下腔静脉滤器回收后血管形态改变的CT静脉造影研究

目的 探讨下腔静脉滤器回收后肾下段下腔静脉CT静脉造影(CTV)血管壁形态的改变,并分析相关影响因素。方法 回顾性研究。纳入2015年1月-2018年2月在北京积水潭医院血管外科下腔静脉滤器回收后规范抗凝治疗70例患者的下腔静脉CTV图像为滤器组,男34例、女36例,年龄17~79(48.11±13.86)岁;在北京积水潭医院下腔静脉CTV数据库中随机抽取40例非血栓性疾病患者为对照组,男23例、女17例,年龄18~70(46.70±12.16)岁。在下腔静脉CTV图像上测量并比较两组下腔静脉最小直径和肾静脉开口下方1 cm平面参考直径的差异;观察滤器组肾下段下腔静脉壁有无增厚,应用logistic回归分析其影响因素。结果 两组患者的性别、年龄差异均无统计学意义(P值均＞0.05)。滤器组和对照组下腔静脉参考直径分别为(16.0±2.6)、(20.2±2.4) mm,最小直径分别为(13.0±3.6)、(19.3±2.3)mm,差异均有统计学意义(t=8.267、10.032,P值均＜0.01)。滤器组35.7%(25/70)的患者血管壁局限性或环状增厚,下腔静脉最小直径为(10.3±3.6)mm; 64.3%(45/70)患者没有血管壁增厚,下腔静脉最小直径为(14.5±2.5)mm,差异有统计学意义(t=5.330, P＜0.01)。血管壁增厚患者与无增厚患者的下腔静脉血栓形成、下腔静脉参考直径差异均有统计学意义(χ²=6.459, t=3.794, P值均＜0.05);logistic多因素分析显示,下腔静脉血栓形成和下腔静脉参考直径是下腔静脉壁增厚的独立影响因素(OR=5.410、1.500,P值均＜0.01)。结论 滤器回收后下腔静脉会出现不同程度的狭窄和血管壁增厚,下腔静脉血栓形成和较小的下腔静脉参考直径明显增加下腔静脉壁增厚的风险。     

A new self-convertible inferior vena cava filter: In vivo experimental evaluation北大核心

BACKGROUND: An inferior vena cava filter is an effective tool to prevent fatal pulmonary embolism. The existing filters have some shortcomings that limit their clinical application. OBJECTIVE: To evaluate the feasibility and capture efficiency of a new self-convertible inferior vena cava filter (SCF) in vivo. METHODS: L-lactide and e-caprolactone were fused and polymerized to act as a degradable deformable switch of the filter. Medical stainless steel wire as the metal structure of the filter was combined with the degradable deformable switch to make the SCF. Eight SCFs were implanted into the inferior vena cava of eight adult Beagle dogs. The inferior vena cava angiography was performed to evaluate the release process, morphology and location of the filter. Venous angiography was performed 2 weeks later to evaluate the morphology and location of the filter and inferior vena cava patency. Detection of pulmonary embolism or other complications was performed at autopsy. RESULTS AND CONCLUSION: Eight SCFs were successfully implanted and positioned accurately with no tilt, and they were converted successfully at 2 weeks after the implantation, as assessed by the venous angiography. One of the eight SCFs migrated to the orifice of the right atrium, and caused asymptomatic inferior vena cava obstruction. The remaining SCFs were normally positioned with no tilt and local lesion or obstruction after deformation. No marked filling defect in the trunk of the pulmonary artery was shown by the pulmonary artery angiography. The autopsy report revealed that the filter arm had been endothelialized, and the inferior vena cava that was in contact with the filter arm had no obvious stenosis. Mild intimal hyperplasia, less than 1 mm in thickness, was found in the bottom of the filter arm, but it did not cause a stenosis in the lumen. No vena cava perforation, retroperitoneal hemorrhage, and injury of the surrounding viscera were found. Overall, the design of the SCF is feasible. © 2018, Journal of Clinical Rehabilitative Tissue Engineering Research. All rights reserved.     

