Diagnostic significance of phlebotonometry for evaluation of indications for angioplasty and stenting of compressed iliac veins in patients with varicocele and pelvic congestion disease

The aim of the study was to assess the information content of the phlebotonometry method when determining indications for endovascular x-ray angioplasty and stenting of the iliac veins during their arterial compression.Materials and methods. Thirty-six patients with bilateral varicocele and varicose veins of the pelvic organs were examined. The examination included assessment of the condition using the international index of erectile function, ultrasound examination of the scrotum organs with color Doppler mapping, transrectal ultrasound of the prostate and veins of the prostatic plexus, magnetic resonance imaging of the inferior vena cava and pelvic vessels, venography of the renal caval and ileocaval segments, phlebotonometry of these segments in a calm state and during the Valsalva test.Results. Pressure gradient between left and right external iliac veins >2 mm Hg in a calm state was detected in 4 (11.1 %) patients, >3 mm Hg with Valsalva test – in 9 (25.0 %) patients, between the left and right common iliac veins >2 mm Hg in a calm state – in 3 (8.3 %) patients, >3 mm Hg with a Valsalva test, in 15 (41.7 %) patients. At the same time, in 20 (55.6 %) of 36 cases, phlebotonometry data were of a contradictory logic nature, which we attribute to the insufficient sensitivity of this research method. Our data suggest that collateral circulation leads not only to varicose veins of the pelvic organs, but also to equalization of pressure in the ipsilateral segments of the iliac veins due to the law of communicating vessels.Conclusion. Phlebotonometry in the diagnosis of iliac venous compression can only be used as an additional research method. Indications for angioplasty and stenting of the iliac veins during compression should be determined on the basis of clinical data, the severity of varicose veins of the pelvic organs according to the results of transrectal ultrasound examination, the results of magnetic resonance imaging of the inferior vena cava and pelvic vessels (or computed tomography of the abdominal organs with contrast or multispiral computed tomography of the abdominal cavity organs), radiopaque phlebography and intravascular ultrasound.The author declares no conflict of interest.All patients gave written informed consent to participate in the study.

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May-Thurner syndrome and varicose veins of the pelvic organs in men

Andrology and Genital Surgery ◽

10.17650/2070-9781-2018-19-4-28-38 ◽

2018 ◽

Vol 19 (4) ◽

pp. 28-38

Author(s):

A. A. Kapto

Keyword(s):

Varicose Veins ◽

Prostate Gland ◽

Maximum Diameter ◽

Study Objective ◽

X Ray ◽

Compression Syndrome ◽

Pelvic Organs ◽

Venous Compression ◽

Left And Right ◽

Angioplasty And Stenting

The study objectiveis to study the methods of diagnosis and treatment of iliac venous compression in men with urological and andrological pathology and varicose veins of the pelvic organs.Materials and methods. From 2015 to 2018, 110 patients with bilateral varicocele, varicose veins of the pelvic organs and May–Thurner syndrome in age from 17 to 69 years (mean 33.2 years) were examined. Ultrasound echography of the scrotum organs and vessels of the penis, including transrectal and Doppler mode, magnetic resonance phlebography, dynamic pharmacocavernosography were used for the examination.Results.The presence of bilateral varicocele in all patients was verified. Aorto-mesenteric compression in combination with iliac venous compression was detected in 36 (32.7 %) patients. X-ray surgical treatment of ileal venous compression syndrome was performed in 26 patients. After 3 months in all cases there was a decrease in the maximum diameter of the veins of the prostate gland. In 13 patients with isolated ileal compression (without combination with arterial aorto-mesenteric forceps), by 3 months after surgery, a reduction in varicocele was observed: in all cases the diameter of the left and right testicular veins lying and without tension was less than 2 mm.Conclusion.Angioplasty and stenting of the iliac veins in arterio-venous conflicts is a highly effective method of treating patients with varicose veins of the pelvic organs in combination with varicocele.

