridimensional turbo. La mayoría de los pacientes (3166, 41 %) fueron remitidos para estadificación y seguimiento de tumores malignos. Se presentaron complicaciones postoperatorias en 1777 pacientes (23 %), dolor abdominal no especificado en 1467 (19 %), evaluación preoperatoria en 849 (11 %) y traumatismo en 463 pacientes (6 %). La venografía por resonancia magnética (RMV) mostró una mayor sensibilidad, precisión diagnóstica, y resultando no invasiva para la evaluación de la vena cava inferior (VCI). RMV es una modalidad más útil, no invasiva para la evaluación de la VCI. VCID es una anomalía frecuente, encontrándose en nuestro estudio una incidencia de 0,064 %. Además se realizó una revisión de la literatura, la embriogénesis, y la importancia de esta anomalía. También, se proporcionaron cifras de muestras de los casos relevantes.

Computed Tomograpy Venography diagnosis of iliocaval venous obstruction in advanced chronic venous insufficiency / Diagnóstico angiotomográfico da obstrução venosa ilíaco-cava na Insuficiência Venosa Crônica avançada

Objective: Iliocaval obstruction is associated with venous hypertension symptoms and may predispose to deep venous thrombosis (DVT). Ultrasonography may fail to achieve noninvasive diagnosis of these obstructions. The possibility of using Computed Tomography Venography (CTV) for these diagnoses is under investigation. Methods: Patients with CVI graded at CEAP clinical classes 3 to 6 and previous treatment failure underwent evaluation with CTV. Percentage obstruction was rated by two independent examiners. Obstruction prevalence and its associations with risk factors and CEAP classification were analyzed. Results: A total of 112 limbs were prospectively evaluated. Mean patient age was 55.8 years and 75.4% were women. Obstructions involved the left lower limb in 71.8% of cases and 35.8% of patients reported a medical history of deep venous thrombosis. Overall, 57.1% of imaging studies demonstrated venous obstruction of at least 50% and 10.7% showed obstruction of >80%. The only risk factor that was found to be independently associated with a significantly higher incidence of >50% venous obstruction was a medical history of DVT (p=0.035) (Fisher's exact test). There was a positive relationship between clinical classification (CEAP) and degree of venous obstruction in the limbs studied (Chi-square test for linear trend; p=0.011). Conclusion: Patients with advanced CVI are often affected by obstructions in the iliocaval venous territory and CTV is able to diagnose the degree of obstruction. There is a positive association between degree of obstruction and both previous history of DVT and severity of symptoms of CVI. .

Objetivo: A obstrução ilíaco-cava é associada a sintomas de hipertensão venosa e é um fator de risco para a trombose venosa profunda (TVP). A ultrassonografia pode falhar em seu diagnóstico. Não existe método de "sreening" bem estabelecido. A capacidade da Angiotomografia em realizar esse diagnóstico vem sendo investigada. Método: Pacientes portadores de IVC avançada e com falha no tratamento clínico foram submetidos à Angiotomografia. As imagens foram classificadas quanto ao grau de obstrução por dois investigadores independentes. Foram avaliados a prevalência e o grau de obstrução, e a sua relação com dados demográficos, fatores de risco e sintomas clínicos (CEAP). Resultados: Foram avaliados 112 membros. A idade média dos pacientes foi de 55,8 anos e 75,4% eram mulheres. A obstrução acometia o membro inferior esquerdo em 71,8% e havia história de TVP em 35,8% destes. Em 57,1% dos membros, havia obstrução > 50% e, em 10,7%, a obstrução era > 80%. A história de TVP foi o único fator demográfico com associação positiva com o grau de obstrução (p = 0,035) (teste Exato de Fisher). Houve associação positiva entre a classificação clínica (CEAP) e o grau de obstrução venosa (Teste Qui-quadrado para tendência linear; p=0,011). Conclusão: Pacientes portadores de IVC avançada são frequentemente acometidos por obstrução venosa ilíaco-cava e a Angiotomografia é capaz de identificar o grau dessa obstrução. Existe uma relação positiva entre o grau de obstrução e a classificação clínica, e a história de TVP .

Análisis del rol de la venografía de extremidades inferiores por tomografía computada en pacientes con sospecha clínica de tromboembolismo pulmonar / Analysis of the role of ct venography of lower limbs in patients with clinically suspected pulmonary embolism

Objetivos. Determinar el rol de la venografía por tomografía computada e identificar variables que determinen el diagnóstico de trombosis venosa profunda de extremidades inferiores en pacientes con sospecha clínica de TEP y sometidos a angiografía de tórax por tomografía computada. Diseño. Cohorte retrospectiva que evaluó 151 pacientes en los que se realizó venografía de extremidades inferiores - angiografía de tórax mediante tomografía computada. Se tabularon factores de riesgo como la edad, sexo, servicio de proveniencia, riesgo para TEP (según score de Wells), ecotomografía Doppler de EEII previa y sus resultados, diagnóstico y lugar anatómico de TEP y diagnóstico y lugar anatómico de TVP según los resultados obtenidos con la venografía. Resultados. Se dispuso de información completa para 151 pacientes. 40 fueron positivo para TEP (26,5%) y 13 venografías resultaron positivas (8.6% del total). Los casos provenían en un 41,7% de Urgencia; 31,1% de UPC; 19,8% hospitalizados (no crítico); y 7,2% de consultas ambulatorias. De las variables estudiadas, ninguna resultó estadísticamente significativa para predecir el hallazgo de trombosis venosa profunda en concomitancia con la angiografía pulmonar mediante TC. En aquellos pacientes con ultrasonido Doppler contemporáneo, la venografía por tomografía computada no aportó nueva información de aquella ya disponible. Conclusiones. En este estudio no se encontraron variables que a priori apoyen la realización de una fase venográfica en concomitancia con una angiografía de tórax mediante tomografía computada cuando existe la sospecha clínica de tromboe-mbolismo pulmonar. No se justificaría realizar venografía por TC en pacientes con hemodinamia estable y sospecha de TEP.

