Filtro de vena cava inferior, resultados a mediano y largo plazo / Inferior vena cava filter medium to long-term results

Resumen Introducción: El tromboembolismo pulmonar sin tratamiento, presenta un riesgo de recurrencia del 20%, con una mortalidad del 18% al 26%, en pacientes con embolia pulmonar donde esta contraindica o fracasa la anticoagulación, es necesario interrumpir parcialmente la vena cava inferior, siendo los filtros de vena cava la alternativa más utilizada. Objetivo: Analizar las variables epidemiológicas involucradas en la enfermedad tromboembólica y los resultados de la inserción del filtro de vena cava inferior. Materiales y Método: Estudio retrospectivo, observacional y descriptivo, donde se analiza la inserción sucesiva de 82 filtros de vena cava inferior, en un período de 10 años (2009 al 2019), en el Hospital Dr. Eduardo Pereira de Valparaíso, Chile. Resultados: Sexo femenino 53,6%, edad promedio 60,4 años (rango 19-86), la principal causa para desarrollar enfermedad tromboembólica fueron las enfermedades oncológicas (56,09%), la principal vía de acceso fue la vena femoral común (69,51%), localización del filtro suprarrenal (4,87%), se obtuvo un seguimiento actualizado en el 89,02%, la supervivencia a 5 años fue de 73,17% y a 10 años de 57,32%, morbilidad en relación al procedimiento (9,75%), éxito del procedimiento (97,5%), no hubo mortalidad relacionada. Discusión: Los grandes ensayos, demuestran el beneficio de la interrupción de la vena cava inferior mediante filtros, especialmente en pacientes oncológicos, con elevado riesgo de embolia pulmonar. Conclusión: La inserción de un filtro de vena cava inferior, adecuadamente indicado, es un procedimiento mínimamente invasivo, de bajo riesgo y con excelentes resultados en la profilaxis de la embolia pulmonar.

Introduction: Pulmonary thromboembolism without treatment presents a risk of recurrence of 20%, with a mortality of 18% to 26%. In patients with pulmonary embolism, when anticoagulation therapy is contraindicated or failed, it is necessary to intervene partially the inferior vena cava on which cava vein filters are the main used alternative. Aim: Analyze the epidemiological variables involved on thromboembolic disease, and the outcomes of the inferior vena cava filter insertions. Materials and Method: Retrospective, observational and descriptive study, which analyzes the successive insertion of 82 inferior vena cava filters, over a period of 10 years (2009 to 2019), in the Dr. Eduardo Pereira Hospital, Valparaíso, Chile. Results: Female sex 53.6%, average age 60.4 years (range 19-86), the main cause to develop thromboembolic disease were oncological diseases (56.09%); the main access path was the common femoral vein (69.51%); in a 4.87% the location of the filter was suprarenal. Complete follow-up was obtained in 89.02% of the cases, 5-year survival with 73.17% ratio and 10-years survival of 57.32%, morbidity in relation to the procedure was 9.75%; success of the procedure 97.5%; there was no mortality related. Discussion: Large studies demonstrate the benefits of interruption on the inferior vena cava through filters, especially in cancer patients with high risk of pulmonary embolism. Conclusion: The insertion of an inferior vena cava filter when indication is adequate, is a minimally invasive procedure with low risk and excellent results in the prophylaxis of pulmonary embolism.

Resección hepática extendida con vena cava inferior por colangiocarcinoma intrahepático: presentación de 2 casos / Extended hepatic resection with inferior cava vein for intrahepatic cholangiocarcinoma: presentation of two cases

Resumen Introducción: El colangiocarcinoma intrahepático (CIH) corresponde al segundo tumor hepático primario y la resección quirúrgica es la única alternativa válida para el tratamiento curativo de esta enfermedad. Reporte de casos: Describimos 2 paciente portadores de CIH con compromiso de vena cava inferior (VCI) que fueron sometidos a resección en Clínica Alemana de Santiago (CAS). Ambas pacientes son de género femenino de 39 y 47 años de edad. Ambas fueron sometidas a resección mayor hepática izquierda, asociada a resección del segmento I y extendida a VCI. La reconstrucción de la VCI fue realizada con parche pericárdico bovino y cierre primario respectivamente. El período desde el posoperatorio hasta el alta, fue de 13 y 23 días respectivamente. Discusión: Aunque la reseccion quirúrgica es la única vía para la curación en el CIH, el compromiso de estructuras vasculares hacen que esto no sea posible. El manejo multidisciplinario asociado a una técnica meticulosa realizada por un equipo quirúrgico experimentado, hacen posible lograr buenos resultados.

