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Background: Pulmonary embolism (PE) is a life-threatening condition causing an abrupt reduction in blood flow in the pulmonary vasculature due to a migrating thrombus. The most cases are related to thromboembolism events originating in the lower limbs. However alternate etiologies should be suspected in certain clinical cases mainly in young patients with no risk factors. Case Presentation: We present a case of a young patient with proximal PE caused by compression on the inferior vena cava by an abdominal benign tumor measuring 11 × 28 cm. The patient was treated surgically and started on a therapeutic dose of Anticoagulation. The etiology of PE in this case was attributed to large vein compression promoting blood stasis and leading to thrombus formation. Conclusion: In short, acute PE in young female patients, is unusual and should raise suspicion for miscellaneous causes including vascular compression by tumors. [ABSTRACT FROM AUTHOR]

This article discusses a study on the effectiveness and safety of using a combination of avelumab and axitinib as presurgical therapy for nonmetastatic renal cell carcinoma (RCC) with inferior vena cava (IVC) tumor thrombus. The study included 6 patients who underwent surgery after 3 months of this therapy, and all patients showed a reduction in tumor thrombus without any negative effects on surgery. The authors suggest that this combination therapy may be a viable option for reducing tumor thrombus and improving surgical outcomes in patients with advanced RCC. The document also provides a list of references that explore the use of targeted molecular therapies and immunotherapies for RCC with vena cava tumor thrombus, indicating that neoadjuvant therapy with these agents may be effective in reducing tumor thrombus and improving outcomes. [Extracted from the article]

Background: Trauma is an independent risk factor for venous thromboembolism (VTE). Due to contraindications or delay in starting pharmacological prophylaxis among trauma patients with a high risk of bleeding, the inferior vena cava (IVC) filter has been utilized as alternative prevention for pulmonary embolism (PE). Albeit, its clinical efficacy has remained uncertain. Therefore, we performed an updated systematic review and meta-analysis on the effectiveness and safety of prophylactic IVC filters in severely injured patients. Methods: Three databases (MEDLINE, EMBASE, and Cochrane) were searched from August 1, 2012, to October 27, 2021. Independent reviewers performed data extraction and quality assessment. Relative risk (RR) at 95% confidence interval (CI) pooled in a randomized meta-analysis. A parallel clinical practice guideline committee assessed the certainty of evidence using the GRADE approach. The outcomes of interest included VTE, PE, deep venous thrombosis, mortality, and IVC filter complications. Results: We included 10 controlled studies (47 140 patients), of which 3 studies (310 patients) were randomized controlled trials (RCTs) and 7 were observational studies (46 830 patients). IVC filters demonstrated no significant reduction in PE and fatal PE (RR, 0.27; 95% CI, 0.06-1.28 and RR, 0.32; 95% CI, 0.01-7.84, respectively) by pooling RCTs with low certainty. However, it demonstrated a significant reduction in the risk of PE and fatal PE (RR, 0.25; 95% CI, 0.12-0.55 and RR, 0.09; 95% CI, 0.011-0.81, respectively) by pooling observational studies with very low certainty. IVC filter did not improve mortality in both RCTs and observational studies (RR, 1.44; 95% CI, 0.86-2.43 and RR, 0.63; 95% CI, 0.3-1.31, respectively). Conclusion: In trauma patients, moderate risk reduction of PE and fatal PE was demonstrated among observational data but not RCTs. The desirable effect is not robust to outweigh the undesirable effects associated with IVC filter complications. Current evidence suggests against routinely using prophylactic IVC filters. [ABSTRACT FROM AUTHOR]

Inferior vena cava (IVC) filters should be removed when no longer needed, given their association with complications such as thrombosis of the IVC and lower extremities, fracture, migration, and growth into adjacent structures. While this is generally straightforward in the setting of retrievable filters, permanent filters present more of a challenge. In fact, many operators will not attempt to do so for fear of intraprocedural complications, among them, filter fracture and fragment embolization. Despite this, leaving the filters in situ places patients at risk of the complications described above. Here, the authors illustrate a novel technique for retrieving permanent filters using a funneled sheath to protect against embolization. [ABSTRACT FROM AUTHOR]

We assessed preoperative factors associated with overall survival in patients with renal cell carcinoma with IVC thrombus (cT2b, cT3c). We confirmed that cT3c, cN1, and cM1 were independently associated with poor OS. In patients with =2 risk factors, the median overall survival was 8.9 months. Stratification of patients before surgery allows us to determine whether the benefits of the procedure outweigh the risks. Introduction: Surgical resection of renal cell carcinoma (RCC) with inferior vena cava (IVC) thrombus is a complex procedure with significant morbidity. Patient selection is critical to determining whether the benefits of the procedure outweigh the risks. In this study, we identified and stratified the risk factors that were associated with overall survival (OS) and recurrence-free survival (RFS) in patients undergoing surgical resection of RCC with IVC thrombus. Methods: We identified all patients with RCC with IVC tumor thrombus (stages cT3b and cT3c) who had undergone radical nephrectomy with tumor thrombectomy between December 1, 1993 and June 30, 2009. Kaplan-Meier method was used to estimate OS and RFS. Cox proportional hazards models were used to determine the association between risk factors and OS. Patients were stratified into 3 groups based on the number of risk factors present at diagnosis. Results: Two hundred twenty-four patients were included in the study. A total of 45.3% of patients had metastasis at presentation, 84.5% had cT3b, and 90.2% had clear cell RCC. cT3c, cN1, and cM1 were significantly associated with the risk of death. Group 1 patients (0 risk factors) had a median OS duration of 77.6 months (95% CI 50.5-90.4), group 2 (1 risk factor) 26.0 months (95% CI 19.5-35.2), and group 3 (=2 risk factors) 8.9 months (95% CI 5.2-12.9; P < .001). Conclusions: Stratification of patients with RCC and IVC thrombus by risk factors allowed us to predict survival duration. In patients with =2 risk factors, new treatment strategies with preoperative systemic therapy may improve survival. [ABSTRACT FROM AUTHOR]