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Use of Cardiac Magnetic Resonance Imaging Based Measurements of Inferior Vena Cava Cross-Sectional Area in the Diagnosis of Pericardial Constriction

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2014.12.007 ◽

2015 ◽

Vol 66 (3) ◽

pp. 231-237 ◽

Cited By ~ 2

Author(s):

Kate Hanneman ◽

Paaladinesh Thavendiranathan ◽

Elsie T. Nguyen ◽

Hadas Moshonov ◽

Rachel Wald ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Cardiac Magnetic Resonance ◽

Inferior Vena ◽

Vena Cava ◽

Area Ratio ◽

Cross Sectional Area ◽

Sectional Area ◽

Resonance Imaging ◽

Cross Sectional ◽

Aortic Area

Purpose To evaluate the value of cardiac magnetic resonance imaging (MRI)–based measurements of inferior vena cava (IVC) cross-sectional area in the diagnosis of pericardial constriction. Methods Patients who had undergone cardiac MRI for evaluation of clinically suspected pericardial constriction were identified retrospectively. The diagnosis of pericardial constriction was established by clinical history, echocardiography, cardiac catheterization, intraoperative findings, and/or histopathology. Cross-sectional areas of the suprahepatic IVC and descending aorta were measured on a single axial steady-state free-precession (SSFP) image at the level of the esophageal hiatus in end-systole. Logistic regression and receiver-operating curve (ROC) analyses were performed. Results Thirty-six patients were included; 50% (n = 18) had pericardial constriction. Mean age was 53.9 ± 15.3 years, and 72% (n = 26) were male. IVC area, ratio of IVC to aortic area, pericardial thickness, and presence of respirophasic septal shift were all significantly different between patients with constriction and those without ( P < .001 for all). IVC to aortic area ratio had the highest odds ratio for the prediction of constriction (1070, 95% confidence interval [8.0-143051], P = .005). ROC analysis illustrated that IVC to aortic area ratio discriminated between those with and without constriction with an area under the curve of 0.96 (95% confidence interval [0.91-1.00]). Conclusions In patients referred for cardiac MRI assessment of suspected pericardial constriction, measurement of suprahepatic IVC cross-sectional area may be useful in confirming the diagnosis of constriction when used in combination with other imaging findings, including pericardial thickness and respirophasic septal shift.

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Frequency of metastatic tumors in the heart

Vojnosanitetski pregled ◽

10.2298/vsp0512915r ◽

2005 ◽

Vol 62 (12) ◽

pp. 915-920 ◽

Cited By ~ 8

Author(s):

Sasa Rafajlovski ◽

Vujadin Tatic ◽

Srbislav Ilic ◽

Vladimir Kanjuh

Keyword(s):

Magnetic Resonance Imaging ◽

Pericardial Effusion ◽

Inferior Vena ◽

Vena Cava ◽

Cytological Analysis ◽

Resonance Imaging ◽

Metastatic Tumors ◽

Primary Tumors ◽

The Right ◽

Primary Localization

Introduction. Secondary or metastatic tumors in the heart occur more frequently than primary ones, and, according to the published series, their frequency found in autopsic material ranges from 1.6% to 20.6%. Metastatic tumors in the heart are rarely clinically symptomatic, and, therefore, they are rarely diagnosed within the lifetime. They are mostly diagnosed at autopsy. The aim of this study was to analyze the frequency of metastatic tumors of the heart, their primary localization, as well as the localization of the metastases found in the autopsic material within the period 1972?2004. Metods. During the autopsy of the patients died of metastatic tumors, we microscopically and macroscopically analyzed all the organs and tissues to determine the metastases of primary tumors in other organs, especially in the heart and pericardium. Results. Within the period from 1972?2004, 11 403 autopsies were performed. In 2 928 (25.6%) out of 11 403 autopsies, the presence of malignant tumor was diagnosed, and in 79 (2.7%) of these cases, metastasis of the heart was found out. Only in 5 of the cases, the presence of metastasis in the heart was diagnosed during the lifetime. The most frequent metastases in the heart were caused by pulmonary carcinoma (18 cases), leukemia and malignant lymphoma (8 cases, each), then pancreatic and breast carcinoma, while the metastases of other carcinomas were rather rare. In 40 (60.76%) cases, the metastasis was localized in the myocardium, but more often in the left ventricle, in 24 (30.38%) cases in the pericardium, in 4 cases in the epicardium and in the 3 of them in the mitral and tricuspid valve. Only in one case of renal carcionoma, metastasis was found in the right atrium and it occurred by spreading (dissemination) through the lumen of the inferior vena cava. Conclusion. Metastatic tumors of the heart are rather rare, and rarely clinically symptomatic, and, thus, rarely diagnosed during life. The methods of choice for the diagnosis of the metastasis in the heart are echocardiography, computerized tomography, magnetic resonance imaging, cytological analysis of the pericardial effusion and biopsy. The treatment includes surgery, chemotherapy and radiotherapy.