Vascular patches tissue-engineered with autologous bone marrow-derived cells and decellularized tissue matrices

Synthetic polymer vascular patches used in cardiovascular surgery have shortcomings such as thrombosis, intimal hyperplasia, calcification, infection, and no growth potential. Tissue-engineered vascular patches using autologous vascular cells may solve these problems. In this study, we developed a tissue-engineered vascular patch using autologous bone marrow-derived cells (BMCs) and decellularized tissue matrices. Vascular smooth muscle cells and endothelial cells were differentiated from bone marrow mononuclear cells in vitro. Tissue-engineered vascular patches were fabricated by seeding these cells onto decellularized canine inferior vena cava matrices and implanted into the inferior vena cava of dogs. Three weeks after implantation, the tissue-engineered vascular patches were patent with no sign of thrombus formation. Histological, immunohistochemical, and electron microscopic analyses of the vascular patches retrieved 3 weeks after implantation revealed regeneration of endothelium and smooth muscle and the presence of collagen and elastin. BMCs labeled with a fluorescent dye prior to implantation were detected in the retrieved vascular patches, indicating that the BMCs survived after implantation and contributed to the vascular tissue regeneration. This study demonstrates that vascular patches can be tissue-engineered with autologous BMCs and decellularized tissue matrices.     

Safe ECMO femoral decannulation by placement of inferior vena cava filter via internal jugular vein

Veno-arterial extracorporeal membrane oxygenation (ECMO) is a lifesaving treatment in patients with cardiogenic shock or cardiac arrest caused by massive pulmonary embolism. In these patients, positioning an inferior vena cava filter is often advisable, especially if deep venous thrombosis is not resolved at the time of the ECMO suspension. Moreover, in ECMO patients, a high incidence of deep venous thrombosis at the site of venous cannulation has been reported, and massive pulmonary embolism following ECMO decannulation has been described. Nonetheless, an inferior vena cava filter cannot be positioned as long as an ECMO cannula is inside the inferior vena cava. Thus, we developed a strategy to allow placement of an inferior vena cava filter through the internal jugular concurrently with the removal of the femoral venous ECMO cannula. In two women supported by veno-arterial ECMO for cardiac arrest secondary to pulmonary embolism, this novel approach allowed for safe ECMO decannulation.     

Focal nodular hyperplasia of the liver associated with portal vein agenesis: a morphological and immunohistochemical study of one case and review of the literature

Congenital absence of portal vein (CAPV) is a rare malformation. To our knowledge, sixteen cases are reported in western literature. All the cases are associated with other diseases, cardiac malformations (12/17 patients; 16 plus the present case) and hepatic neoplasms being the most frequent observations. We present the case of a girl with a complex malformative syndrome consisting of multicystic kidney dysplasia, CAPV and nodular tumor-like mass of the liver. Angiography showed that the splenic vein and superior mesenteric vein joined to form a common trunk directly entering the inferior vena cava above the liver. A review of the CAPV cases of the literature and the clinical and pathological features of the hepatic lesion, classified as Focal Nodular Hyperplasia (FNH), are extensively discussed.     

The pathogenesis of hyaline globules in liver cells after partial hepatectomy in rats

To clarify the pathogenesis of hyaline globules in liver cells after partial hepatectomy, the present study was undertaken in rats. When partial hepatectomy was performed by the surgical procedure of Higgins and Anderson, the inferior vena cava pressure was raised, and many hyaline globules, which are very similar to those caused by condensation of the contents of vacuoles in liver cells after temporary pressure elevation of the inferior vena cava, were induced in liver cells. On the other hand, when the median lobe and the left lateral lobe were removed carefully one at a time to avoid operative narrowing of the inferior vena cava, the inferior vena cava pressure was not elevated, and only very few hyaline globules were formed. This suggests that hyaline globules in liver cells following partial hepatectomy in rats may be caused by elevation of inferior vena cava pressure due to narrowing of the inferior vena cava by surgical procedure.     