Small bowel-origin carcinoid tumor is indolent but may metastasize relentlessly to various sites, including the liver. Over the past 9 years, we have treated a 69-year-old woman who has undergone 5 percutaneous liver ablations, 5 hepatic intra-arterial chemoembolizations, an ovarian cryoablation, and a trans-ventral hernia mesenteric cryoablation. These interventions are all related to her inoperable carcinoid malignancy. After the patient presented with swelling of the abdomen and both lower extremities, computed tomography (CT) angiography was performed, revealing a circumferential hepatic metastatic mass encasing the intrahepatic inferior vena cava (IVC) and extensive third spacing of fluids specific to the IVC distribution below the diaphragm. A venogram of the intrahepatic IVC revealed extrinsic compression causing 95% narrowing of the vessel. A balloon was advanced to the level of the lesion and inflated, increasing the caliber of the vessel. Subsequently, 2 covered aortic stent graft cuffs were deployed in an overlapping fashion within the lumen of the IVC, traversing the area of narrowing. Next, an open-cell aortic dissection stent was placed across both overlapping aortic stents from the renal veins to the hepatic veins. Following this, three 17-gauge cryoablation probes were inserted into the segment 1 intrahepatic lesions encasing the newly stented IVC via an anterior percutaneous approach. Two 10-min freeze cycles were performed with intraoperative CT imaging, demonstrating circumferential coverage of the lesions. Posttreatment venogram revealed patent stent grafts within the intrahepatic IVC, and restoration of vessel patency. No immediate postoperative complications were noted. The patient's abdominal and lower extremity swelling resolved completely within 1 week after procedure. Two-month follow-up CT demonstrated markedly decreased size of the metastatic lesions and no adverse effects. Six- and 9-month PET-CT scans demonstrated maintained patency of the IVC stent. This palliative procedure allowed the patient to maintain good performance status and alleviated her symptoms of IVC syndrome. The radial force generated by the multiple aortic stents will ostensibly maintain the patency of the intrahepatic IVC. Cryoablation of the encasing metastatic lesion was performed with markedly decreased size of the tumor on the 2-month follow-up. [ABSTRACT FROM AUTHOR]

Objectives: The primary aim of this study was to determine the value of the inferior vena cava (IVC) ultrasound in the decision to hospitalise acute decompensated heart failure (ADHF) patients. Our secondary aim was to find the most successful IVC measurement method in monitoring volume status. Methods: ADHF patients were accepted over a 1-year period in this study. Patients' vital signs, laboratory tests and IVC measurements measured by six methods (in B- and M-mode; maximum, minimum diameter and caval index) performed on an hourly basis were recorded. The presence of any statistically significant difference between the IVC measurement methods, laboratory tests and vital parameters between the hospitalised and discharged patients was calculated. ROC curves were produced in order to determine the ability of parameters to differentiate two groups. Spearman's correlation test was used to investigate correlation between the IVC measurement methods and patients' urine outputs. Results: A total of 71 patients were included in the study; 42 of these were hospitalised and 29 were discharged. Potassium, brain natriuretic peptide, respiration rate, urine output, maximum and minimum IVC diameters differed significantly between the two groups. Minimum IVC diameter measured in M-mode was identified as a weak marker with 65% sensitivity and 64% specificity (þPPV: 73%; -NPV:54%) for hospitalisation. Change in maximum IVC diameter measured in B-mode exhibited a high degree of correlation with change in body fluid (cc: 0.802). Conclusion: IVC ultrasound may have a limited value in the decision to hospitalise ADHF patients. But Maximum IVC diameter may be an ideal method for monitoring hypervolemic patients' volume status. [ABSTRACT FROM AUTHOR]

Objectives: Inferior vena cava collapsibility (cIVC) measured by point-of-care ultrasound (POCUS) has been proposed as a noninvasive means of assessing fluid responsiveness. We aimed to prospectively evaluate the performance of a 25% cIVC cutoff value to detect fluid responsiveness among spontaneously breathing intensive care unit (ICU) patients when assessed with POCUS by novice versus expert physician sonologists. Methods: Prospective observational study of spontaneously breathing ICU patients. Fluid responsiveness was defined as a ≥10% increase in cardiac index following a 500 mL fluid bolus, measured by bioreactance. Novice sonologist measured cIVC with POCUS. Their measurements were later compared to an expert physician sonologist who independently reviewed the POCUS images and assessed cIVCs. Results: Of the 85 participants, 44 (52%) were fluid responders. A 25% cIVC cutoff value performed better when assessed by expert sonologists than novice physician sonologists (receiver--operator characteristic curve, ROC = 0.82 [0.74-0.88] vs ROC = 0.69 [0.60-0.77]). Conclusions: A 25% cIVC cutoff value measured by POCUS detects fluid responsiveness. However, the experience of the physician sonologist affects test performance and should be considered when interpreting and clinically using cIVC to direct intravenous fluid resuscitation. [ABSTRACT FROM AUTHOR]

Objective. To share our experience in the prenatal diagnosis of agenesis of ductus venosus (ADV) secondary to interrupted inferior vena cava (IIVC) and how does this affect the outcome. Methodology. A prospective study has been conducted in our center regarding the ADV outcome, since October 2016. In all cases, the main features of abdominal fetal circulation were evaluated in all secondtrimester ultrasound scans, including the presence of a normal drainage of the umbilical vein, via ductus venosus, and the normal location of inferior vena cava (IVC). We present an analysis regarding the outcome of the ADV cases secondary to IIVC and we compare our data with those from the literature. Results. A total of five cases with prenatally diagnosed ADV and IIVC were identified. The gestational age at diagnosis ranged from 18 to 27 weeks. Karyotyping was performed in all cases but one, with an abnormal result in one case. Two cases were part of left isomerism syndrome and had an unfavorable outcome. Two cases did not present other anomalies and had a good outcome, according to the neonatal and pediatric cardiology follow-up. Conclusions. Postnatal outcome in cases with ADV and IIVC mainly depends on the presence of concomitant malformations. In isolated cases, the prognosis is generally good, but counseling is often difficult in such cases, and it is very important to exclude other structural or genetic anomalies. [ABSTRACT FROM AUTHOR]

Inferior vena cava leiomyosarcoma (IVCL) is a rare tumor with a poor prognosis, and its surgical resection remains a challenge. To date, surgery is the only potentially curative treatment for IVCL with a 5-year survival rate of 55%. The main challenge is to combine oncological surgery with clear margins and vascular reconstruction of the inferior vena cava (IVC). In this review, we discuss the different approaches to vascular reconstruction after IVCL resection, using a prosthetic or autologous patch, direct suture or simple ligation without IVC reconstruction. The reconstruction of IVC depends of tumor location and its extension. We recommend no reconstruction if venous collaterality is well-established. When vascular reconstruction is required, we prefer prosthetic PTFE graft. These patients should be referred to high-volume centers with a multidisciplinary team of sarcoma surgeons with cardiothoracic, vascular and hepatic specialties. [ABSTRACT FROM AUTHOR]

