Endovascular Treatment of Late Aortic Perforation due to Vena Cava Filter

Perforation of inferior vena cava (IVC) by filter struts ranges from 9% to 24%, and clinical sequelae and complications are unpredictable. The aim of this article was to report an unusual case of late complication of IVC filter that caused an IVC wall perforation and penetration of the filter's hooks in the aorta, which was treated by endovascular procedure. Molding strut tip by balloon angioplasty, its accommodation with a bare stent, and its coverage and protection with an endoprosthesis is probably the first technique reported so far in this situation.

Long-term histopathologic evaluation of inferior vena cava after modified Greenfield filter implantation - Experimental study in sheep

Aim. The authors assess a modified Greenfield filter (GF) for the long-term patency, filter tilting and histopathologic alterations of the inferior vena cava (IVC).Methods. Adult sheep (n=7) underwent modified GF placement in the IVC. Cavograms were obtained every 3 months and pulmonary angiography at 12 months. Histopathologic and scanning electron microscopy (SEM) analyses were performed on the IVC explanted at 12 months.Results. Cavograms showed that all IVC were patent at the end of the study. Filter tilting occurred in 2/7 animals and extrusion of struts was not observed. Macroscopic examination at explantation showed minimal venous wall thickening. Microscopic examination showed minimal IVC fibrosis and intimal hyperplasia. SEM showed endothelium on the IVC surface at the filter implantation site and a presumed endothelial layer covering partially or totally the struts. The interface filter-IVC was covered by deposits of leucocytes and platelets. No signs of pulmonary embolism were found in all pulmonary angiograms of both groups.Conclusion. The modified filter presented good biocompatibility, stability and absence of thrombogenicity at 12 months. It presented low tendency to tilting and extrusion of struts. The long-term histopathologic alterations in vena caval wall were minimal and the appearance of the studied filters in the IVC was similar to stents placed in the arterial system.

Architecture of the caudal vena cava wall of the dog at the level of the liver caudate lobe

The vascular segment of the caudal vena cava of the dog at the level of the caudate lobe was shown to be intimately related to hepatic tissue through the hepatic capsule and parenchyma. The tunica adventitia of the caudal vena cava was formed mainly by smooth muscle cells with collagen and elastic fibers arranged in bundles. The thin tunica media of the vein was also formed by smooth muscle cells, collagen and elastic fibers arranged in bundles. The tunica intima presented an elastic sub-endothelial network. The hepatic segment of the caudal vena cava showed a myoconnective architecture and propulsive characteristics in terms of its hemodynamic pattern.

Involvement of the AT1 receptor in the venoconstriction induced by angiotensin II in both the inferior vena cava and femoral vein

Although angiotensin II-induced venoconstriction has been demonstrated in the rat vena cava and femoral vein, the angiotensin II receptor subtypes (AT1 or AT2) that mediate this phenomenon have not been precisely characterized. Therefore, the present study aimed to characterize the pharmacological receptors involved in the angiotensin II-induced constriction of rat venae cavae and femoral veins, as well as the opposing effects exerted by locally produced prostanoids and NO upon induction of these vasomotorresponses. The obtained results suggest that both AT1 and AT2 angiotensin II receptors are expressed in both veins. Angiotensin II concentration–response curves were shifted toward the right by losartan but not by PD 123319 in both the vena cava and femoral vein. Moreover, it was observed that both 10−5 Mindomethacin and 10−4 M L-NAME improve the angiotensin II responses in the vena cava and femoral vein. In conclusion, in the rat vena cava and femoral vein, angiotensin II stimulates AT1 but not AT2 to induce venoconstriction, which is blunted by vasodilator prostanoids and NO.

Double-lumen catheter in the right jugular vein induces two sub-endothelial abscesses in an unusual place, the transition between the superior vena cava and the right atrium: a case report

Endocarditis is a type of infection that is common in internal medicine wards and in haemodialysis clinics. The location that is most affected are the heart valves. Herein, we report a case of an uncommon abscess, a sub-endothelial abscess between the transition of the superior vena cava and the right atrium. There were several emboli to the lung and foot, and the agent was related to Staphylococcus aureus and a double-lumen catheter. Usually, this type of abscess is located in valves, either the tricuspid valve if related to catheters or injection drug use or the mitral valve if related to other causes. An exhaustive review was made, but we found no information about the location of this abscess and the rarity of the event motivating the report of infection.

Morphofunctional characterization of decellularized vena cava as tissue engineering scaffolds

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Implante de filtro em veia cava inferior dupla: relato de caso e revisão da literatura

Veia cava inferior dupla é uma variação anatômica rara cuja prevalência é de 0,2-3%. O implante de filtro de veia cava, quando indicado em casos com duplicidade da veia cava inferior, pode ser realizado de diferentes formas: em ambas as veias cavas; em uma delas, embolizando a anastomose entre ambas; em somente uma delas; ou por implante supra-renal. Relatamos um caso de trombose venosa profunda no pós-operatório de implante de prótese de quadril com contra-indicação para tratamento anticoagulante e cuja cavografia evidenciou duplicidade de veia cava inferior. O implante de filtro de veia cava inferior realizado em posição supra-renal mostrou-se opção adequada e segura.