Hepatic stellate cells are activated around central scars of focal nodular hyperplasia of the liver--a potential mechanism of central scar formation

Focal nodular hyperplasia of the liver is typically accompanied by a central scar, but cases that lack the central scar are occasionally encountered. This study was performed to clarify the mechanism of the central scar formation in focal nodular hyperplasia. Immunohistochemical analysis was performed for liver sections of focal nodular hyperplasia with and without a central scar. For comparison, liver specimens of focal nodular hyperplasia-like nodules and nodular regenerative hyperplasia were used. Immunostaining showed that activated hepatic stellate cells, as determined by alpha-smooth muscle actin expression, were invariably observed in all cases of focal nodular hyperplasia with a central scar, whereas focal nodular hyperplasia without a central scar and nodular regenerative hyperplasia lacked hepatic stellate cell activation. Hepatic stellate cell activation in focal nodular hyperplasia with a central scar was accompanied by the expression of 8-hydroxy-2'-deoxyguanosine and inducible nitric oxide synthase in the liver. Expression of 8-hydroxy-2'-deoxyguanosine and inducible nitric oxide synthase was rarely seen in focal nodular hyperplasia without a central scar, focal nodular hyperplasia-like nodules, or nodular regenerative hyperplasia. Overexpression of vascular endothelial growth factor was also observed in focal nodular hyperplasia with a central scar. These results suggest that the central part of focal nodular hyperplasia suffers from hyperoxic conditions due to arterial hyperperfusion; and the resultant oxidative stress may activate hepatic stellate cells, leading to central scar formation. In addition, vascular endothelial growth factor may contribute to the proliferation of abnormal vessels as an angiogenic inducer.     

Focal hyperplastic hepatocellular nodules in hepatic venous outflow obstruction: a clinicopathological study of four patients and 24 nodules

AIMS: In hepatic venous outflow obstruction (Budd-Chiari syndrome), focal hepatocellular nodules are occasionally discovered showing variable morphology. These could be interpreted either as neoplastic (adenoma), regenerative (large regenerative nodule) or reactive to abnormal vasculature (focal nodular hyperplasia). The aim of this study was to investigate their histogenesis and to determine their morphological characteristics in order to provide diagnostic criteria. MATERIAL AND METHODS: Twenty-four hepatocellular nodules were studied, which were found in three explanted livers and in one additional autopsied liver from four patients with Budd-Chiari syndrome. As controls, we employed three explanted livers without nodules from patients who also suffered from Budd-Chiari syndrome. We attempted to classify the nodules morphologically as either adenoma-like, large regenerative nodule or focal nodular hyperplasia-like, using criteria from the literature. RESULTS: Out of the four cases, we observed two nodules in each of two livers, five in the third one and up to 15 in the remaining one. The size of the nodules ranged from 4 to 25 mm. Eleven nodules could be categorized as large regenerative nodules (two of them with a central scar), seven as focal nodular hyperplasia-like and six as adenoma-like. Some large regenerative nodules showed proliferated arteries with muscular hyperplasia similar to that seen in focal nodular hyperplasia. In the individual livers we could find nodules of various categories. Patchy or diffuse monoacinar regeneration was seen in most cases (six out of seven cases) in the macroscopically non-nodular liver parenchyma. In addition, thrombotic obstruction of portal vein branches was present in all except one of the nodular cases, but in none of the controls. Thus, it appears that portal venous obstructions are frequently, but not invariably associated with the development of nodules. CONCLUSIONS: The hepatocellular nodules seen in livers from patients with Budd-Chiari syndrome share morphological characteristics with large regenerative nodules, focal nodular hyperplasia and hepatocellular adenomas. Their multiplicity, the existence of mixed lesions, the frequent hepatocellular regenerative background as well as the frequently associated portal venous obstructions suggest that these nodules are regenerative in nature and conditioned by an uneven blood perfusion throughout the liver. In their differential diagnosis, the clinicopathological context in which they occur is of paramount importance and should allow recognition that those resembling adenomas may not be true neoplasms.     

Radiologic anatomy of duplication of the inferior vena cava: A trap in abdominal imaging. A report of 8 cases

Eight cases of duplication of the inferior vena cava are reported. Three of these bear witness to the errors of interpretation that may be committed when the anomaly is not initially detected in the ultrasonographic transverse sections and when no preliminary phlebography is available. Two other cases illustrate the influence of this duplication on the choice of the prophylactic surgical treatment of pulmonary embolism. The last clinical observation indicates the need to puncture both the femoral veins when performing iliocaval phlebography. Finally, two observations on the cadaver help to clarify the imaging appearances of this anomaly. The report concludes with a review of the classical anatomic and pathogenic concepts and a short discussion of the practical problems posed by duplication of the inferior vena cava.     