Introduction: Although the outcomes of patients with retrohepatic inferior vena cava (IVC) injury have improved because of damage control (DC) strategies, some rare complications have been observed. Case Presentation: We present the case of a 35-year-old man with diverticulum-like projections (DLPs) of the retrohepatic IVC that occurred following peri-IVC packing based on DC strategies. The DLPs were treated conservatively with anticoagulant therapy and he recovered completely. Conclusions: Caution must be exercised regarding such rare complications after abbreviated surgery. Conservative therapy may be the optimal treatment for patients with DLPs of the retrohepatic IVC after peri-IVC packing. [ABSTRACT FROM AUTHOR]

Background: The treatment of venous thromboembolic disease the treatment of choice is systemic anticoagulation. However, the interruption of the inferior vena cava with filters has been recommended when anticoagulation fails or there is a contraindication. Due to the rising inferior vena cava filter (IVCF) complications, physicians are encouraged to retrieve them when there is no longer recommended. In daily practice, it may be a difficult close follow-up of these patients. In this study, the primary objective was to evaluate the IVCF retrieval rate of all implanted filters in a Spanish registry. Secondary objectives were to analyze the causes of failed retrieval, procedure-related complications, and outcomes at a 12-month follow-up. Results: Three hundred fifty-six vena cava filters were implanted in 355 patients. The types of filter were: Gunther Tulip (Cook Medical) 160 (44.9%), Optease (Cordis) 77 (21.6%), Celect (Cook Medical) 49 (13, 7%), Aegisy (Lifetech Scientific) 33 (9.2%), Option ELITE (Argon Medical devices) 16 (4.4%), Denali filter (BD Bard) 11 (3.08%), ALN filter (ALN) 10 (2.8%). Removal was achieved in 274/356 (76,9%). eighty-two (23,1%) IVCF were not retrieved due to the following: 41 (11,5%) patients required ongoing filtration, 24 IVCF (6,7%) patients died before retrieval, and 17 (4,7%) impossibility of retrieval because of a tilted and embedded filter apex. There were no major complications observed. Conclusions: The global retrieval rate of IVCF was achieved in 76.9%, and the adjusted retrieval rate was of 94.15% with no major complications. IVCF tilting was associated with failure of filter removal in less than 5% of cases. This study demonstrates that the retrieval procedure of IVCF is controlled by the clinician and not by the interventional radiologist. [ABSTRACT FROM AUTHOR]

Primary leiomyosarcoma is rare tumor approximately 1/100000 people. It is reported that only 2% of leiomyosarcoma is vascular in origin arising from inferior venacava (IVC). Considering its incidence, it is more common in females and middle segment of IVC is most commonly involved. We report here, case of 37-year-old female presented with right flank pain for one year then after radiological imaging neoplastic mass noted arising from infrahepatic and juxtarenal IVC and ultrasound guidance biopsy was taken that proved leiomyosarcoma of IVC. Surgery was performed with clear resection margins and regular follow-up was performed in our oncology OPD with the necessary imaging and laboratory work. No recurrence seen after 6 months of postoperative surgery, but we still need follow-up for any late recurrence. [ABSTRACT FROM AUTHOR]

Ultrasound assessment of the respiratory-induced change in size of the inferior vena cava is a useful technique in the evaluation and management of critically ill patients. We have developed an automated technique based on the Kanade-Lucas-Tomasi feature tracker and pyramidal segmentation to continuously track the diameter of the inferior vena cava during ultrasound. To test the accuracy of this automated process, the inferior vena cava of 47 spontaneously breathing patients were measured by trained ultrasound physicians and compared against the results obtained via the automated tracking. Good agreement between the techniques was found, with intra-class correlation coefficients for maximum vessel diameter, minimum diameter and caval index of 0.897, 0.967 and 0.975, respectively. More than 95% of the difference between physicians and automated measurements agreed to within 10% of the inferior vena cava collapse. Furthermore a phenomenon of cardiac collapsibility index variability was observed and reported. The accuracy and precision of this algorithmic technique provide a foundation for future automated measures for critical care ultrasound. [ABSTRACT FROM AUTHOR]

Objective: To present our technique and initial results of dual combined retroperitoneal and transperitoneal laparoscopic approach for the treatment of renal-cell carcinoma (RCC) with level 0–II venous tumor thrombus. Patients and Methods: We included nine consecutive patients with RCC and level 0–II inferior vena cava (IVC) thrombus who underwent laparoscopic radical nephrectomy and IVC thrombectomy using dual combined laparoscopic approach in our department between January 2016 and June 2017. Results: The mean operative time was 150 minutes when cavotomy was not performed and 240 minutes when cavotomy with thrombectomy was required. The mean IVC clamping time was 24 minutes and the mean blood loss was 300 mL. We encountered no major intraoperative or postoperative complications (Clavien III–IV). The patients were discharged a mean of 7 days after the procedure. At the 6-month follow-up, all patients were alive. One patient presented a retroperitoneal enlarged lymph node and started systemic treatment. Conclusions: The dual combined laparoscopic approach for kidney tumors with level 0–II IVC thrombus is feasible, reproducible, and especially useful in patients with complex renal pedicle. The technique provides early arterial control by retroperitoneal approach, which reduces the blood flow through the renal vein and has the advantage of minimal mobilization of the thrombus-bearing renal vein; it therefore lowers the risk of tumor embolism and intraoperative hemorrhage. [ABSTRACT FROM AUTHOR]

We present the unique case of a 15‐month‐old male born with biliary atresia and situs inversus totalis and disrupted inferior vena cava who underwent a successful liver transplantation. The patient had previously undergone a failed Kasai procedure and presented with persistent hyperbilirubinemia. The patient was transplanted with a left lateral segment donor having standard arterial anatomy. Technical considerations included identifying completely replaced arterial anatomy in the recipient from the superior mesenteric artery and creating a branch patch between the gastroduodenal artery and HA, anastomosing the donor left hepatic vein to confluences of the donor left, middle, and right hepatic veins, using a “lazy‐S” configuration of portal vein anastomosis, and suspending the allograft to the abdominal wall. Post‐operatively, his liver function tests and total bilirubin normalized and he progressed to tolerating an oral diet with tube‐feed supplementation. [ABSTRACT FROM AUTHOR]

