Reversal of cardiopulmonary exercise intolerance in patients with post-thrombotic obstruction of the inferior vena cava

Abstract

Background: It is unclear whether cardiopulmonary exercise intolerance in patients with chronic obstruction of the inferior vena cava (IVC) is reversible following endovascular IVC reconstruction. Methods: In 17 patients (mean age 45 ± 15 years, 71% men) with post-thrombotic syndrome due to IVC obstruction and preserved left ventricular ejection fraction (mean 58 ± 3%), we performed cardiopulmonary exercise testing before and 3 months after IVC reconstruction (mean 4.1 ± 1.5 implanted stents). The median time from latest episode of deep vein thrombosis to intervention was 150 (interquartile range 102-820) days. Results: At baseline, 12 (71%) patients reported New York Heart Association (NYHA) class II or III symptoms, 76% did not achieve >85% of predicted oxygen uptake at peak exercise (mean 61.8 ± 13.7%). After IVC reconstruction, the following changes were observed at anaerobic threshold: work rate increased by 14.6 W, 95% CI (− 0.7; 30.0), oxygen uptake increased by 1.8 ml/kg, 95%CI (0.3; 3.3). Oxygen pulse increased by 1.95 ml per beat, 95%CI (1.12; 2.78), corresponding to a mean relative increase of 22.5%, 95%CI (12.4; 32.7) (p < 0.001). The following changes were observed at peak exercise: work rate increased by 48.1 W, 95%CI (27.8; 68.4), oxygen uptake increased by 6.4 ml/kg, 95%CI (3.8; 9.1). Oxygen pulse increased by 2.68 ml per beat, 95%CI (1.60; 3.76), corresponding to a mean relative increase of 29.4%, 95%CI (17.7; 41.2) (p < 0.001). At follow-up, 5 (29%) patients remained in NYHA class II. Conclusions: In patients with chronic IVC obstruction, cardiopulmonary exercise intolerance as a result of impaired cardiac filling is at least partially reversible following endovascular IVC reconstruction. Study registration: URL: https://clinicaltrials.gov. Unique identifier: NCT02433054.

Changes in perfusion angiography after IVC filter placement and retrieval

“…Incidence of IVC stenosis and/or thrombosis is estimated at 2.8% of filter placements, occasionally requiring extensive iliocaval reconstruction to treat the resulting lower extremity swelling, pain, exercise intolerance, or phlegmasia. [ 14 , 17 , 18 ]…”

“…Incidence of IVC stenosis and/or thrombosis is estimated at 2.8% of filter placements, occasionally requiring extensive iliocaval reconstruction to treat the resulting lower extremity swelling, pain, exercise intolerance, or phlegmasia. [14,17,18] IVC filters are hypothesized to induce changes in flow dynamics, with the creation of turbulent flow, recirculation zones, and high sheer force, leading to vascular remodeling and thrombus formation. [19,20] In vitro and computational studies have examined the hemodynamic properties of IVC filters to elucidate these effects, however, hemodynamic changes caused by IVC filters are not well documented in vivo.…”

Exercise Intolerance That Resolved After venous Stenting of the Inferior Vena Cava

“…Endovenous recanalization, followed by venous stenting, could relieve exercise intolerance in IVC-obstruction. 6 Cardiorespiratory functioning tests can be used to evaluate exercise intolerance in IVC-obstruction and its response to treatment. 7 However, the impact of treatment on hemodynamics and quality of life (QoL) is unclear.…”