Introduction: Intrahepatic cholangiocarcinoma is the second most common primary liver tumor and surgical resection the only valid curative treatment. Case reports: We describe two patients harboring an intrahepatic cholangiocarcinoma with cava vein involvement who underwent resection at Clinica Alemana of Santiago. Both patients were females with ages of 39 and 47 years old. Both patients underwent left liver resection, associated to resection of segment I and of a portion of cava vein. Reconstruction of resected portion of the cava vein was performed by using a pericardium bovine patch and primary closure respectively. Postoperative period was uneventfully being discharged at 13 and 23 days respectively. Discussion: Although surgical resection is the only way to get curativeness, frequent involvement of large vascular structures make treatment unfeasible. A multidisciplinary approach associated with a meticulous technique performed by an experienced surgical team make possible to accomplish the above objective.

Índice de colapsabilidad de la vena cava inferior como predictor de hipotensión intraoperatoria / Inferior vena cava collapsibility index of the as a predictor of intraoperative hypotension

OBJECTIVE: To evaluate the lower vena cava Collapse Index (CI) as a predictor parameter of hypotensive episodes after general anesthesia induction in ASA I and II patients who were scheduled for elective surgery. MATERIALS AND METHODS: A prospective, observational and simple blind study was designed. A sample of 80 patients was recruited. In the preoperative stage, they underwent protocolarized sedation and CI was obtained. Prior to induction, the baseline values ​​of heart rate, non-invasive mean arterial pressure and continuous electrocardiographic tracing in DII were noted. In the post-orotracheal intubation stage, the aforementioned hemodynamic monitoring variables were recorded manually for 10 minutes. RESULTS: The data of 78 individuals are presented. After anesthetic induction, 8 (10.3%) patients developed hypotension. The adjustment of the univariate logistic regression model for CI shows a good diagnostic capacity, with the area under the ROC curve equal to 0.76. The chance of presenting hypotension is increased by 62% by increasing the CI by 5 points (p = 0.003). Regarding the negative predictive value, we found that with values ​​corresponding to the cutoff points between 39% and 46%, a probability of at least 93.1% of not presenting hypotension was obtained. The optimal cutoff point of the CI to predict hypotension is estimated at 43%, with a sensitivity of 62.5% and a specificity of 92.9%. CONCLUSION: A lower IC was associated with a lower probability of developing intraoperative hypotension. The use of this tool could be useful to anticipate which patients will be prone to intra-surgical hypotension.

OBJETIVO: Evaluar el índice de colapsabilidad (IC) de la vena cava inferior (VCI) como predictor de episodios hipotensivos posinducción de anestesia general en cirugía electiva de pacientes ASA I y II. MATERIALES Y MÉTODOS: Se diseñó un estudio prospectivo, observacional y simple ciego. Se reclutó una muestra de 80 pacientes. En etapa preoperatoria fueron sometidos a una sedación protocolizada y se obtuvo el IC. Previo a la inducción, se anotaron los valores basales de la frecuencia cardíaca, la presión arterial media y el trazado electrocardiográfico continuo en DII. Posintubación orotraqueal, se registraron manualmente las variables hemodinámicas mencionadas durante 10 minutos. RESULTADOS: Se presentan datos de 78 individuos. Luego de la inducción, 8 (10,3%) pacientes desarrollaron hipotensión. El ajuste del modelo de regresión logística univariado para IC muestra una buena capacidad diagnóstica, siendo el área bajo la curva ROC igual a 0,76. La chance de presentar hipotensión se incrementa en un 62% al aumentar el IC en 5 puntos (p = 0,003). En cuanto al valor predictivo negativo, encontramos que con valores correspondientes a los puntos de corte entre 39% y 46%, se obtenía una probabilidad de 93,1% de no presentar hipotensión. El punto de corte óptimo del IC para predecir hipotensión se estima en 43%, con una sensibilidad del 62,5% y una especificidad del 92,9%. CONCLUSIÓN: Un menor IC se asoció con una menor probabilidad de desarrollar hipotensión intraoperatoria. El uso de esta herramienta podría ser de utilidad para anticipar qué pacientes serán propensos a hipotensión intraquirúrgica.