Objectives. To determine the role of CT venography and identify variables that determine the diagnosis of deep venous thrombosis (DVT) of lower extremities in patients with clinical suspicion of PE, and who underwent chest CT angiography. Design. Retrospective group study that evaluated hundred fifty-one patients in whom lower extremity venography- chest CT angiography was performed. Risk factors were tabulated - such as age, sex, department origin, risk of PE (according to Wells Criteria), previous Doppler ultraso-nography of lower extremities and their results, diagnosis and anatomical site of PE, and diagnosis and anatomical site of DVT according to the results obtained with the venography. Results. Complete data was available for 151 patients. 40 were positive for PE (26.5 percent) and 13 venographs were positive (8.6percent of the total). The case origins were 41.7 percent from Emergency Department, 31.1 percent from ICU, 19.8 percent hospitalized (non-critical) and 7.2 percent from outpatient consultations. Of the variables studied, none resulted statistically significant for predicting the discovery of deep vein thrombosis in conjunction with CT pulmonary angio-graphy. In those patients with contemporary Doppler ultrasound, the CT venography did not provide new information from that already available. Conclusions. In this study we did not find variables that support a priori the realization of a venography phase in conjunction with chest CT angiogram when there is clinical suspicion of pulmonary embolism. Performing CT venography in patients with stable hemodynamics and suspected PE, would not be justified.

Superior Vena Cava Syndrome Associated with Right-to-Left Shunt through Systemic-to-Pulmonary Venous Collaterals

Superior vena cava (SVC) obstruction is associated with the gradual development of venous collaterals. We present a rare form of systemic-to-pulmonary subpleural collateral pathway that developed in the bridging subpleural pulmonary veins in a 54-year-old woman with complete SVC obstruction. This uncommon collateral pathway represents a rare form of acquired right-to-left shunt due to previous pleural adhesions with an increased risk of stroke due to right-to-left venous shunting, which requires lifelong anticoagulation.

Isolated dilatation of the inferior vena cava

The diameter and collapsibility of the inferior vena cava (IVC) should be interpreted in consideration with other clinical and echocardiographic parameters before drawing definitive diagnostic conclusions. We report a case of a 46-year-old female with isolated IVC dilation and diminished inspiratory collapse without other abnormalities, and provide a brief review of the literature.

Tratamento endovascular da Sindrome de Quebra-nozes (Nutcracker) / Endovascular treatment of Nutcracker syndrome

A Síndrome do Quebra-nozes se refere a um conjunto de sinais secundários à compressão da veia renal esquerda, mais comumente entre a artéria mesentérica superior e a aorta, levando ao comprometimento do fluxo para a veia cava. O diagnóstico desta síndrome frequentemente é difícil e, por esta razão, o diagnóstico é demorado, em muitos casos. É relatado, nesta publicação, o caso de uma mulher de 51 anos, tratada com sucesso pela embolização da veia ovariana associada ao implante de stent autoexpansível na veia renal esquerda. São discutidos os aspectos técnicos e as dificuldades do procedimento.

Nutcracker syndrome refers to signs and symptoms secondary to compression of the left renal vein, most commonly between the superior mesenteric artery and the aorta, leading to impaired outflow to the vena cava. Diagnosis of this syndrome is often difficult and as result is late in most cases. We report on the case of a 51-year-old woman successfully treated with embolization of the ovarian vein and insertion of a self expandable stent in the left renal vein. Technical details and pitfalls are discussed.

CT Venography for Deep Vein Thrombosis Using a Low Tube Voltage (100 kVp) Setting Could Increase Venous Enhancement and Reduce the Amount of Administered Iodine

OBJECTIVE: To investigate the validity of the 100 kVp setting in CT venography (CTV) in the diagnosis of deep vein thrombosis (DVT), and to evaluate the feasibility of reducing the amount of administered iodine in this setting. MATERIALS AND METHODS: After receiving the contrast medium (CM) of 2.0 mL/kg, 88 patients underwent CTV of the pelvis and lower extremities by using one of four protocols: Group A, 120 kVp setting and 370 mgI/mL CM; group B, 120 kVp and 300 mgI/mL; group C, 100 kVp and 370 mgI/mL; group D, 100 kVp and 300 mgI/mL. The groups were evaluated for venous attenuation, vein-to-muscle contrast-to-noise ratio (CNRVEIN), DVT-to-vein contrast-to-noise ratio (CNRDVT), and subjective degree of venous enhancement and image quality. RESULTS: Venous attenuation and CNRVEIN were significantly higher in group C (144.3 Hounsfield unit [HU] and 11.9), but there was no significant difference between group A (118.0 HU and 8.2) and D (122.4 HU and 7.9). The attenuation value of DVT was not significantly different among the four groups, and group C had a higher absolute CNRDVT than the other groups. The overall diagnostic image quality and venous enhancement were significantly higher in group C, but there was no difference between groups A and D. CONCLUSION: The 100 kVp setting in CTV substantially help improve venous enhancement and CNRVEIN. Furthermore, it enables to reduce the amount of administered iodine while maintaining venous attenuation, as compared with the 120 kVp setting.