Fatal Pulmonary Thromboembolism due to Inferior Vena Cava Thrombosis

Hanterdsith, Boonsak

doi:10.3400/avd.cr.10.00021

Cited by 4 publications

(5 citation statements)

References 9 publications

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“…In the present study, the patients with IVCT had a higher PE rate risk than patients with non-IVCT, but this did not reach statistical significance (62.5 vs. 54.2%, p = 0.329). Of note, the occurrence of PE mainly located in the proximal pulmonary arteries in IVCT patients was a higher rate risk than that in non-IVCT patients (32.0 vs. 16.3%, p = 0.067), implying that a non-negligible number of patients with IVCT will be more likely to encounter a potential risk of pulmonary hypertension and even life-threatening conditions, which was consistent with the prior findings that the mortality associated with IVCT is twice that of LEDVT alone ( 9 ); therefore, early detection of IVCT is of paramount importance because thrombi in the IVC can be floating and, if dislodged, can result in fatal PE ( 8 ). However, the morbidity reported in the present study may be influenced by some confounding variables linked to proximal or bilateral LEDVT, which are known to occur more frequently in cases of proximal or bilateral LEDVT ( 5 , 8 ).…”

Section: Discussionsupporting

confidence: 89%

“…Of note, compared with filter-associated IVCT, nonfilter-associated IVCT may be more prone to lead to life-threatening conditions, with twice the mortality rate than thrombosis confined in the filters ( 2 , 6 – 8 ). The genesis is likely to lurk in a higher incidence of fatal pulmonary embolism (PE), which serves as a severe consequence of clot migration ( 9 ).…”

Section: Introductionmentioning

confidence: 99%

“…Hence, screening all suspected or inapparent patients with LEDVT routinely with CT and/or MRI for the diagnosis of IVCT can be tedious, low-yield, and cost-ineffective ( 1 – 3 ). However, considering the potential severe risks ( 7 , 9 , 11 ), it seems to be more of a help than a hindrance to screen in selected LEDVT patients with high-risk factors for IVCT. However, the risk factors for IVCT have not been well elucidated.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors and a predictive model for nonfilter-associated inferior vena cava thrombosis in patients with lower extremity deep vein thrombosis

Gong

Kong

Shi

et al. 2023

Front. Cardiovasc. Med.

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ObjectiveNonfilter-associated inferior vena cava thrombosis (IVCT) is an under-recognized but severe state of venous thromboembolism. The aims of this study were to investigate risk factors and develop a prediction model based on clinical data and imaging findings to evaluate the probability of IVCT in patients with lower extremity deep vein thrombosis (LEDVT).MethodsA single-center retrospective cohort study was conducted. We analyzed the clinical data and multimodal imaging findings of consecutive patients with confirmed LEDVT between February 2016 and January 2022. The demographics, presentation of LEDVT, laboratory examination, thrombus characteristics, comorbidities and risk factors for LEDVT, and imaging findings were analyzed using an independent t-test, Chi-square test, Fisher's exact test, and regression analysis to determine the univariable and multivariable associations and to establish a predictive model to assess the probability of IVCT.ResultsA total of 267 eligible patients were included, of whom 40 were in the IVCT group and 227 were in the non-IVCT group. The incidence of nonfilter-associated IVCT was 15.0% (40/267). Age < 63.5 years [odds ratio (OR) 2.54; 95% confidence interval (CI), 1.10–5.85, p = 0.029], male sex (OR 2.82; 95% CI, 1.19–6.72, p = 0.019), proximal DVT (OR 8.21; 95% CI, 1.01–66.76, p = 0.049), bilateral DVT (OR 7.30; 95% CI, 3.28–16.21, p < 0.001), and D-dimer >4.72 μg/ml (OR 4.64; 95% CI, 1.80–11.72, p = 0.001) were risk factors for IVCT's occurrence. Then, we established a prediction model based on these risk factors. The diagnostic efficiency [area under the curve (AUC) of receiver operating characteristic (ROC) curve was 0.858] for predicting IVCT was superior to that of isolated risk factors, including age < 63.5 years (AUC of ROC curve was 0.624) or D-dimer >4.72 μg/ml (AUC of ROC curve was 0.656).ConclusionAge < 63.5 years, male sex, proximal LEDVT, bilateral LEDVT and D-dimer >4.72 μg/ml were risk factors. The diagnostic efficiency of the predictive model for predicting IVCT was superior to that of a single risk factor alone. It may be used for predicting the probability of nonfilter-associated IVCT in patients with LEDVT.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk factors and a predictive model for nonfilter-associated inferior vena cava thrombosis in patients with lower extremity deep vein thrombosis

Gong

Kong

Shi

et al. 2023

Front. Cardiovasc. Med.