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.

Colapsibilidade da Veia Cava Inferior e sinais e sintomas de insuficiência cardíaca: novos insights e possíveis associações / Inferior Vena Cava collapsibility and heart failure signs and symptoms: new insights about possible links

FUNDAMENTO: Nos pacientes com Insuficiência Cardíaca Crônica (ICC) foram propostas medidas ultrassonográficas do Índice de Colapsibilidade da Veia Cava Inferior (ICVCI) para obter uma avaliação e classificação minuciosa da congestão hemodinâmica. OBJETIVO: A finalidade deste estudo era correlacionar os achados no exame físico com o ICVCI em pacientes com ICC. MÉTODOS: De acordo com um projeto de coorte retrospectivo, analisamos 54 pacientes com ICC, direita ou biventricular, classe NYHA III. O plano era determinar se alguma faixa de ICVCI basal poderia predizer uma persistência ou agravamento da congestão clínica achada no final do acompanhamento subsequente (isto é, após 1-2 meses do tratamento oral otimizado). Para essa finalidade, os pacientes foram subdivididos em três grupos de acordo com o valor de ICVCI basal: ≤ 15% (13 pts), 16 - 40% (21 pts) e > 40% (20 pts). Diversos critérios clínicos de congestão foram comparados por meio dos três grupos e incorporados subsequentemente ao modelo multivariado de Cox. RESULTADOS: Preditores multivariados de alto escore de congestão foram distensão da veia jugular (FC: 13,38 95% IC: 2,13 - 84 p = 0,0059) e estertores (FC: 11 95% C.I : 1,45 - 83,8 p = 0,0213). O ICVCI ≤ 15% esteve sempre associado com um alto escore de congestão na segunda visita; todavia, o ICVCI o ≤ 15% não predisse um alto escore de congestão na segunda visita. CONCLUSÃO: No âmbito da ICC, um baixo ICVCI não predisse, em forma confiável, um elevado escore de congestão. Não obstante, o conjunto com ICVCI ≤ 15% sempre se achou associado com sinais e sintomas de uma ICC descompensada, tanto do lado direito como do esquerdo. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

BACKGROUND: In chronic heart failure patients (CHF), ultrasound measurement of inferior vena cava collapsibility index (IVCCI) has been proposed to yield careful assessment and grading of the hemodynamic congestion. OBJECTIVE: The purpose of this study was to correlate the findings of physical examination with IVCCI in CHF patients. METHODS: According to a retrospective cohort design, we analyzed 54 CHF patients with right or biventricular CHF, belonging to III NYHA class. We planned to determine whether any basal IVCCI range would be able to predict persistent or worsening clinical congestion found at the end of subsequent follow up (i.e. after 1-2 months of oral optimized therapy). For this purpose, the patients were subdivided by three groups according to the basal IVCCI value: ≤ 15% (13 pts), 16 - 40% (21 pts) and > 40% (20 pts).Several clinical criteria of congestion were compared across the three groups and subsequently entered in the Cox multivariate model. RESULTS: Multivariate predictors of high congestion score were jugular venous distension (HR: 13,38 95% C.I.: 2,13 - 84 p = 0,0059) and rales (HR: 11 95% C.I : 1,45 - 83,8 p = 0,0213). IVCCI ≤ 15% was always associated with high congestion score at the second visit; but IVCCI ≤ 15% failed to predict high congestion score at the second visit. CONCLUSION: In CHF setting, low IVCCI did not reliably predict high congestion score. Nevertheless, the cluster with IVCCI ≤ 15% was always found associated with signs and symptoms from both right and left-sided decompensated CHF. (Arq Bras Cardiol. 2012; [online].ahead print, PP.0-0).