Background. The increase in intra-abdominal pressure (IAP) during closed abdominal hyperthermic intraperitoneal chemotherapy (HIPEC) leads to major haemodynamic changes and potential organ dysfunction. We investigated these effects on hepatic blood flow (HBF) and liver function in patients undergoing HIPEC following cytoreductive surgery and fluid management guided by dynamic preload indices. Methods. In this prospective observational clinical study including 15 consecutive patients, we evaluated HBF by transesophageal echocardiography and liver function by determination of the indocyanine green plasma disappearance rate (ICG-PDR). Friedman’s two-way analysis of variance by ranks and Wilcoxon signed-rank test were performed for statistical analysis. Results. During HIPEC, HBF was markedly reduced, resulting in the loss of any pulsatile Doppler flow signal in all but one patient. The ICG-PDR, expressed as median (interquartile 25–75), decreased from 23 (20–30) %/min to 18 (12.5–19) %/min (p<0.001). Despite a generous crystalloid infusion rate (27 (22–35) ml/kg/h), cardiac index decreased during the increased IAP period, inferior vena cava diameter decreased, stroke volume variation and pulse pressure variation increased, lung compliance dropped, and there was an augmentation in plateau pressure. All changes were significant (p<0.001) and reversed to baseline values post HIPEC. Conclusion. Despite optimizing intravenous fluids during closed abdominal HIPEC, we observed a marked decrease in HBF and liver function. Both effects were transient and limited to the period of HIPEC but could influence the choice between closed or open abdominal cavity procedure for HIPEC and should be considered in similar clinical situations of increased IAP. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic congestion syndrome is described as chronic pelvic pain arising from dilated and refluxing pelvic veins, although the causal relationship between pelvic vein incompetence and pelvic pain is not established. Embolization appears to provide symptomatic relief in the majority of women and is safe. Case report: We report the case of a young woman affected by pelvic congestion syndrome associated with a rare venous anomaly, duplicity of inferior vena cava with azygos vein continuation. Endovascular treatment consisted of detachable coil embolization of the right ovarian vein, as pelvic pain was prevalently on this side. Technical and clinical outcome were positive with a significant improvement of quality of life. Conclusion: This is the first reported case of a pelvic congestion syndrome associated with inferior vena cava anomaly and effectively treated with ovarian vein embolization. [ABSTRACT FROM AUTHOR]

Background: Vena cava anomalies are a rare group of anatomical variations due to an incorrect development of the superior or inferior vena cava during fetal life. They generally show no clinical relevance and the diagnosis is done due to the association with congenital heart diseases in most of cases. However, preoperative identification of these anomalies is mandatory for surgeons to proper surgical planning. If not recognized, lethal complications may occur, as already reported in literature.Case Presentation: We report a case series of three different unidentified vena cava anomalies in patients undergoing lung resection. These unrecognized anomalies led to minor complications in two cases and required an accurate intraoperative evaluation in another. A careful retrospective evaluation of preoperative radiological images showed the anomalies.Conclusions: A careful evaluation of the vena cava anatomy at pre-operative imaging is mandatory for thoracic surgeons to properly plan the surgery and avoid complications. [ABSTRACT FROM AUTHOR]

Background Clinical benefits of presurgical axitinib therapy for renal cell carcinoma (RCC) extending into the inferior vena cava (IVC) remain unclear. We aimed to investigate surgical benefits and pathological antitumor effects of presurgical axitinib therapy for RCC with IVC thrombus. Methods Of 56 consecutive RCC patients with IVC thrombus between January 1994 and December 2016, 41 patients who underwent radical nephrectomy (RN) were categorized as upfront RN (Upfront group) or presurgical axitinib followed by RN (Presurgical group). We retrospectively evaluated safety, radiologic tumor responses, and Ki-67 proliferation index before and after axitinib administration in the Presurgical group. Surgical outcomes, postoperative complications, and fibrosis within the IVC thrombus were compared between the Upfront and Presurgical groups. Results The number of patients in the Upfront and Presurgical groups was 31 and 10, respectively. Major presurgical axitinib-related adverse events were grade 2 or 3 hypertension (50%). The median radiological tumor response in the renal tumor, IVC thrombus length, and IVC thrombus volume were -19%, -21 mm, and -54%, respectively. The fibrosis within the IVC thrombus was significantly higher in the Presurgical group (10%) than in the Upfront group (3.4%). The Ki-67 proliferation index was significantly decreased in RN specimens (7.3%) versus needle biopsy specimens (23%) in the Presurgical group. Blood loss and operative duration were significantly lower and shorter, respectively, in the Presurgical group than in the Upfront group. Conclusions Presurgical axitinib therapy enhanced tumor reduction accompanied by fibrosis and may contribute to surgical risk reduction for selected patients. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Inferior vena cava (IVC) aneurysms are extremely rare. Patients can be asymptomatic, have thrombosis, rupture, or pulmonary embolism. Thrombosis of the IVC aneurysm may mimic a retroperitoneal tumor. Surgical treatment of abdominal venous aneurysms with thrombosis is warranted and is necessary for the management of intraoperative bleeding and thrombosis. [ABSTRACT FROM AUTHOR]

Objectives To evaluate normative sonographic measurements of the inferior vena cava (IVC), aorta (Ao), and IVC/Ao ratio in the first 2 days of life in term neonates. Methods We prospectively observed 200 term (more than 36 and 6/7 weeks of gestation), single, healthy neonates born in a city hospital. The exclusion criteria were congenital abnormalities, an Apgar score of less than 8, and hyperbilirubinemia requiring phototherapy. Maximum IVC (distal to the hepatic-IVC junction) and Ao (above the superior mesenteric artery) diameters were measured in the first 2 days of life in the longitudinal plane. Neonatal weight loss was calculated as a percentage lost from birth weight (BW). Results A total of 200 (50% born vaginally, 53% male) neonates were enrolled. Correlations between IVC and aortic diameters as a function of gestational age, method of birth, weight loss, and body surface area (BSA) were calculated using the Spearman's rank correlation coefficient. The correlation coefficients were statistically significant for the IVC ( P = .017) and Ao ( P = .006) abdominal diameters versus gestational age. The Ao diameter correlated with BSA ( P = .0001). In neonates with weight loss less than 8% of BW, the IVC/Ao ratio remained constant at 0.62 (95% confidence interval, 0.60-0.63). Conclusions Sonographic measurements of IVC and Ao maximum diameters in term neonates suggests a significant positive correlation among gestational age, BSA, and IVC and Ao diameters. The IVC/Ao ratios remain constant over 48 hours after birth in neonates with weight loss up to 8% of BW, and appear to be lower than previously reported ratios for healthy children. [ABSTRACT FROM AUTHOR]