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“…Unexpectedly, however, these results were reversed in patients with bilateral LEDVT. IVCT has been reported to result in fatal PE; the patient in the report died on the way to the emergency room 25 .…”

Section: Discussionmentioning

confidence: 93%

Impact of inferior vena cava thrombosis on the incidence of pulmonary embolism in patients with lower extremity deep vein thrombosis

Zhang,

Meng,

et al. 2024

Preprint

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Inferior vena cava thrombosis (IVCT) is a special form of venous thromboembolism. Lower extremity deep vein thrombosis (LEDVT) is associated with an increased incidence of pulmonary embolism (PE), but the association between concomitant IVCT and PE in patients with LEDVT has not been reported. We conducted a retrospective analysis of clinical data from patients confirmed with LEDVT at the First Affiliated Hospital of Xi’an Jiaotong University. Predictive variables of PE were selected using LASSO regression, and independent risk factors were identified through multivariable logistic regression. Of the 2929 patients, 40.9% had PE and 12.8% had IVCT. Multivariable logistic regression suggested that IVCT (OR 1.42, 95% CI 1.13–1.79) was an independent risk factor for PE. Subgroup analysis showed that IVCT was associated with increased odds of PE in patients with left LEDVT (OR 2.00, 95% CI 1.50–2.67), right LEDVT (OR 2.05, 95% CI 1.20–3.50), distal LEDVT (OR 5.15, 95% CI 1.31–20.22), and proximal LEDVT (OR 1.48, 95% CI 1.19–1.86). Concomitant IVCT significantly increased the incidence of PE in patients with LEDVT. There was no difference in PE severity or risk stratification between patients with and without IVCT. These finding could contribute to further improve the understanding of IVCT among clinicians, and optimize monitoring and management strategies of patients with LEDVT.

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“…HCCs with IVC and/or RA invasion are generally presumed to have poor prognoses, with expected survival of <3 months, while those with PVT have even poorer prognoses. 14 , 18 In addition, given the possibility of sudden death due to circulatory failure, 19 physicians have been highly cautious about performing surgeries that may burden the circulatory system. In HCCs with IVC thrombosis, total hepatic vascular exclusion is required to block IVC blood flow and perform thrombectomy.…”

Section: Surgical Resectionmentioning

confidence: 99%

Efficacy of Local Treatments for Hepatocellular Carcinoma Involving the Inferior Vena Cava and/or Right Atrium

Lee

Rim

2020

JHC

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Major vessel invasion is frequently observed in locally advanced hepatocellular carcinoma (HCC). The most commonly involved major vessel is the portal vein; however, approximately 4% of patients with HCC have inferior vena cava (IVC) and/or right atrium (RA) invasion. Although these conditions have dismal prognoses, local treatments have not been regularly administered because they may affect systemic circulation. Owing to recent technological advances, various local treatments including surgery and external radiotherapy have increasingly been performed in these patients. Since irradiating tumorous lesions in the liver while preserving normal tissues is possible and major vessels are relatively resistant to radiation, external radiotherapy has been a feasible palliative modality for treating vessel-invasive HCC. In addition, systemic fatal complications that were initially a cause of concern have become rare after radiotherapy. While invasive procedures such as extracorporeal circulation or hepatic vascular exclusion may be required, pioneering surgeons have performed surgical resections in selected patients and have obtained promising results. Surgery has shown the best survival outcomes compared to other treatment options including radiotherapy, but the possibility of perioperative morbidity should be considered. In addition, a combination of local treatment and novel systemic agents, which demonstrated better survival and response rates than sorafenib, is expected to maximize therapeutic effects. In this review, we have discussed the most recent treatments for HCC with IVC and/or RA involvement and have provided information intended to guide therapeutic decisions and facilitate future research.

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Fatal Pulmonary Thromboembolism due to Inferior Vena Cava Thrombosis

Cited by 4 publications

References 9 publications

Risk factors and a predictive model for nonfilter-associated inferior vena cava thrombosis in patients with lower extremity deep vein thrombosis

Risk factors and a predictive model for nonfilter-associated inferior vena cava thrombosis in patients with lower extremity deep vein thrombosis

Impact of inferior vena cava thrombosis on the incidence of pulmonary embolism in patients with lower extremity deep vein thrombosis

Efficacy of Local Treatments for Hepatocellular Carcinoma Involving the Inferior Vena Cava and/or Right Atrium

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