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Inferior Vena Cava Disorders
By: Hollie Peterson
Objectives
At the end of this presentation you will be able to:
 Describe the anatomy & physiology of the IVC
Understand...
 Largest vein of the body that drains the
LE & abdomen into the RA of the heart
 The Inferior Vena Cava is a continuatio...
Overview:
Disorders/Treatments
Anatomic Variants
Neoplastic Obstructions (Rare)
Acute Thrombosis
 Extrinsic Compressio...
 Asymptomatic
 The hepatic segment of
the IVC is absent and
the hepatic veins join and
drain directly into
the right atr...
Neoplastic Obstruction
(Rare)
Typically: Intraluminal tumors arising from renal or hepatic veins
that secondarily obstruc...
Acute Thrombosis
Obstruction of venous outflow within the deep or superficial vein
by thrombosis
Location: valve site, v...
Theory of Virchow’s Triad
 States that venous thrombus is caused by combination of:
A) Venous Stasis
 Non-movement of bl...
Theory of Virchow’s Triad
Combination of any of these can result in venous thrombosis
Extrinsic Compression
Paget-Syndrome
 Refers to axillary-subclavian vein thrombosis associated with
strenuous + repetiti...
Pulmonary Embolism (PE)
The occlusion of a pulmonary artery by a thromboembolus
o Complication of venous thrombosis
o Thi...
What is an IVC filter?
A device that traps large clots from the lower extremity
o Consist of thin metal struts that conve...
IVC Filter Placement
Aim of procedure is to “catch” any thrombi floating in the blood
stream from the LE (legs + pelvis) ...
Retrieval of IVC Filter
A: Infrarenal IVC surrounded by scar tissue (tan color) on endoluminal surface
B: Filter is beginn...
Quiz
1. is a device used to traps large clots from the lower
extremity that consists of a metal frame that converges into ...
References
 http://go.galegroup.com.libproxy.clemson.edu/ps/i.do?p=HRCA&u=clemsonu_main&id=GALE|A2092
39110&v=2.1&it=r&si...
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Inferior Vena Cava Disorders

This is a venous research presentation I gave at the Patewood branch of Greenville Hospital System.

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Inferior Vena Cava Disorders