Agenesia de veia cava inferior associada à trombose venosa profunda / Agenesis of inferior vena cava associated with deep venous thrombosis

A agenesia da veia cava inferior é uma anomalia congênita rara, que foi recentemente identificada como um importante fator de risco para o desenvolvimento e a recorrência de trombose venosa profunda de membros inferiores em jovens. O objetivo deste trabalho foi relatar o caso de uma paciente que apresentou trombose venosa profunda dois meses após a realização de cirurgia de varizes. A angiotomografia computadorizada demonstrou a presença de anomalia venosa complexa com ausência da veia cava inferior.

The agenesis of the inferior vena cava is a rare congenital anomaly, which was recently identified as an important risk factor for the development and recurrence of deep venous thrombosis especially in young people. The goal of this work was to report the case of a patient who presented deep venous thrombosis approximately two months after varicose vein surgery. The computerized angiotomography demonstrated the presence of a complex venous anomaly with absence of the inferior vena cava.

Surgical management of renal cell carcinoma with inferior vena caval thrombus: a teaching hospital experience.

PURPOSE: To evaluate the outcome of patients of renal cell carcinoma (RCC) with inferior vena caval (IVC) thrombus treated by radical nephrectomy and IVC thrombectomy in terms of clinical and pathological factors and prognosis. MATERIALS AND METHODS: Sixty-three consecutive patients of RCC with IVC thrombus who underwent radical nephrectomy with IVC thrombectomy between June 1993 and May 2003 were included in this retrospective analysis. Data was analyzed in terms of clinical factors, such as level of thrombus and pathological factors, such as grade, local invasion and N status. RESULTS: Tumor thrombus level was infrahepatic in 35 patients, retrohepatic in 20 and suprahepatic in 8, including 5 with right atrial thrombus. The immediate post-operative mortality was 3% and the incidence of major post-operative complications was 34%, but most of them improved after conservative management except one who needed surgery for burst abdomen. The disease free survival (DFS) was 48.5%, 50.6%, 66.6% and 40% for infrahepatic, retrohepatic, suprahepatic and intra-atrial tumors, respectively. Of the histological types, patients with clear cell tumors had the best prognosis; those with granular cell had the worst prognosis (DFS of 53.5% vs 33.3%, though statistically not significant). Grade-2 tumors had better prognosis than grade-4 tumors (DFS 66.6% vs 0%, P < 0.001). Sixty-eight percent of patients without perinephric fat invasion were free of disease as compared to 31% of those with perinephric fat invasion (P < 0.01). Further, N status showed DFS of 60.9% in patients with negative nodes and 30% in patients with positive nodes (P < 0.05). CONCLUSION: Though surgery for RCC with IVC thrombus has high morbidity, it can give good results in terms of prolonged DFS in expert hands. Regarding long-term survival, pathological factors, such as local stage and grade, are more important than clinical factors, such as level of thrombus.

Fluxo no ducto venoso e na veia cava inferior dos fetos em gestações isoimunizadas / Assess flow velocity in the ductus venosus and inferior vena cava in fetuses in isoimmunized pregnancies