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Respiratory changes in biometry of suprarenal inferior vena cava in patients with varicose veins of lower extremities

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520974135 ◽

2020 ◽

pp. 026835552097413

Author(s):

Yury Rusinovich ◽

Volha Rusinovich

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Venous Return ◽

Varicose Veins ◽

Vena Cava ◽

Lower Extremities ◽

P Value ◽

Venous Disease ◽

Venous Compliance ◽

Collapsibility Index

Aim This study examines respiratory biometry of inferior vena cava in patients with varicose veins of lower extremities. Material and Methods We performed retrospective analysis of clinical and ultrasound data of 67 patients with primary varicose veins. Results The largest expiratory (mean 16.2 mm, p-value 0.09) and inspiratory (mean 8.2 mm, p-value 0.02) inferior vena cava diameters were in C3 Clinical Etiological Anatomical Pathophysiological clinical class; the smallest expiratory diameters (mean 13.1 mm, p-value 0.5) were in C6 class; the smallest inspiratory diameters (mean 4.6 mm, intercept) were in C2 class. C2 class was associated with highest inferior vena cava collapsibility index (mean 68.2%, intercept); C6 class was associated with lowest collapsibility index (mean 48.3%, p-value 0.04). Recurrent varices in comparison with previously untreated were associated with smaller inspiratory diameters of inferior vena cava (mean 4.4 mm, p-value 0.005), smaller expiratory diameters (mean 13.4 mm, p-value 0.06) and higher collapsibility index (mean 68.5%, p-value 0.005). Patients with recurrent and bilateral varicose veins had identical respiratory biometry of inferior vena cava. Older age was associated with smaller inferior vena cava diameters (p-value <0.01). Conclusion Clinical presentation of varicose veins is associated with different respiratory biometry of suprarenal inferior vena cava. C6 clinical class in comparison with C2 clinical class is associated with lower central venous compliance possible due to the narrowing of inferior vena cava. Smaller inferior vena cava diameters and higher collapsibility index in recurrent subgroup in comparison with previously untreated can be a sign of the significantly altered pressure gradient between the systemic capillaries and the right heart and impaired peripheral venous return. Narrowing of inferior vena cava with age can be a sign of more profound changes in systemic venous return with age in patients with varicose veins in comparison to those without chronic venous disease.

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Role of angiotensin and adrenoceptors in hemodynamic response to aortic cross-clamping

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.1993.264.1.h14 ◽

1993 ◽

Vol 264 (1) ◽

pp. H14-H20

Author(s):

S. Gelman ◽

S. E. Curtis ◽

W. E. Bradley ◽

C. T. Henderson ◽

D. A. Parks ◽

...

Keyword(s):

Inferior Vena Cava ◽

Vascular Resistance ◽

Inferior Vena ◽

Enzyme Inhibitor ◽

Vena Cava ◽

Alpha Adrenoceptors ◽

Beta Adrenoceptor ◽

Adrenergic Antagonist ◽

Left And Right

An earlier study has shown that angiotensin and catecholamines were responsible for the vasoconstriction observed in the isolated hindlimb preparation during aortic cross-clamping. That study also demonstrated that when vasoconstriction was blocked with an alpha-adrenergic antagonist, phenoxybenzamine, vasodilation was elicited by aortic cross-clamping. The present study tested the hypothesis that this vasodilation was mediated via beta-adrenergic receptors. Eighteen dogs had their hindlimb denervated, vascularly isolated, and pump perfused with blood drained from the inferior vena cava, after passing through a gas-exchanging membrane where oxygen and carbon dioxide tensions were normalized. Left and right thoracotomies were performed, and the aorta and inferior vena cava were cross-clamped. The cross-clamping was associated with 29-37% increase in limb vascular resistance in control dogs (n = 6), in animals pretreated with propranolol (2 mg/kg, n = 6), and in dogs pretreated with a combination of phenoxybenzamine (3 mg/kg) and propranolol (2 mg/kg, n = 6). In animals pretreated with a combination of phenoxybenzamine, propranolol, and enalaprilat (2 mg/kg, n = 6), an angiotensin-converting enzyme inhibitor, limb vascular resistance did not change. This study has confirmed that aortic cross-clamping is associated with vasoconstriction induced by angiotensin and activation of alpha-adrenoceptors and has further demonstrated that vasodilation is attributable to beta-adrenoceptor activation.

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