Early stage acute kidney injury (AKI) is an independent risk factor for an increase in mortality. Accurate assessment of volume status is a major challenge during the early stages of acute renal injury. Determining volume status based on the history and physical exam lacks accuracy. Urine sodium and free excretion of sodium (FENa) provide objective evidence of intravascular volume status when interpreted carefully and is helpful to delineate prerenal from intrinsic renal failure. In recent years point of care ultrasound has been used to assess volume status. Our team conducted a retrospective chart review to assess the association of inferior vena cava collapsibility by point of care ultrasound (POCUS) and urine electrolytes (urine sodium, fractional excretion of sodium) during early stage AKI (Stage 1-2 of KDIGO guidelines). We reviewed 150 cases based on the provisional diagnosis. 36 patients met the criteria for further review. Using bivariate analysis, we found a strong association between >50% IVC collapsibility with FENa < 0.4% with an odds ratio 5.3 (CI 1.1-24.5, p = 0.04) and urine sodium <20 meq/dl with an odds ratio of 6.7 (Cl 1.5-30, p = 0.02). Subsequently, multivariate analysis and Spearman correlation showed an inverse relation between IVC collapsibility and fractional excretion of sodium FENa (β =-0.4, p = 0.001) and (r =-0.44, p = 0.01). These findings suggest the role of POCUS and urinary markers in determining the intravascular volume status in AKI. POCUS is also valuable to assess volume status in cases of renal failure where urine studies are difficult to interpret. [ABSTRACT FROM AUTHOR]

Background: Fetal thrombotic vasculopathy is a described placental diagnosis associated with adverse perinatal outcomes. It may also predispose children to somatic thromboembolic events. As far as we know, this is the first case of inferior vena cava thrombosis associated with fetal thrombotic vasculopathy in a completely asymptomatic newborn.Case Presentation: We report the case of an asymptomatic, full-term Turkish male neonate delivered at 39 weeks of gestation diagnosed as having thrombosis of the renal vein and inferior vena cava. Diagnosis was guided only by the presence of edematous umbilical cord with macroscopic signs of clotting and, subsequently, microscopic features of the placenta, suggesting fetal thrombotic vasculopathy.Conclusions: Thrombosis of the renal and inferior vena cava in our healthy, asymptomatic full-term neonate is clearly associated with fetal thrombotic vasculopathy. The diagnosis of thrombosis in this neonate was incidental. This suggests that fetal thrombotic vasculopathy may cause unrecognized neonatal thrombosis. Untreated neonatal thrombosis may later compromise growth and function of the involved organs; therefore, maintaining a high index of suspicion based on thrombotic vasculopathy is paramount. [ABSTRACT FROM AUTHOR]

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Inferior vena cava (IVC) filters are typically used for prophylaxis against pulmonary embolism. A new version of the Günther Tulip filter, the Celect IVC filter was introduced in April 2007. To the best of our knowledge, there are no reports commenting on Celect IVC filter fracture and fragment embolization to liver. We report a case in which the strut of the Celect IVC filter embolized to the liver. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the impact on practice of vena cava filter insertion guidelines (Eastern Association for the Surgery of Trauma: practice management guidelines).Design: The study was performed at a level 1 trauma centre with data from the 'Trauma Audit and Research Network' cross-referenced to hospital data.Results: A total of 1138 specific 'high-risk' major trauma patients were identified over a 6-year period. The mean age was 46 years (18-102) and the male to female ratio was 3.3:1. The average Injury Severity Score was 23.6 (4-75). The overall DVT rate was 2.6% and the PE rate was 1.8%. A retrievable IVC filter was inserted in 42 cases (3.8%). The filter retrieval rate was 23.8% at a mean of 68.5days (4-107). Only one complication was reported of a breakthrough PE despite filter. Applying the EAST guidelines to this cohort would have suggested filter insertion in 279 (24.6%) cases. The kappa concordance value between observed practice and the 'EAST filter group' was 0.103 (poor). The PE rate in the 'EAST filter group' was 2.2% vs 1.6% in the 'no filter group' (p=0.601, no statistical difference) and the observed odds ratio was 0.814 (95% CI 0.413, 1.602).Conclusion: The EAST guidelines are useful but may be overestimating the need for filter insertion. [ABSTRACT FROM AUTHOR]

Pheochromocytoma associated with inferior vena cava (IVC) thrombosis is very rare. A 27-year-old female presented with right flank pain and hypertensive urgency. Contrast-enhanced CT abdomen and gadolinium-contrast MRI abdomen revealed right adrenal mass suspicious of malignancy with invasion and compression to the right IVC wall along with IVC thrombus extending from the level of renal veins to the level of confluence with hepatic veins. Her routine laboratory investigations including 24-hour urine fractionated metanephrines, vanillylmandelic acid, and cortisol were normal. Right adrenalectomy with IVC thrombectomy was done. Perioperative period was uneventful. Histopathology of the mass turned out to be pheochromocytoma with thrombus revealing fibroadipose tissue with fibrin. Pheochromocytoma may present with IVC thrombus as well as normal serum and urinary markers. Thus, clinical suspicion is imperative in perioperative management of adrenal mass. [ABSTRACT FROM AUTHOR]

Purpose: To compare the results of computed tomography venography (CTV) with a fixed and a flexible delayed scan time for Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction.Material and Methods: A total of 209 consecutive BCS patients with IVC obstruction underwent either a CTV with a fixed delayed scan time of 180s (n=87) or a flexible delayed scan time for good image quality according to IVC blood flow in color Doppler ultrasonography (n=122). The IVC blood flow velocity was measured using a color Doppler ultrasound prior to CT scan. Image quality was classified as either good, moderate, or poor. Image quality, surrounding structures and the morphology of the IVC obstruction were compared between the two groups using a χ2-test or paired or unpaired t-tests as appropriate. Inter-observer agreement was assessed using Kappa statistics.Results: There was no significant difference in IVC blood flow velocity between the two groups. Overall image quality, surrounding structures and IVC obstruction morphology delineation on the flexible delayed scan time of CTV images were rated better relative to those obtained by fixed delayed scan time of CTV images (p<0.001). Evaluation of CTV data sets was significantly facilitated with flexible delayed scan time of CTV. There were no significant differences in Kappa statistics between Group A and Group B.Conclusion: The flexible delayed scan time of CTV was associated with better detection and more reliable characterization of BCS with IVC obstruction compared to a fixed delayed scan time. [ABSTRACT FROM AUTHOR]