超声检测足月妊娠孕妇左侧卧位时下腔静脉及子宫-胎盘血流的变化

目的:探讨彩色多普勒超声检测足月妊娠孕妇左侧卧位下腔静脉、子宫动脉及胎儿脐动脉的血流动力学变化。方法:回顾分析2014年1月—2019年10月在东南大学医学院附属江阴医院就诊的73例单胎足月妊娠孕妇的超声资料。孕妇年龄20～42(29.34±5.16)岁,孕周37～40.3(39.1±1.0)周。孕妇均采用彩色多普勒超...     

Innervation pattern of inferior vena cava in mouse and rat

Summary The innervation pattern of rat and mouse inferior vena cava was studied using catecholamine fluorescence and cholinesterase histochemical methods.Adrenergic nerve fibers innervate only abdominal protions of the inferior vena cava, while cholinergic nerves are chiefly distributed to the thoracic inferior vena cava and show a gradual decrease in the abdomen.Chemical sympathectomy performed with the neurotoxin 6-hydroxydopamine does not alter the pattern of cholinergic innervation of the inferior vena cava, suggesting the parasympathetic nature of cholinergic nerves.     

下腔静脉滤器置入预防肺栓塞

背景：下腔静脉滤器置入预防肺栓塞是有效的,也为手术取栓提供了安全保障。 目的：探讨下腔静脉滤器临床应用的研究进展。 方法：由第一作者检索1985/2010 FMJS数据库及万方数据库有关下腔静脉滤器材料学的发展,置入的适应证、禁忌证,置入技术,并发症及置入后抗凝问题方面的文献。 结果与结论：下腔静脉滤器材料学发展迅速,其置入技术显著提高,但对其临床应用指针还没有统一的认识。对于置入后抗凝问题认识也存在差异,而滤网位置偏移、游走、成角及腔静脉穿孔和对周围脏器的损伤报道随着下腔静脉滤器应用的增多而相应增多。下腔静脉滤器置入预防肺栓塞的临床疗效是值得肯定的,但应该高度重视置入后的并发症及其严重性,相信随着下腔静脉滤器材料学的进一步发展及生物相容性的提高,其临床应用前景会越来越广阔。关键词：下腔静脉滤器;深静脉血栓;肺栓塞;置入;综述文献 doi:10.3969/j.issn.1673-8225.2012.16.033     

Anomalous inferior vena cava with azygos continuation in a japanese man

During an ordinary dissection by medical students at Nara Medical University in 1998, a case of anomalous inferior vena cava with azygos continuation was found in a cadaver of a 91-year-old Japanese man. The left and right inferior venae cavae were present and were joined at the height of the first lumbar vertebra. The joined inferior vena cava continued the azygos vein and the azygos vein entered the superior vena cava at the height of the fifth thoracic vertebra. Furthermore, the heart was normal.     

A case of idiopathic deep vein thrombosis improved with glucocorticoid therapy.

A healthy, middle-aged Japanese man with no family history of thrombotic disorders presented with acute abdominal pain due to ischemic colitis. Two months later, he developed left leg pain and swelling. A venogram of the lower limbs, computed tomography, and a scintigram of pulmonary blood flow revealed deep vein thrombosis of the left lower limb extending to the inferior vena cava and emboli of both pulmonary arteries with bilateral pleural effusions. The responsible coagulation disorder was not detected in this case. Since these thrombi were refractory to the thrombolytic therapy with urokinase and anticoagulant therapy with warfarin, prednisolone was chosen for the suppression of accompanying thrombophlebitis. Two months following the initiation of prednisolone (20 mg/day), the venous thrombosis, abnormal pulmonary shadows, and pleural effusions had completely resolved. This case demonstrates the successful treatment of idiopathic venous and pulmonary thrombosis with glucocorticoids.     