OBJETIVO: Avaliar a velocidade de fluxo na veia cava inferior e no ducto venoso em fetos, nas gestações isoimunizadas. MÉTODOS: De junho de 1999 a junho de 2004, foram avaliados 61 fetos, entre 27 e 35 semanas, de gestantes portadoras de isoimunização por antígenos eritrocitários. Em todos os fetos foram avaliadas as velocidades de fluxo na veia cava inferior e no ducto venoso. Obteve-se amostra de sangue fetal para determinação dos valores da hemoglobina e calculou-se o déficit da concentração de hemoglobina. Esses fetos foram divididos em quatro grupos, de acordo com o déficit da concentração de hemoglobina: fetos não anêmicos, anêmicos leves, anêmicos moderados e anêmicos graves. Utilizou-se o teste Qui-quadrado para comparar os quatro grupos de fetos quanto à proporção da alteração da velocidade média de fluxo na veia cava inferior e no ducto venoso. RESULTADOS: A velocidade de fluxo na veia cava inferior estava alterada em 3,8 por cento dos fetos não anêmicos, em 3,1 por cento dos fetos com anemia leve, em 40 por cento dos anêmicos moderados e em 76 por cento dos fetos com anemia grave. Já a velocidade de fluxo no ducto venoso estava alterada em 7,7 por cento dos fetos não anêmicos, em 3,1 por cento dos fetos com anemia leve, em 32,5 por cento dos anêmicos moderados e em 68 por cento dos fetos com anemia grave. O valor p foi inferior a 0,001. CONCLUSÃO: Verificou-se aumento da freqüência de alteração da velocidade de fluxo na veia cava inferior e no ducto venoso à medida que a anemia se agravava.

OBJECTIVE: Ductus venosus and inferior vena cava flow velocity was assessed in fetuses in isoimmunized pregnancies. METHODS: Examination of 61 fetuses aged 27 to 35 weeks from Rh-erythrocyte antigen isoimmunized women was carried out from June 1999 to June 2004. All fetuses were submitted to the examination of ductus venosus and inferior vena cava flow velocity. Blood samples were collected to determine hemoglobin values and hemoglobin concentration deficits. Accordingly, fetuses were grouped as follows: non-anemic; mildly anemic; moderately anemic and severely anemic fetuses. Comparison of the variation of average flow velocity in the inferior vena cava and ductus venosus across the four groups was carried out using the chi-square test. RESULTS: Inferior vena cava flow velocity was found to be altered in 3.8 percent of non-anemic fetuses; in 3.1 percent of the mildly anemic, in 40.0 percent of those moderately anemic; and in 76.0 percent of the severely anemic ones. Alteration in ductus venosus flow velocity, in turn, was identified in 7.7 percent of non-anemic fetuses; 3.1 percent of mildly anemic; 32.5 percent of moderately anemic and 68.0 percent of those severely anemic. Results were statistically significant with p < 0.001. CONCLUSION: The study shows that alteration of flow velocity in the inferior vena cava and ductus venosus increased with the severity of anemia.

Leiomiossarcoma de retroperitônio: relato de caso / Retroperitoneal leiomyosarcoma: case report

Os autores relatam um caso de leiomiossarcoma de retroperitônio, provavelmente originário da parede da veia cava inferior, em que foram realizados numerosos exames por imagem, com resultados contraditórios e conduta cirúrgica muito retardada. Comenta-se ainda sobre a necessidade de estabelecer-se rapidamente o diagnóstico da lesão, por meio de exames de imagem com biópsia dirigida, e a necessidade de ressecção completa da lesão, sempre que possível, ou mesmo a realização de ressecções parciais seguidas de tratamento complementar.

Trombosis masiva de vena cava inferior asociada a déficit de proteína C: caso clínico / Massive inferior vena cava thrombosis associated to protein C deficiency: one case report

Inferior vena cava thrombosis is infrequent and in 30 percent of cases, the potential cause is an alteration of the natural anticoagulant protein system. We report a 18 years old male with an inferior vena cava thrombosis that was associated to a protein C deficiency. He was successfully treated with an infusion of intravenous streptokinase during 30 hours and intravenous heparin during 10 days, followed by oral anticoagulation therapy

