Identificação pela ultrassonografia vascular da compressão da veia ilíaca comum esquerda em mulheres assintomáticas: ortostatismo pode influenciar o diagnóstico?

Engelhorn, Ana Luiza; Lima, Lucas de Brito; Werka, Maria Julia Saggiorato; Engelhorn, Anna Victoria Valiente; Bombardelli, Dirceu Augusto Rüdiger; Silva, Lucas Daniel Oliveira da; Barbosa, Giovanna Silva; Engelhorn, Carlos Alberto

doi:10.1590/1677-5449.200188

Cited by 3 publications

(4 citation statements)

References 19 publications

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“…Furthermore, the spermatic vein in patients with (suspected) varicocele increased in diameter in upright relative to supine position [19][20][21]. The common iliac vein diameter increased in R-TB [22] and upright position [23,24]. For the right hepatic vein and portal vein dimensions, no correlation was found between supine and TB positions [26].…”

Section: Abdomenmentioning

confidence: 93%

“…In the abdominal region, US was the most frequently reported imaging modality in different body postures and positions with 13 out of 19 articles [15][16][17][18][19][20][21][22][23][24][25][26][27]. Of these thirteen studies, the majority focused on the inferior vena cava (IVC) diameter that increased when going from supine to prone position by approximately 0.2 cm [15] and increased further with 0.2 cm from prone to standing position [27].…”

Section: Abdomenmentioning

confidence: 99%

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Position- and posture-dependent vascular imaging—a scoping review

van Zandwijk,

Simmering,

Schuurmann

et al. 2023

Eur Radiol

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Objectives Position- and posture-dependent deformation of the vascular system is a relatively unexplored field. The goal of this scoping review was to create an overview of existing vascular imaging modalities in different body positions and postures and address the subsequent changes in vascular anatomy. Methods Scopus, Medline, and Cochrane were searched for literature published between January 1, 2000, and June 30, 2022, incorporating the following categories: image modality, anatomy, orientation, and outcomes. Results Out of 2446 screened articles, we included 108. The majority of papers used ultrasound (US, n = 74) in different body positions and postures with diameter and cross-sectional area (CSA) as outcome measures. Magnetic resonance imaging (n = 22) and computed tomography (n = 8) were less frequently used but allowed for investigation of other geometrical measures such as vessel curvature and length. The venous system proved more sensitive to postural changes than the arterial system, which was seen as increasing diameters of veins below the level of the heart when going from supine to prone to standing positions, and vice versa. Conclusions The influence of body positions and postures on vasculature was predominantly explored with US for vessel diameter and CSA. Posture-induced deformation and additional geometrical features that may be of interest for the (endovascular) treatment of vascular pathologies have been limitedly reported, such as length and curvature of an atherosclerotic popliteal artery during bending of the knee after stent placement. The most important clinical implications of positional changes are found in diagnosis, surgical planning, and follow-up after stent placement. Clinical relevance statement This scoping review presents the current state and opportunities of position- and posture-dependent imaging of vascular structures using various imaging modalities that are relevant in the fields of clinical diagnosis, surgical planning, and follow-up after stent placement. Key Points • The influence of body positions and postures on the vasculature was predominantly investigated with US for vessel diameter and cross-sectional area. • Research into geometrical deformation, such as vessel length and curvature adaptation, that may be of interest for the (endovascular) treatment of vascular pathologies is limited in different positions and postures. • The most important clinical implications of postural changes are found in diagnosis, surgical planning, and follow-up after stent placement.

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Section: Abdomenmentioning

confidence: 93%

Section: Abdomenmentioning

confidence: 99%

Position- and posture-dependent vascular imaging—a scoping review

van Zandwijk,

Simmering,

Schuurmann

et al. 2023

Eur Radiol

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“…To elucidate the mechanism by which IVCS predisposes patients to venous thrombosis, several studies have investigated the effect of IVCS on iliac vein hemodynamics. Ultrasound studies have demonstrated that anatomical compression of the LCIV increases post-stenotic blood velocities by as much as 3-8x (Labropoulos et al, 2007;Oğuzkurt et al, 2007;Cheng et al, 2017;Engelhorn et al, 2021). Computational fluid dynamics studies have further demonstrated that IVCS leads to increased blood velocities, wall shear stresses, and pressure gradients in the stenosed vessel (Wang et al, 2022;Assi et al, 2023;Li et al, 2023).…”

Section: Introductionmentioning

confidence: 99%

A comparative study of altered hemodynamics in iliac vein compression syndrome

Assi,

Lynch,

Ricker

et al. 2024

Front. Bioeng. Biotechnol.

