Risk-Group Targeted Inferior Vena Cava Filter Placement in Gastric Bypass Patients

Background  Despite a growing body of evidence guiding appropriate perioperative thromboprophylaxis in the general population, few data direct strategies to reduce deep venous thrombosis (DVT) and pulmonary embolism (PE) in the morbidly obese. We have implemented a novel protocol for venous thromboembolism (VTE) risk stratification in Roux-en-Y gastric bypass (RYGB) candidates at our institution, which augments clinical assessment with screening for thrombophilias, to guide retrievable inferior vena cava (IVC) filter utilization. Methods  A retrospective review of prospectively collected data from patients who underwent primary RYGB between 2001 and 2008 at the University of North Carolina at Chapel Hill was completed. During that time, clinical assessment of VTE risk was amplified by focused plasma screening for common thrombophilias (factors VIII, IX, and XI, d-dimer, fibrinogen). Preoperative prophylactic IVC filters were offered to high-risk patients. The database was reviewed for perioperative DVTs, PEs, and filter-related complications. Results  Of 330 patients, in 162 attempts, 160 had prophylactic IVC filters placed with four complications overall (2.47%). No patient had symptoms of PE during the planned 6-week filter period, though one had a PE occur immediately after filter removal (0.63%); in contrast, five of 170 patients (2.94%) without prophylactic IVC filters presented with symptomatic PE (p = 0.216). In total, 147 (91.88%) prophylactic filters were removed. Conclusions  Risk-group targeted prophylactic inferior vena cava filter placement prior to RYGB is safe with a trend towards reduced occurrence of PE. The authors have no disclosures of commercial interests or sources of financial or material support.     

下腔静脉滤网在骨科复杂创伤中的初步应用

目的探讨下腔静脉滤网在骨科复杂创伤伴有下肢深静脉急性血栓形成患者中的应用价值。方法对已发现的下肢深静脉血栓形成的骨科复杂创伤患者20例,术前置入下腔静脉滤网后再行手术治疗,术后随访评价患者静脉血栓的情况。结果20例发现下肢深静脉血栓的骨科复杂创伤患者接受了下腔静脉滤网植入术,术中顺利,未见严重并发症,骨科手术时,无一例患者发生肺栓塞,术后患者功能恢复满意。经随访,10例患者静脉血栓缩小,5例消失,5例未见明显变化。滤网周围均未见血栓形成。结论下腔静脉滤网能有效防止下肢深静脉栓塞引起的严重并发症,提高骨科手术的安全性。     

Pseudolipoma of the Inferior Vena Cava

Pseudolipoma of inferior vena cava refers to a normal variant of adipose collection that is seen in typical pericaval or juxtacaval location; however, it mimics an intracaval mass lesion, especially fat-containing lesions such as lipoma. Awareness of this entity is very important to avoid misdiagnosis and unnecessary diagnostic procedures.     

Superior Vena Cava Bypass with Superficial Femoral Vein for Benign Superior Vena Cava Syndrome

Superior vena cava (SVC) syndrome can result from benign causes such as temporary hemodialysis catheters placed into the central veins. The indications for open, surgical revascularization are rare and usually reserved for patients whose symptoms are refractory to anticoagulation and endovascular treatment. The current report documents the case of a 54-year-old woman with recurrent SVC syndrome secondary to long-term indwelling central venous catheters for total parenteral nutrition. She presented to the vascular service with moderate head/neck edema and persistent headaches despite chronic anticoagulation and multiple previous endovascular attempts including both angioplasty and stenting. An internal jugular-SVC bypass was performed using autogenous superficial femoral vein (SFV), which resulted in the resolution of her symptoms and a patent graft 12 months postoperatively. Autogenous SFV is an ideal conduit for central vein revascularization secondary to its size, relative ease associated with harvesting, and handling characteristics. It may be the ideal conduit for revascularization in patients with SVC syndrome secondary to benign causes because of their favorable life expectancy, although documentation of long-term graft patency is necessary.     

下腔静脉平滑肌肉瘤

1病历摘要 患者女,62岁,因"上腹部胀痛不适伴呃逆2年"人院.患者2年前无诱因出现上腹部胀痛不适,疼痛部位向右腹部及腰部放射,肛门排气后略缓解,伴有呃逆,未行特殊治疗.     

Current Status of Inferior Vena Cava Filters

Annals of Vascular Surgery -     

Inferior Vena Cava Syndrome and Morbid Obesity

A case is reported of inferior vena cava syndrome in a patient with extreme obesity (BMI: >70 kg/m²), treated at a public hospital. The inferior vena cava obstruction was diagnosed during an attempt at inferior vena cava filter percutaneous insertion, in prebariatric surgery period. The diagnosis occurred after a hepatic scintillography, and was confirmed with a femoral venography and celiac trunk arteriography. The patient underwent a biliopancreatic diversion-duodenal switch and has lost weight. A venography 7 months after the surgery did not show any inferior vena cava rechanneling evidence.