Inferior thrombosis

It also appears that the incidence of hepatic adenomas is increased in women taking oral contraceptives. Ischemic bowel disease secondary to thrombosis of the celiac and superior and inferior mesenteric arteries and veins has also been reported in women using these drugs. 

Venous thrombosis is produced in rats by insertion of a stainless steel wire coil into the inferior caval vein. Platelets as well as plasmatic coagulation are activated on the wire coil. Thrombus formation onto the wire is quantitated by measuring the protein content of the thrombotic material isolated. The kinetics of thrombus formation show an increase in weight and protein content within the first 30 min followed by a steady state between thrombus formation and endogenous thrombolysis leading to a constant protein content of thrombi between 1 and up to 48 h following implantation of the wire coil. Thrombosis incidence in untreated control animals in this model is 100%. The test is used to evaluate antithrombotic and thrombolytic properties of compounds in an in vivo-model of venous thrombosis in rats. 

The most frequent cause of posthepatic portal hypertension is right ventricular insufficiency. The central venous pressure is transferred to the hepatic veins and the sinusoids. Constrictive pericarditis leads to a state of pronounced posthepatic portal hypertension with the early development of ascites. Severe tricuspid valve incompetence also culminates in this condition. A membranous obstruction of the inferior vena cava was likewise described in 1968 as a genetically determined cause of posthepatic portal hypertension (S. Yamamoto et al.). Three variants can be distinguished by angiography, depending on the different ways in which the hepatic veins are involved or whether they are affected at all. Thrombosis of the inferior vena cava can develop either from thrombosis of the pelvic veins or independently in the presence of predisposing factors. 

Complications The following complications have been reported (i.) cholangitis, (2.) obstructive jaundice, (i.) intrahepatic cholelithiasis, (4.) sepsis, (J.) portal hypertension (oesophageal varices, portal vein thrombosis, chronic Budd-Chiari syndrome, etc.), (6.) thrombosis of the inferior vena cava, (7.) amyloidosis, (8.) immune complex-associated glomerulonephritis, (9.) metastases, (10.) acute on chronic liver insufficiency or acute liver failure, and (11.) bronchobiliary fistula. 

Hodkinson, J., Couper-Smith, J., Kew, M.C. Inferior vena cava and right atrial thrombosis complicating an amebic hepatic abscess. Amer. J. Gastroenterol. 1988 83 786 - 788... 

K. Unusual complication of l datid cysts Acute inferior vena caval thrombosis. Dig. Surg. 1993 10 114-115... 

The Budd-Chiari syndrome (BCS) is defined as partial or complete obstruction of the hepatic veins due to thrombosis. This may affect the whole hepatic venous system from the central vein to the large hepatic veins, even as far as the opening of the inferior vena cava into the right atrium. However, the obstruction can simply occur in individual branches of the hepatic veins and thus affect only certain areas of the liver. The syndrome may have an acute onset or begin insidiously and take a chronic course. The clinical picture is usually characterized by the Chiari triad hepatomegaly, abdominal pain and ascites. 

Mild local phlebitis sometimes occurs at intravenous sites of administration of GM-CSF. Central venous catheter site thrombosis, inferior vena cava thrombosis, and possible pulmonary embolism have sometimes been observed (5,18). Although chemotherapy for breast cancer is associated with a higher risk of developing vascular thrombosis, iliac artery thrombosis was attributed to GM-CSF in two patients (19). 

White RH, Zhou H, Kim J, Romano PS. A population-based study of the effectiveness of inferior vena cava filter use among patients with venous thrombosis. Arch Intern Med 2000 160 2033-2041. 

The thrombolytic effect in vivo was studied in rabbits with a radioactive thrombus produced in the inferior vena cava. The radioactivity over the occluded venous segment was measured by a scintillation probe fitted with a collimator adapted to the anatomical conditions. Comparison of equivalent doses of urokinase and benzoyl-urokinase in the model of venous thrombosis showed that the acylated form of the enzyme was more active than the free enzyme [38). 

In a model of thrombin induced thrombosis in the dog coronary artery, 7E3F(ab )2 (0.8mg/kg i.v.) markedly accelerated thrombolysis with recombinant tissue plasminogen activator (rtPA), and fully prevented reocclusion [153]. Similar models were used to show the inferiority of aspirin and dipyr-amidole in the dog coronary artery [154], or of aspirin in the baboon femoral artery [155], compared with 7E3F(ab )2 as adjunctive agents to thrombolysis with rtPA. However, in another dog study using this model, the thrombin in-... 