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Introduction: Iliac vein compression syndrome (IVCS) is present in over 20% of the population and is associated with left leg pain, swelling, and thrombosis. IVCS symptoms are thought to be induced by altered pelvic hemodynamics, however, there currently exists a knowledge gap on the hemodynamic differences between IVCS and healthy patients. To elucidate those differences, we carried out a patient-specific, computational modeling comparative study.Methods: Computed tomography and ultrasound velocity and area data were used to build and validate computational models for a cohort of IVCS (N = 4, Subject group) and control (N = 4, Control group) patients. Flow, cross-sectional area, and shear rate were compared between the right common iliac vein (RCIV) and left common iliac vein (LCIV) for each group and between the Subject and Control groups for the same vessel.Results: For the IVCS patients, LCIV mean shear rate was higher than RCIV mean shear rate (550 ± 103 s−1 vs. 113 ± 48 s−1, p = 0.0009). Furthermore, LCIV mean shear rate was higher in the Subject group than in the Control group (550 ± 103 s−1 vs. 75 ± 37 s−1, p = 0.0001). Lastly, the LCIV/RCIV shear rate ratio was 4.6 times greater in the Subject group than in the Control group (6.56 ± 0.9 vs. 1.43 ± 0.6, p = 0.00008).Discussion: Our analyses revealed that IVCS patients have elevated shear rates which may explain a higher thrombosis risk and suggest that their thrombus initiation process may share aspects of arterial thrombosis. We have identified hemodynamic metrics that revealed profound differences between IVCS patients and Controls, and between RCIV and LCIV in the IVCS patients. Based on these metrics, we propose that non-invasive measurement of shear rate may aid with stratification of patients with moderate compression in which treatment is highly variable. More investigation is needed to assess the prognostic value of shear rate and shear rate ratio as clinical metrics and to understand the mechanisms of thrombus formation in IVCS patients.

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“…Echo-Doppler velocimetric parameters of a mature AVF are vein diameter greater than 6 mm, fistula flow greater than 600 mL/min, and vein depth in relation to the dermal surface of less than 6 mm. 4,8 AVF dysfunctions can be stenotic (thrombosis or hemodynamically significant stenosis) or non-stenotic (steal syndrome, pseudoaneurysm, hematoma, or infection). 3 CVC is an alternative access, preferably tunneled, and it is acceptable to use non-tunneled CVC for up to 2 weeks.…”

Section: Introductionmentioning

confidence: 99%

Assessment of the performance of vascular access for hemodialysis

et al. 2022

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Background: Life and quality of life on hemodialysis depends on adequate vascular access. An autogenous arteriovenous fistula (AVF) has the best performance, while the use of a central venous catheter (CVC) may have a negative impact on fistula performance and may be associated with increased systemic inflammation. Our objective is to evaluate the performance of vascular accesses in patients undergoing a chronic hemodialysis program. Methods: This is an observational, cross-sectional, and descriptive study that included patients on chronic hemodialysis for more than 90 days. Patients with an acute systemic inflammatory disease and those with acute cardiovascular illness were excluded. Clinical data, dialysis session parameters, and serum levels of inflammatory markers were evaluated. Results: A total of 91 patients were evaluated, 59 (65%) had an AVF and 32 patients (35%) had a CVC. The adequacy rate was 67%; being 67.8% with AVF and 65.6% with CVC. Among the causes of AVF inadequacy, the ones that presented the highest prevalence ratio (PR) were non-mature AVF (PR: 4.055; 95% CI: 2.017–8.151), pseudoaneurysm (PR: 6.580; 95% CI: 3.723–11.629) and presence of hematoma (PR: 4.360; 95% CI: 2.125–8.946), p < 0.001. Among the catheter group, the causes of inadequacy with the highest PR were the presence of access thrombosis, indicating the use of thrombolytics (PR: 11.103; 95% CI: 4.746–25.977; p < 0.001) and infection (PR: 2.984; 95% CI: 1.293–6.889; p = 0.010). Median primary AVF patency was 72 months compared to 7 months of catheters ( p < 0.001). There was no significant difference in serum inflammatory markers between the two groups. Conclusions: Adequacy rates of vascular accesses did not differ between the groups, but the primary and functional patency of AVF is 10 times higher than that of catheters. Infection in dialysis catheters is associated with worse access performance. There was no association between systemic inflammation and vascular access.

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Identificação pela ultrassonografia vascular da compressão da veia ilíaca comum esquerda em mulheres assintomáticas: ortostatismo pode influenciar o diagnóstico?

Cited by 3 publications

References 19 publications

Position- and posture-dependent vascular imaging—a scoping review

Position- and posture-dependent vascular imaging—a scoping review

A comparative study of altered hemodynamics in iliac vein compression syndrome

Assessment of the performance of vascular access for hemodialysis

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