Experiência preliminar com novo filtro de veia cava: resultados de 15 implantes

Este estudo apresenta resultados preliminares obtidos com um novo filtro permanente de veia cava, baseado no desenho de Greenfield, com três hastes prolongadas de um total de seis, para dar estabilidade central ao filtro na luz da veia cava. Neste artigo, relatamos sua avaliação clínica preliminar quanto à aplicabilidade, eficácia e segurança. de agosto de 2004 a dezembro de 2006, 15 filtros foram implantados em nove homens e seis mulheres, com idades variando de 38 a 79 anos (média de 57,8 anos). O acesso foi feito sempre por via transjugular. As indicações foram: trombose venosa proximal, com contra-indicação de anticoagulação em 12 pacientes; complicações hemorrágicas com anticoagulação em dois pacientes; e embolia pulmonar, apesar de anticoagulação adequada, em um paciente. Os filtros foram avaliados quanto à liberação, inclinação, mau posicionamento e perfuração de cava. No seguimento, avaliou-se trombose no local de acesso, tromboembolismo venoso recorrente, migração do filtro e trombose de cava pelo ultra-som. Nenhum paciente recebeu anticoagulantes no seguimento. O filtro foi liberado com sucesso em todos os casos sem mau posicionamento, inclinação, perfuração ou trombose de acesso. Os pacientes foram seguidos entre 3 e 23 meses (média de 11 meses). Nenhum paciente teve recorrência de tromboembolismo venoso. Não houve casos de trombose de veia cava ou migração do filtro. Óbito ocorreu em sete casos, todos relacionados com a moléstia de base. Os resultados preliminares indicam potencial eficácia e segurança do uso do novo filtro no período estudado.

Ausência parcial de veia cava inferior associada à malformação intestinal

Criança de 6 anos de idade, sexo feminino, procurou serviço médico devido a mal-formação gastrointestinal. Durante o acompanhamento médico, foi diagnosticada ausência parcial de veia cava inferior, alteração congênita rara que envolve a drenagem vascular do segmento inferior do corpo. Realizados exames de imagem, os quais contribuíram para avaliação e descrição do caso. Mantido tratamento conservador com anticoagulante oral. Paciente apresenta boa evolução após longo tempo de acompanhamento cardiovascular.

Avaliação morfométrica, realizada pelo exame ultrassonográfico, da veia porta, veia cava caudal e aorta abdominal em cães saudáveis de diferentes pesos corpóreos

The diameters and areas of portal vein, caudal vena cava and abdominal aorta are useful measurements in dogs. These values can be easily measured by ultrasonographic exam, and variations of normality can be an important indicator of hepatic or extra-hepatic alterations. This study aimed to measure the diameter and areas of portal vein, caudal vena cava and abdominal aorta in healthy dogs, with normal corporal score, divided in groups according to the body weight, and assess whether the data are influenced by animal weight. Thirty dogs were examined and divided into three groups (Group A: ≤ 10 kg Group B: from 10.1 to 20.0 kg; Group C: ≥ 20.1 kg). To measure the diameters and areas of portal vein, caudal vena cava and abdominal aorta, the animal was kept in left lateral decubitus position and the transducer was placed on the right lateral abdominal wall, at approximately the 10 th or 11 th intercostal space, in the porta hepatis region. The diameters and areas of the portal vein, caudal vena cava and abdominal aorta were significantly lower for dogs in Group A with respect to other groups and the dogs from Groups B and C had similar results with each other. The diameters and areas of the portal vein, caudal vena cava and abdominal aorta may vary with the animal size, and reference values must be specific for small, medium and large dogs.

Estrutura, ultraestrutura e morfometria da veia cava de paca (Cuniculus paca Linnaeus, 1766) criada em cativeiro

The paca (Cuniculus paca) is the second largest rodent of the Brazilian fauna. The excellent meat quality of this specie encourages the development of their commercial production. Moreover, this animal can become a viable alternative for animal experimentation although there exists scarce detailed information concerning their morphology. Therefore the purpose of this study is to describe the morphology, morphometry and ultrastructure in segments of the cranial and caudal portions of vena cava in four adult males and females of Cuniculus paca from the squad of Wild Animals Sector of Animal Science Department of FCAV-Unesp. Parts of the segments were examined by light microscopy and part by scanning electron microscopy. Thickness measures of the tunica intima and media complex and tunica adventitia of the vena cava were taken and analyzed using T test (p<0.05). In vena cava the thickness values of the intima, media and adventitia, for all animals, were significantly higher in the cranial segment. The layers of the vessel walls showed variations in structure and thickness, presumably due to an adaptation to functional demand.

Estrutura, ultraestrutura e morfometria da aorta e veia cava de paca (Cuniculus paca, Linnaeus, 1766) criada em cativeiro

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)