Bronchopulmonary sequestration (BPS) is a rare congenital problem with anomalous vascular supply and absence of tracheobronchial communication. Continued inflammation consequent to sequestration can, in rare cases, lead to atherosclerotic damage to the feeding artery and resultant aneurysm formation. We present a case of BPS presenting with partial inferior vena cava obstruction caused by aneurysmal dilatation of the feeding artery. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the collapsibility index of the inferior vena cava recorded during a deep standardized inspiration predicts fluid responsiveness in nonintubated patients.Design: Prospective, nonrandomized study.Setting: ICUs at a general and a university hospital.Patients: Nonintubated patients without mechanical ventilation (n = 90) presenting with sepsis-induced acute circulatory failure and considered for volume expansion.Interventions: We assessed hemodynamic status at baseline and after a volume expansion induced by a 30-minute infusion of 500-mL gelatin 4%.Measurements and Main Results: We measured stroke volume index and collapsibility index of the inferior vena cava under a deep standardized inspiration using transthoracic echocardiography. Vena cava pertinent diameters were measured 15-20 mm caudal to the hepatic vein junction and recorded by bidimensional imaging on a subcostal long-axis view. Standardized respiratory cycles consisted of a deep standardized inspiration followed by passive exhalation. The collapsibility index expressed in percentage equaled the ratio of the difference between end-expiratory and minimum-inspiratory diameter over the end-expiratory diameter. After volume expansion, a relevant (≥ 10%) stroke volume index increase was recorded in 56% patients. In receiver operating characteristic analysis, the area under curve for that collapsibility index was 0.89 (95% CI, 0.82-0.97). When such index is superior or equal to 48%, fluid responsiveness is predicted with a sensitivity of 84% and a specificity of 90%.Conclusions: The collapsibility index of the inferior vena cava during a deep standardized inspiration is a simple, noninvasive bedside predictor of fluid responsiveness in nonintubated patients with sepsis-related acute circulatory failure. [ABSTRACT FROM AUTHOR]

Background: Many patients are subjected to the potential risks and morbidity associated with an indwelling inferior vena cava (IVC) filter when standard methods fail to remove the filter. We evaluated the safety and effectiveness of the excimer laser sheath technique for removing embedded IVC filters.Methods: Over a 5-year period, 251 consecutive patients undergoing laser-assisted filter retrieval were prospectively enrolled. There were 103 men and 148 women (mean, 46 years; range, 15-82 years). Indications for retrieval included symptomatic acute IVC thrombosis, chronic IVC occlusion, and/or pain from filter penetration. Retrieval was also performed to prevent risks from prolonged implantation and potentially to eliminate the need for lifelong anticoagulation. After retrieval failed using three times the standard retrieval force (digitally measured), treatment escalation was attempted using a laser sheath powered by a 308-nm XeCl laser. Success was defined as complete filter detachment and removal from the body. Primary safety outcomes were major procedure-related complications.Results: Laser-assisted retrieval was successful in 249 of 251 patients (99.2%) (95% CI, 97.2%-99.9%), with a mean implantation of 979 days, range: 37-7,098 days (> 19 years), among retrievable-type filters (n = 211) and permanent-type filters (n = 40). Average force during failed attempts without laser was 6.7 vs 3.8 lbs during laser-assisted retrievals (P < .0001). The major complication rate was 1.6% (95% CI, 0.4%-4.0%), and all were successfully treated. Successful retrieval allowed cessation of anticoagulation in 45 of 46 patients (98%) (95% CI, 88%-99%) and alleviated filter-related morbidity in 55 of 57 patients (96%) (95% CI, 88%-99%).Conclusions: The excimer laser sheath technique is safe and effective for removing embedded IVC filters refractory to standard retrieval and high force. This technique can be used to alleviate or prevent filter-related morbidity and may allow cessation of filter-related anticoagulation.Trial Registry: ClinicalTrials.gov; No.: NCT01158482; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Inferior vena cava thrombosis (IVCT) is a rare but severe disease that is associated with a high rate of mortality. IVCT can be categorized into primary versus secondary thrombosis dependent upon the underlying pathophysiology. The diagnosis includes both clinical probability assessment as well as the imaging evaluation. The optimal therapeutic strategy remains the target of continued research. Although anticoagulation therapy remains fundamental in treating IVCT, its inherent limitations have led to the use of minimally invasive, endovascular treatment options, including transcatheter thrombolysis, mechanical thrombectomy or a combination of these techniques. This review focuses on the etiology, diagnostic assessment, and endovascular treatment options for IVCT. [ABSTRACT FROM AUTHOR]

Background and Aim The diagnosis of the partially obstructed inferior vena cava (IVC) in Budd-Chiari syndrome (BCS) patients has received little attention. We aimed to evaluate the diagnostic accuracy of computed tomographic angiography (CTA) for patients with BCS and a partially obstructed IVC. Methods A total of 329 patients with BCS and an obstructed IVC were endovascularly treated with balloon dilation and/or stent placement. All patients underwent a CTA examination prior to endovascular treatment, and the data were retrospectively reviewed. The presence of a round, oval, irregular shape or jet sign low-density area without enhancement within the enhanced proximal IVC was considered a sign of a partially obstructed IVC. Digital subtraction angiography was used as the gold standard. Results The results from the digital subtraction angiography revealed a partially obstructed IVC in 108 BCS patients and a complete obstruction in 221 patients. The CTA discovered a partially obstructed IVC in 99 patients and a completely obstructed IVC in 230 patients. From the CTA results, 15 were false negatives, and six were false positives. The patient-based evaluation yielded an accuracy of 93.6%, a sensitivity of 86.1%, specificity of 97.3%, positive predictive value of 93.9%, and negative predictive value of 93.5% for the detection of BCS patients with a partial IVC obstruction. Conclusions Computed tomographic angiography offered a high diagnostic accuracy and sensitivity in BCS patients with a partially obstructed IVC. The low-density area within the enhanced proximal IVC above the membrane in artery phase can be considered a reliable indicator of a stenotic IVC in BCS patients. [ABSTRACT FROM AUTHOR]

The most common causes of renal mass with malignant venous thrombosis are Wilms' tumor and renal cell carcinoma. Although renal involvement may occur in disseminated lymphomas, primary renal Burkitt lymphoma (BL) is rare. Vascular tropism is not a usual feature of lymphoma; thus, primary renal BL with venous extension is distinctly unusual. However, it is important to diagnose this entity because such patients respond well to medical management and may not require surgery. We report a pediatric case of primary renal BL with malignant vascular thrombus and systemic dissemination where biopsy was diagnostic and enabled appropriate treatment. [ABSTRACT FROM AUTHOR]

Purpose To evaluate causes of failed optional inferior vena cava filter (IVCF) retrievals. Methods Single-center retrospective study. Results IVCF retrievals were attempted in 26/211 (12%) patients at a mean 42.9 days. There were 9 failures (all OptEase) due to: inability to snare the hook ( n = 5), noncollapsible IVCF ( n = 3), and unusual procedural pain ( n = 1). Median duration of retrieved IVCFs was 31 days compared to 53 days for failures ( P < .05). IVCFs aligned with the IVC's cephalocaudal axis were retrieved in 13/16 cases, while misaligned IVCFs were retrieved 4/10 cases ( P < .05). Conclusion Filter duration and misalignment were significantly associated with retrieval failures. [ABSTRACT FROM AUTHOR]