Filtros de vena cava inferior: presentación de 28 casos

Introducción: El tromboembolismo pulmonar (TEP) sigue siendo una causa importante de morbilidad y mortalidad en el mundo. Su origen más común es la trombosis venosa profunda (TVP). La anticoagulación y el control de los factores de riesgo son el tratamiento convencional. En un número importante de casos este tratamiento no es suficiente o no es aplicable, por lo cual la interrupción parcial del retorno venoso está indicada. Esta interrupción se puede efectuar mediante la colocación de filtros en la vena cava inferior. Objetivo: Describir la experiencia de la Fundación Santafé de Bogotá (FSFB) en la colaboración de filtros de vena cava inferior. Diseño: Estudio observacional, descriptivo, de una serie de casos. Pacientes y Métodos: Se incluyeron los pacientes a quienes se colocó filtro de vena cava inferior entre 1991 y 1995. Se revisaron las historias, haciendo énfasis en factores de riesgo para TVP-TEP, indicación de la colocación del filtro de vena cava inferior, tipo de filtro y complicaciones. Resultado: Se presentaron 28 casos con las variables descritas. No se presentan datos de seguimiento a mediano y largo plazo.

Angioplastía transluminal percutánea de la vena cava inferior / Percutaneous angioplasty of the inferior vena cava

Se describe el caso de una paciente femenina de 65 años de edad, en quien se realizó angioplastía percutánea, con balón, de la vena cava inferior. La paciente tenía calcificación extensa de aurícula derecha, anillo y válvula tricúspide, lo que producía estenosis de la misma. Estaba involucrada la vena cava inferior con obstrucción. Como único factor predisponente a dicha calcificación, es una derivación ventrículo-atrial por cisticercosis cerebral por un periodo prolongado de tiempo (32 años). Se había realizado valvuloplastía tricuspídea percutánea 2 años y medio previamente, con éxito. Se realizó dilatación con balón obteniendo mejoría angiográfica significativa en la obstrucción. Se describe la técnica utilizada, se hace énfasis en lo poco frecuente de esta patología, así como en algunos eventos que sucedieron después de la dilatación. Concluimos que la angioplastía con balón puede ser una alternativa más, a la cirugía convencional en obstrucciones de la vena cava inferior

Interrupción de la vena cava inferior en el tromoembolismo pulmonar / Interruption of inferior cava vein in lung thromboembolism

El Tromboembolismo pulmonar (TEP) es una entidad frecuente y a menudo de consecuencias graves, obligando de esta manera al médico a tomar a veces conductas terapeúticas mas agresivas. Es por esto que en Centro Médico Quirúrgico Boliviano Belga (CMQBB) se han realizado en 31 pacientes procedimientos quirúrgicos para prevenir complicaciones cardiopulmonares. Para analizar estos casos se ha ejecutado un estudio retrospectivo transversal de 1976 a 1992, donde se estudiaron sobre 125 casos de TEP a esos 31 pacientes de entre 38 a 82 años, se efectuaron 3 procedimientos principales: Ligaduras venosas (7), clip venosos (5) y filtros endoluminales (19) (mobin-Udin 10, Greenfield 9). Las indicaciones principales para esta conducta fueron: TEP recidivante (12), corazón, pulmonar crónico (9), TEP amenazante (3) y diferentes otras causas en 7 casos. En todos estos procedimientos no hubieron complicaciones mayores y la mortalidad hospitalaria fue menor al 1 por consiguiente creemos que en todo paciente con factores de riesgo y/o en aquellos en quienes la anticoagulación a las dosis necesarias para la profilaxis del TEP tenga alguna contraindicación, uno de los procedimientos citados puede ser de elección, para evitar complicaciones cardiopulmonares.

Vena cava filter insertion as a primary therapy for deep venous thrombosis in patients with malignant disease