  1. 1. Inferior Vena Cava Disorders By: Hollie Peterson
  2. 2. Objectives At the end of this presentation you will be able to:  Describe the anatomy & physiology of the IVC Understand the pathologic conditions & anatomic variants of the Inferior Vena Cava Identify and discuss the Theory of Virchow’s Triad Define Inferior Vena Cava filter placement and uses
  3. 3.  Largest vein of the body that drains the LE & abdomen into the RA of the heart  The Inferior Vena Cava is a continuation of the common femoral vein (CFV)  Right & left CFV join to form IVC  Travels cephalad and terminates in the RA What is the Inferior Vena Cava?
  4. 4. Overview: Disorders/Treatments Anatomic Variants Neoplastic Obstructions (Rare) Acute Thrombosis  Extrinsic Compression  Theory of Virchow’s Triad  Pulmonary Embolism (PE) IVC Filter Placement
  5. 5.  Asymptomatic  The hepatic segment of the IVC is absent and the hepatic veins join and drain directly into the right atrium. Absent Intrahepatic IVC “Azygos Continuation” Left sided IVC  Paired IVC (duplication terminates at level of renal veins)  IVC on left side only (can terminate in left renal vein or extend cranially to drain into azygos vein in the chest) Anatomic Variants “Azygos Vein”: a large vein on the right side at the back of the thorax, draining into the superior vena cava.
  6. 6. Neoplastic Obstruction (Rare) Typically: Intraluminal tumors arising from renal or hepatic veins that secondarily obstruct or thrombose the IVC  Leimyosarcoma:  Rare intraluminal tumor that develops in the middle portion of the IVC  Primarily found in women  Discovered by German doctor in 1871  By 2006, <300 cases have been reported  Unknown cause  Asymptomatic (due to deep origin)  Vague Symptoms: abdominal pain, palpable mass, LE edema  Treatment: surgical removal of tumor & surrounding tissue. (Resection necessary)
  7. 7. Acute Thrombosis Obstruction of venous outflow within the deep or superficial vein by thrombosis Location: valve site, venous confluences Patient history: Previous DVT, Post-op, Persistent swelling ( usually unilateral ), clotting issues, localized pain/burning/itching, symptoms of PE  Causes: Virchow’s Triad, Varicose veins, Extrinsic Compression  Once thrombosis forms it: 1) Stabilizes (adheres to vessel wall) 2) Propagate (“growth of thrombus” in size) 3) Shed/Embolize (portion of thrombus breaks free & travels)
  8. 8. Theory of Virchow’s Triad  States that venous thrombus is caused by combination of: A) Venous Stasis  Non-movement of blood that leads to coagulation  Platelets become trapped behind valve cusp (recirculation)  Results from: obesity, post-op, immobility, etc. B) Hypercoaguble State  Increased activation of coagulation factors along with a decrease of coagulation inhibitors  Results from: cancer, pregnancy, etc. C) Endothelial Damage (Intimal Injury)  Results from: Surgery, trauma, central catheterization, IV drug abuse
  9. 9. Theory of Virchow’s Triad Combination of any of these can result in venous thrombosis
  10. 10. Extrinsic Compression Paget-Syndrome  Refers to axillary-subclavian vein thrombosis associated with strenuous + repetitive activity of upper extremity  Unusual cause of venous compression & intimal injury leading to thrombosis May-Thurner Syndrome (MTS)  Caused when the left iliac vein is compressed by the right iliac artery, which increases risk of Deep Vein Thrombosis (DVT) in left extremity
  11. 11. Pulmonary Embolism (PE) The occlusion of a pulmonary artery by a thromboembolus o Complication of venous thrombosis o Third most common cause of death in the United States  Top “unexpected death” in ANY age group o 1/3 patients are asmptomatic o Source is typically iliofemoral thrombus (LE deep veins involved 90% of time) IVC RA RV Pulmonary Artery
  12. 12. What is an IVC filter? A device that traps large clots from the lower extremity o Consist of thin metal struts that converge together to form a cone shape
  13. 13. IVC Filter Placement Aim of procedure is to “catch” any thrombi floating in the blood stream from the LE (legs + pelvis) that occasionally travel to the lungs causing a PE Who gets one?  Patients with a history/ at risk for developing blood clots in the legs  Patients unable to tolerate blood thinning agents  Inserted via catheter (using the CFV, EIV, or jugular access)  Patient under local anesthesia  Hospital stay: 12-24 hours (back to normal activity in 1-2 days)
  14. 14. Retrieval of IVC Filter A: Infrarenal IVC surrounded by scar tissue (tan color) on endoluminal surface B: Filter is beginning to be sheathed C: Filter is sheathed from top to bottom in preparation for removal D: Laser sheath is activated and removal occurs by detaching filter from wall of IVC
  15. 15. Quiz 1. is a device used to traps large clots from the lower extremity that consists of a metal frame that converges into a cone shape. 1. The Theory of Virchow’s Triad states that a combination of stasis, hypercoaguable state, and endothelial damage leads to . 2. is considered to be the most common cause of venous thrombosis. IVC filter thrombosis Pulmonary Embolism (PE)
  16. 16. References  http://go.galegroup.com.libproxy.clemson.edu/ps/i.do?p=HRCA&u=clemsonu_main&id=GALE|A2092 39110&v=2.1&it=r&sid=summon&userGroup=clemsonu_main&authCount=1  http://www.sciencedirect.com.libproxy.clemson.edu/science/article/pii/S1936879813006699  http://search.credoreference.com.libproxy.clemson.edu/content/entry/ehsdorland/may_thurner_syndrom e  http://www.surgicalcasereports.com/content/1/1/35  Kupinski, Ann Marie. "The Inferior Vena Cava and Iliac Veins." Diagnostic Medical Sonography. Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2013. 323-330. Print.  Size, Gail P., and Laurie Lozanski. Inside Ultrasound Vascular Reference Guide. Inside Ultrasound, Incorporated, 2013. 19, 67, 76-77, 209,. Print.

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This is a venous research presentation I gave at the Patewood branch of Greenville Hospital System.

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