Objective: Obesity is a risk factor for cardiovascular disease and venous thrombosis. Previous studies have shown that in late pregnancy a compression of the inferior vena cava (VCI) leads to a hypotensive syndrome. The objective of this study was to explore the correlation between obesity and an elevated pressure in the VCI simulating obesity-induced vena cava compression syndrome.Methods: A left and right heart catheterization was performed in 29 patients. After right atrial pressure measurement, the catheter was pulled back through the VCI, and the pressure gradient between the thoracic and abdominal vena cava was measured. We determined the correlation between the BMI and the pressure gradient.Results: In 29 patients, a high BMI was associated with an increased pressure gradient between the thoracic and abdominal vena cava (r = 0.66). This correlation was particularly close in patients with a BMI >30 kg/m(2) (P = 0.0008). Two patients had complications such as recurrent thrombosis, with one of them having the highest pressure gradient of 16 mm Hg.Conclusions: Because mechanical obstruction of the VCI leads to an increased risk for venous thrombosis in patients with obesity, this finding needs to be considered in the decision-making for interventional treatments like bariatric surgery. [ABSTRACT FROM AUTHOR]

Congenital malformations of the inferior vena cava (IVC) are rare and underreported. They can be a risk factor for deep venous thrombosis (DVT) as a result of inadequate venous drainage of the lower extremities through collateral circulation. The significant number of cases reported in the literature highlights their importance, warranting investigating their existence in younger individuals with idiopathic DVT of the lower extremities and pelvic veins. In this systematic review, we depict the typical presentation of IVC malformations, their management, and the management of their associated DVT. [ABSTRACT FROM AUTHOR]

Background Both hypovolemia and hypervolemia are connected with increased morbidity and mortality in the treatment and prognosis of patients. An accurate assessment of volume state allows the optimization of organ perfusion and oxygen supply. Recently, ultrasonography has been used to detect hypovolemia in critically ill patients and perioperative patients. The objective of our study was to assess the correlation between inferior vena cava (IVC) variation obtained with ultrasound and stroke volume variation (SVV) measured by the Vigileo/FloTrac monitor, as fluid responsiveness indicators, in patients undergoing anesthesia for surgery. Methods Forty patients (American Society of Anesthesiologists grades I and II) scheduled for elective gastrointestinal surgery were enrolled in our study. After anesthesia induction, 6% hydroxyethyl starch solution was administered to patients as an intravenous (IV) fluid. The IVC diameters were measured with ultrasonography. SVV and stroke volume index (SVI) were obtained from the Vigileo monitor. All data were collected both before and after fluid challenge. Results Forty patients underwent IVC sonographic measurements and SVV calculation. After fluid challenge, mean arterial pressure, central venous pressure, SVI, and IVC diameters increased significantly, whereas SVV decreased markedly. The correlation coefficient between the increase in SVI and the baseline of IVC variation after an IV fluid was 0.710, and receiver operating characteristic (ROC) curve was 0.85. The correlation coefficient between the increase in SVI and the baseline of SVV was 0.803 with an ROC curve of 0.93. Central venous pressure had no significant correlation with SVI. Conclusions Our data show that IVC variation and SVV proved to be reliable predictors of fluid responsiveness in patients undergoing anesthesia for surgery with mechanical ventilation. [ABSTRACT FROM AUTHOR]

A 50-year-old woman was referred to our institution for medical screening due to an incidental finding on abdominal ultrasonography. She underwent chest, abdomen and cardiac multi-detector computed tomography (MDCT). Her MDCT revealed absence of the hepatic segment of the inferior vena cava (IVC), with hemiazygos continuation and a left single coronary artery. The dilated hemiazygos vein drained directly into the persistent left superior vena cava (SVC). Herein, we reported a very rare case combining an incidentally found interrupted IVC with hemiazygos vein continuation, persistent left SVC and a left single coronary artery diagnosed by MDCT. [ABSTRACT FROM AUTHOR]

Objective To determine the predictors of post-surgical recurrence for patients with non-metastatic renal cell carcinoma ( RCC) and venous thrombus. Methods Records from consecutive patients with non-metastatic RCC with tumour thrombus, treated surgically between 2000 and 2012 at one of three centres, were reviewed. Univariable and multivariable analysis were used to evaluate the association of risk factors for post-surgical recurrence. Results A total of 465 patients with non-metastatic RCC were identified, including patients with thrombus present in the renal vein (257 patients, 55.3%), infrahepatic inferior vena cava ( IVC; 144 patients, 31.0%) and suprahepatic IVC (64 patients, 13.8%). The median (interquartile range) follow-up was 28.3 (12.2-56.4) months, with metastatic RCC developing in 188 patients (40.5%). Independent predictors of recurrence included: body mass index ≤20 kg/m2 (hazard ratio [ HR] 2.66; 95% confidence interval [ CI] 1.29-5.49), low preoperative haemoglobin ( HR 1.54; 95% CI 1.07-2.20), perinephric fat invasion ( HR 1.51; 95% CI 1.09-2.10), IVC thrombus height ( HR 2.64; 95% CI 1.47-4.74), tumour diameter ( HR 1.04 95% CI 1.00-1.09), nuclear grade ( HR 1.56 95% CI 1.12-2.15) and non-clear-cell histology ( HR 2.13; 95% CI 1.30-3.50). Independently predictive variables were used to create a recurrence model for three risk groups based on 0, 1-2, or >2 risk factors, respectively. The 5-year recurrence-free survival rate was significantly different in patients with favourable-risk (79.1%) compared with intermediate- (55.1%) or high-risk (22.1%) disease ( P < 0.001). Conclusions Seven risk factors for recurrence were identified for patients with non-metastatic RCC with thrombus, which can be used to select patients who may benefit from increased surveillance or adjuvant therapy clinical trials. [ABSTRACT FROM AUTHOR]

Leiomyosarcoma (LMS) of inferior vena cava is a rare and aggressive tumor, arising from the smooth muscle cells in the vessel wall. A large complete surgical resection is the essential treatment. The need of vascular reconstruction is not always mandatory. It's above all to understand the place of the reconstruction with artificial vascular patch prosthetics of vena cave after a large resection of the tumor. We rapport two cases of LMS of inferior vena cava in two women who underwent successful large resection of tumor and lower segment of inferior vena cava. In first case, reconstruction of the inferior vena cava was not performed because of the development of venous collaterals derivation. In the second case reconstruction was done using Dacron interposition graft. The necessity of a large resection in management of primary leiomyosarcoma of vena cave makes sometimes unavoidable the sacrifice of a portion of the vena. Indeed, a better comprehension of the development of venous derivation may render unnecessary the reconstruction. [ABSTRACT FROM AUTHOR]