Point-of-care ultrasound assessment of the inferior vena cava distensibility index in mechanically ventilated children in the operating room

Background and aimPoint-of-care ultrasound imaging of the inferior vena cava distensibility index is a potential indicator for determining fluid overload and dehydration in the mechanically ventilated patients. Data on inferior vena cava distensibility index and inferior vena cava distensibility variability are limited in mechanically ventilated pediatric patients. That is why our aim in this study was to measure inferior vena cava distensibility index and to obtain mean values in pediatric patients, ventilated in the operating room before the ambulatory surgical procedure started.Materials and methodsThis crosssectional study was performed between February 2019 and February 2020. Ultrasonographic measurements were performed in a total of 125 children.ResultsIn a period of 13 months, the measurements were performed in a total of 125 children, of which 120 (62.5% male) met the criteria and were included in the study. Overall inferior vena cava distensibility index (%): mean   SD: 6.8   4.0, median (min–max): 5.7 (1.4–19.6), IQR: 3.8–8.7. Overall inferior vena cava distensibility variability (%): mean   SD: 6.5   3.7, median (min–max): 5.5 (1.4–17.8), IQR: 3.7–8.4.ConclusionOur study is the largest series of children in the literature in which inferior vena cava distensibility index measurements were investigated.     

Left inferior vena cava with regressed right inferior vena cava

A left inferior vena cava was found in the cadaver of an 88-year-old Japanese man during a student dissection course at Kumamoto University School of Medicine. The right common iliac vein ascended obliquely toward the left behind the right common iliac artery and united with the left common iliac vein to form the inferior vena cava in front of the fifth lumbar vertebral body behind the left common iliac artery. The inferior vena cava ascended on the left side to the aorta, and after the left renal vein joined to it at the level of the third lumbar vertebral body, it turned obliquely to the right and crossed superficially to the aorta. At the right side of the aorta, the common stem of the third lumbar vein and the posterior renal vein was joined to the oblique part. The inferior vena cava then ascended, receiving the right renal vein as it would normally. The inferior vena cava is thought to develop symmetrically but this left inferior vena cava shows a persistence of the left channel of the infrarenal part, which normally disappears. Although the common stem of the veins that joined to the oblique part on the right side did not continue to the right common iliac vein, gross anatomical findings suggested it to be the remnant of the right inferior vena cava.     

肝静脉,肝短静脉注入下腔静脉壁处在肝移植术中的应用

目的 探讨采用膈下肝段下腔静脉壁前半部钳夹,解决肝移植术中无肝期下肢静脉回流障碍。方法 对17例成人尸肝进行解剖,以时钟刻度方法描述肝静脉、肝短静脉注入下腔静脉壁的位置。结果 肝左静脉、肝右静脉、肝中静脉均注入下腔静脉前半壁(即3～9点),肝短静脉多为针眼大小,注入部位多在5～9点之间(154支),少数注入9～11点(9支)。结论 肝移植术中可以采用下腔静脉壁前半钳夹,解决无肝期下肢静脉回流障碍。     

A rare case of a complete left inferior vena cava associated with the symptoms of Dunbar syndrome

We report a case of an 82-year-old female with an anomalous left inferior vena cava. The left inferior vena cava ascends parallel and to the left of the descending abdominal aorta. At the level of the celiac trunk, the inferior vena cava courses anteriorly and to the right to reach the posterior surface of the liver. The patient also suffers from chronic mild postprandial abdominal pain. It is possible that position of inferior vena cava anterior to the aorta, at the level of the celiac trunk, may lead to intermittent celiac artery compression syndrome (Dunbar syndrome).     

肠系膜上静脉外科干及下腔静脉下段的应用解剖观察

本文解剖了30具成人尸体,对肠系膜上静脉外科干、下腔静脉下段的位置、长度、外径、两者的相互关系以及前者与肠系膜上动脉分支后者与腹主动脉分支的关系等进行了观察测量。认为国人的外科干至少80％能满足手术中行肠腔静脉吻合术应具备的四点要求。     

Rhabdomyosarcoma with focal cartilaginous differentiation (malignant mesenchymoma) of the inferior vena cava.

A sarcoma arising from the inferior vena cava occupied the entire lumen of the inferior vena cava, right atrium, hepatic veins and common iliac veins. Its histological appearance was non-specific sarcoma, except for the presence of a few rhabdomyoblasts and some immature cartilaginous tissue. Immunohistochemically, some tumor cells were positive for myoglobin, desmin, HHF-35, and vimentin. Electron microscopy revealed that some tumor cells contained myofilaments and Z bands in the cytoplasm, which are characteristics of rhabdomyosarcoma. The tumor was diagnosed as rhabdomyosarcoma with focal cartilaginous differentiation (malignant mesenchymoma) of the inferior vena cava.