Although vena cava filters have been in clinical use since fiie 1960 s, they have not always been safe and effective due to late complications. A number of complications have hem reported in the literature, including recurrent pulmonary embolism (2-5%), inferior vena cava thrombosis (6-30%), access site thrombosis (2-28%X filter migration (3-69%X tilting (15-20%) (Figure 6), penetration of the voia cava wall (9-24%), structural fracture of the filter (1%), and guidewire entrapment (<1%) (Figure 7) [9]. 

Abstract Implantation of a permanent or retrievable filter in the inferior vena cava (IVC) is becoming an increasingly popular option for patients at risk of deep vein thrombosis (DVT).This chapter discusses the size and shaping parameters for IVC filters, and considers materials that are suitable. Complications and adverse incidents are also reviewed.The chapter concludes with specifications for an ideal IVC filter and a look at a recent new design that has recently completed clinical trials. 

Key words inferior vena cava (IVC), deep vein thrombosis (DVT), pulmonary embolism, retrievable filter, permanent filter, clot trapping, self-centering, migration. 

The vena cava is the largest vein carrying blood back to the heart. SpedficaUy the inferior vena cava (IVC) is the vein below the heart returning blood from the abdomen and lower limbs, and the superior vena cava (SVC) is the path for blood returning from the brain, upper limbs, and heart (Fig. 17.1). An embolism occurs when a blood clot or thrombus is formed and released in an inflamed vein associated with pain and swelhng. The released clot, called an embolus, is carried by the bloodstream and causes an obstruction in a downstream blood vessel. This adverse event is called deep vein thrombosis (DVT). An embolus can be either part of a thrombus, or an air bubble, piece of fat, bone marrow, or tumor tissue. ... 

Comparative studies Rivaroxaban has been compared with standard anticoagulation (low-molecular-weight heparin followed by warfarin) in patients with acute deep vein thrombosis, who were randomized either to rivaroxaban 15 mg bd for 3 weeks followed by 20 mg/day or to standard anticoagulation for 3-12 months [47. Rivaroxaban was non-inferior to standard anticoagulation in preventing recurrent venous thrombosis (HR=0.68 95% Cl=0.44,1.04). The principal safety outcome was a combination of major or chnically relevant non-major bleeding, and this end-point occurred at a similar rate in patients t ing rivaroxaban or standard anticoagulant therapy (HR =0.97 95% Cl = 0.76,1.2). 

Barnwell SL, Halbach VV, Dowd CF et al (1991a) Multiple dural arteriovenous fistulas of the cranium and spine. AJNR Am J Neuroradiol 12 441-445 Barnwell SL, Higashida RT, Halbach VV et al (1991b) Direct endovascular thrombolytic therapy for dural sinus thrombosis. Neurosurgery 28 135-142 Benndorf G, Bender A, Lehmann R et al (2000) Transvenous occlusion of dural cavernous sinus fistulas through the thrombosed inferior petrosal sinus report of four cases and review of the literature. Surg Neurol 54 42-54 Benndorf G, Bender A, Campi A et al (2001) Treatment of a cavernous sinus dural arteriovenous fistula by deep orbital puncture of the superior ophthalmic vein. Neuroradiology 43 499-502... 

A 58-year-old man had a gastric varix injected twice with a mixture of enbucrilate plus hpiodol and subsequently needed anticoagulant therapy for four episodes of venous thromboembolism. A CT scan showed a linear hyper-dense lesion in the left renal vein due to the presence of enbucrilate and renal vein thrombosis. The thrombus extended into the inferior vena cava and there was splenic infarction [37 ]. 

Dual phase, contrast-enhanced MRI with perfusion sequence will not only delineate the extent and viability of tumor but also serve as a baseline study to plan future treatment. A simple dual-phase MRI or CT is acceptable as well but inferior to MRI perfusion in quantifying viable tumor. In addition to information regarding tumor viability and morphology, cross-sectional provides information regarding the tumor s vascular supply and anatomy. For example, knowing the presence of portal vein thrombosis... 

Fig. 24.9. Inferior vena cava thrombosis related to Wilms tumor. US (sagittal image) shows enlargement of the IVC (arrows). The thrombosis reaches the right atrium (RA). L liver...

Key words coronary angiography coronary occlusion coronary thrombosis ECG myocardial infarction, acute, inferior... 

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