Background: Inferior vena caval filters (IVCFs) may prevent recurrent pulmonary embolism (PE). Despite uncertainty about their net benefit, patterns of use and outcomes of these devices in contemporary practice are unknown.Objectives: The authors determined the trends in utilization rates and outcomes of IVCF placement in patients with PE and explored regional variations in use in the United States.Methods: In a national cohort study of all Medicare fee-for-service beneficiaries ≥65 years of age with principal discharge diagnoses of PE between 1999 and 2010, rates of IVCF placement per 100,000 beneficiary-years and per 1,000 patients with PE were determined. The 30-day and 1-year mortality rates after IVCF placement were also investigated.Results: Among 556,658 patients hospitalized with PE, 94,427 underwent IVCF placement. Between 1999 and 2010, the number of PE hospitalizations with IVCF placement increased from 5,003 to 8,928, representing an increase in the rate per 100,000 beneficiary-years from 19.0 to 32.5 (p < 0.001 for both). As the total number of PE hospitalizations increased (from 31,746 in 1999 to 54,392 in 2010), the rate of IVCF placement per 1,000 PE hospitalizations did not change significantly (from 157.6 to 164.1, p = 0.11). Results were consistent across demographic subgroups, although IVCF use was higher in blacks and patients ≥85 years of age. IVCF utilization varied widely across regions, with the highest rate in the South Atlantic region and the lowest rate in the Mountain region.Conclusions: In a period of increasing PE hospitalizations among Medicare fee-for-service beneficiaries, IVCF placement increased as utilization rates in patients with PE remained greater than 15%. Mortality associated with PE hospitalizations is declining, regardless of IVCF use. [ABSTRACT FROM AUTHOR]

Background In discharged patients with heart failure (HF), diverse conditions can intervene to worsen outcome. We would investigate whether such factors present on hospital admission can affect long-term mortality in subjects hospitalized for acute HF. Methods One hundred twenty-three consecutive patients hospitalized for acute HF (mean age 74.8 years; 57% female) were recruited and followed for 36 months after hospitalization. Results At multivariate Cox model, only inferior vena cava (IVC) diameter and mean arterial pressure (MAP) registered bed-side on admission, resulted, after correction for all confounders factors, the sole factors significantly associated with a higher risk of all-cause mortality in long-term (HR 1.06, p = 0.0057; HR 0.97, p = 0.0218; respectively). Study population was subdivided according to median values of IVC diameter (23 mm) and MAP (93.3 mm Hg). The Kaplan–Meier curve showed that HF patients with both IVC ≥ 23 mm and MAP < 93.3 mm Hg on admission had reduced probability of survival free from all-cause death (log rank p = 0.0070 and log rank p = 0.0028, respectively). Conclusions In patients hospitalized for acute HF, IVC diameter, measured by hand-carried ultrasound (HCU), and MAP detected on admission are strong predictors of long-term all-cause mortality. The data suggest the need for a careful clinical-therapeutic surveillance on these patients during the post-discharge period. IVC diameter and MAP can be utilized as parameters to stratify prognosis on admission and to be supervised during follow-up. [ABSTRACT FROM AUTHOR]

Active cancer (ACa) is strongly associated with venous thromboembolism and bleeding. Retrievable inferior vena cava filters (RIVCF) are frequently placed in these patients when anticoagulation cannot be continued. Objectives. To describe the complications and retrieval rate of inferior vena cava filters in patients with ACa. Methods. Retrospective review of 251 consecutive patients with RIVCF in a single institution. Results. We included 251 patients with RIVCF with a mean age of 58.1 years and a median follow-up of 5.4 months (164 days, IQR: 34–385). Of these patients 32% had ACa. There were no differences in recurrence rate of DVT between patients with ACa and those without ACa (13% versus 17%, p = ns). Also, there were no differences in major filter complications (11% ACa versus 7% no ACa, p = ns). The filter retrieval was not different between groups (log-rank = 0.16). Retrieval rate at 6 months was 49% in ACa patients versus 64% in patients without ACa (p = ns). Filter retrieval was less frequent in ACa patients with metastatic disease (p < 0.01) or a nonsurgical indication for filter placement (p = 0.04). Conclusions. No differences were noted in retrieval rate, recurrent DVT, or filter complications between the two groups. ACa should not preclude the use of RIVCF. [ABSTRACT FROM AUTHOR]

Introduction: Although dehydration from diarrhea is a leading cause of morbidity and mortality in children under five, existing methods of assessing dehydration status in children have limited accuracy. Objective: To assess the accuracy of point-of-care ultrasound measurement of the aorta-to-IVC ratio as a predictor of dehydration in children. Methods: A prospective cohort study of children under five years with acute diarrhea was conducted in the rehydration unit of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b). Ultrasound measurements of aorta-to-IVC ratio and dehydrated weight were obtained on patient arrival. Percent weight change was monitored during rehydration to classify children as having “some dehydration” with weight change 3–9% or “severe dehydration” with weight change > 9%. Logistic regression analysis and Receiver-Operator Characteristic (ROC) curves were used to evaluate the accuracy of aorta-to-IVC ratio as a predictor of dehydration severity. Results: 850 children were enrolled, of which 771 were included in the final analysis. Aorta to IVC ratio was a significant predictor of the percent dehydration in children with acute diarrhea, with each 1-point increase in the aorta to IVC ratio predicting a 1.1% increase in the percent dehydration of the child. However, the area under the ROC curve (0.60), sensitivity (67%), and specificity (49%), for predicting severe dehydration were all poor. Conclusions: Point-of-care ultrasound of the aorta-to-IVC ratio was statistically associated with volume status, but was not accurate enough to be used as an independent screening tool for dehydration in children under five years presenting with acute diarrhea in a resource-limited setting. [ABSTRACT FROM AUTHOR]

Renal primitive neuroectodermal tumor (PNET) is a rare primary renal neoplasm. Morphologically, it may mimic small blue round-cell tumor. Hence, histopathology in conjunction with immunohistochemistry plays a significant role in correctly diagnosing this malignancy. We report a case of PNET of kidney in a 30-year-old female with an extension to inferior vena cava, who succumbed following an aggressive course of illness. [ABSTRACT FROM AUTHOR]