Anticoagulation therapy in patients with malignant disease and deep venous thrombosis [DVT] carries a high hemorrhagic complication rate. Pulmonary showers may also not be properly controlled on anticoagulation. Accordingly, a policy of placing Greenfield vena cava filters [GFs] was established, as a primary therapy instead of anticoagulation whenever this was possible. Since 1988 till present, 40 patients with malignant disease [blood or visceral] and DVT, were treated. 15 patients had GFs as a primary therapy and 25 patients underwent anticoagulation therapy at their own request after explaining both modalities of treatment. The purpose of this study was to compare the result of anticoagulation versus GFs insertion in these two groups of patients. The anticoagulation group A showed a significantly higher number of major complications than GFs group B. Massive pulmonary embolism [PE] occurred in 2 patients despite adequate anticoagulation both resulted in death of the patients. 4 major bleeding episodes occurred, 3 of those were gastrointestinal and one intracerebral. The patients with intracerebral bleeding developed a major stroke and subsequently died. The 3 patients with gastrointestinal bleeding required transfusion of more than 4 units of blood and all received platelet transfusions and one of them subsequently died. Although this study is a small nonrandomized one, the data indicate that GF placement is safer than anticoagulation in patients with malignant disease and DVT

Leiomyosarcoma of inferior vena cava about 2 cases

The authors report two cases of leiomyosarcoma of the inferior vena cava. Leiomyosarcoma of the inferior vena cava is a rare malignant tumor. It's clinical features are unspecific and depend on the localization of the tumor. The diagnosis is difficult and relies on ultrasound tomography, computed tomography, and cavography. Treatment of these tumors is based on surgery with adjuvant chemotherapy. Though tumoral growth rate is slow, the prognosis remains poor

Hipertensión cava-inferior por empiema tabicado / Inferior vena cava hypertension due to an empyema thoracis

Hemos presentado una rara observación de compresión de la vena cava inferior en sus segmentos inter-hepato-cardíaco y retro-hepático por empiema pleural derecho tabicado; que determinó la existencia de un Sindrome de Budd-Chiari agudo reversible. Los procedimientos de estudio efectuado (Rx de torax, neumoperitoneo y Rx de abdomen, ecografía y T.A.C.) no permitieron establecer el diagnóstico etiológico, sin embargo la T.A.C. mostró la compresión de la vena cava en el sector indicado. Fue la laparotomía exploradora que determinó la existencia de una hepatomegalia de éstasis basculada hacia la izquierda, asi como la existencia de un diafragma convexo. La toracotomía permitió drenar un importante empiema tabicado a presión que ocupaba la mitad inferior de la cavidad pleural. El paciente tuvo buen post operatorio. A propósito del caso presentado y como no se encontraron citas bibliográficas al respecto, se analizaron todos los procesos descriptos que afectan a la vena cava inferior en el sector mencionado

Síndrome de vena cava inferior por catéter venoso central / Inferior vena cava syndrome for central venous catheters

La obstrucción venosa es una complicación potencial del uso prolongado de catéteres; además las soluciones hiperosmolares utilizadas en la alimentación parental pueden provocar la formación de trombose. Ha sido reportada la obstrucción de la Vena Cava Superior(CVS) incluso con formación de trombos calcificados en la aurícula derecha. Los signos de obstrucción venosa pueden desaparecer como ha sido reportado en la literatura al retirar el catéter. En la presente comunicación se ha expuesto el caso de un escolar masculino de 7 años de edad que tiene como antecedente una hospitalización en la UTI a los 2 1/2 meses de edad por Schock, Sepsis desequilibrio hidroelectrolítico, deshidratacion severa y fractura supracodilicia de húmero izquierdo, además le fue cateterizado la vena femoral derecha para línea venosa central. Factores todos contribuyentes a la formación de trombos en el sistema venoso profundo. Nuestro paciente presentó edema facial de cuello, de miembros inferiores y ascitis, hepatomegalia con reflujo hepatoyugular con ascultación cardiopulmonar normal, clínica que corresponde a obstrución de ambos sistemas venosos profundos. Se le practicó Caterismo Cardíaco demostrándose obstrucción de la vena cava inferior por debajo de las venas renales. Recibió tratamiento a base de antibióticos, digitalición, Lasix y ácido cetil salicílico, evolucionando satisfactoriamente. No se le realizó tratamiento quirúrgico por la evolución prolongada del cuadro y los resultados pocos satisfactorios en los pacientes que fueron intervenidos. Se hace una revisión de la literatura y comentando los posibles mecanismos fisiopatológicos..