골시멘트 유출에 의한 하대정맥 혈전증의 다중검출기 전산화단층촬영 소견: 증례 보고

황윤섭,구영미,이수림 대한영상의학회 2014 대한영상의학회지 Vol.70 No.6

Although percutaneous vertebroplasty is a relatively safe procedure, cement leakage into the spinal canal and paravertebral veins may occur. Most patients with cement leakage are asymptomatic. However, it can result in spinal cord compression or pulmonary embolism. Cement-induced thrombosis in the inferior vena cava is a very rare complication of percutaneous vertebroplasty, with only few reports in the literature. We report a case of cement leakage-induced thrombosis in the inferior vena cava in a 72-year-old woman, focusing on multidetector CT findings. On contrast-enhanced CT scan, a persistent hypodense filling defect in the opacified lumen of the inferior vena cava combined with a high density cement cast adjacent to the vertebroplasty area were helpful imaging findings in making the diagnosis of bone cement leakage-induced thrombosis in the inferior vena cava. 경피적 척추성형술은 비교적 안전한 시술이지만 척추강(spinal canal), 척추체 주위 정맥(paravertebral vein)으로 골시멘트 유출을 보일 수 있다. 골시멘트 유출은 대부분 특별한 증상이 없지만 드물게 척수압박 또는 폐색전증 등의 심각한 합병증을 유발할 수 있다. 특히 시멘트 유출에 의한 하대정맥의 혈전은 드문 합병증으로 몇 개의 증례만이 보고되었다. 이에 저자들은 경피적 척추성형술을 받은 72세 여자 환자에서 polymethylmethacrylate 골시멘트 유출에 의해 발생한 하대정맥의 혈전을 경험하여 전산화단층촬영 소견을 중심으로 보고하고자 한다. 조영증강 전산화단층촬영에서 하대정맥 내의 충만결손으로 보이는 혈전과, 혈전의 근위부에 척추성형술을 시행한 척추체와 연결을 보이는 고음영의 병변이 있다면 골시멘트 유출에 의해 유발된 하대정맥의 혈전을 진단할 수 있다.

A Case of Vascular Anomaly in Swine : Infrahepatic Caudal/Inferior Vena Cava Interruption with Azygos/Hemiazygos Continuation

Park, Won Kyu,Cho, Kil Ho 영남대학교 의과대학 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

선천성 심장 기형 및 다른 여러 가지 연구를 위해 돼지가 실험동물로 많이 사용되고 있다. 선천성 심장 기형의 연구를 위해 돼지를 이용하여 실험 중 우연히 돼지의 간 아래 하대정맥(caudal vena cava/inferior vena cava)이 없는 선천성 변형을 발견하여 보고한다. 사람에서 보이는 선천성 기형이 돼지와 같은 동물에도 있으며 이러한 하대정맥의 선천성 변형에 대한 정확한 지식은 방사선학적 진단 및 인터벤션의 시술 등에 있어 매우 중요하다. Absence of caudal/inferior vena cava (CVC/IVC) with azygos/hemiazygos continuation is an uncommon vascular anomaly. To the best of the investigators knowledge, this is the first report of absence of CVC/IVC with azygos/hemiazygos continuation in the swine in the world. In this case, absence of CVC/IVC was confirmed by venography and necropsy. The recognition of this congenital venous anomaly (CVC/IVC interruption with azygos/hemiazygos continuation) is important for interventional radiologist and cardiologist.

상간하대정맥부터 총장골정맥분지까지 연장된 하대정맥 평활근 육종의 체외절제 후 인공 하대정맥 재건 및 자가 간이식

문덕복(Deok-Bog Moon),이승규(Sung-Kyu Lee),김기훈(Ki-Hum Kim),안철수(Chul-Soo Ahn),하태용(Tae-Yong Ha),송기원(Gi-Won Song),정동환(Dong-Hwan Jung),유제호(Je-Ho Ryu),김관우(Kwan-Woo Kim),고경훈(Kyoung-Hoon Ko),최남규(Nam-Kyu Choi) 한국간담췌외과학회 2008 한국간담췌외과학회지 Vol.12 No.3

Ex situ resection and hepatic auto-transplantation as devised by Pichlmayr may be an answer for a lesion that has close proximity to or has invade the major hepatic veins. We report here on a 31-year-old female patient with a leiomyosarcoma extending from the suprahepatic vena cava to the bifurcation of the common iliac vein, and this tumor was deemed not accessible by the conventional in situ surgical techniques. The liver and retrohepatic inferior vena cava was removed en bloc and taken to the back-table where the neoplasm invading the cava wall was removed together with the inferior vena cava. The inferior vena cava was then replaced by a 26- mm Dacron graft proximally and a 20-mm ringed polytetrafluoroethylene (PTFE) graft distally, and the outflows of the liver was reconstructed to a single opening with using longitudinallyopened autogenous great saphenous vein fencing. The liver was then autotransplanted by the Piggyback technique. Both renal veins were not reconstructed because both gonadal veins were preserved during the operation. The postoperative course was uneventful and the patient is in good health until now.

초음파를 이용한 하대정맥/대동맥 지표와 중심정맥압의 상관관계

양중일,한규홍,조성욱,이승한,유연호,이진웅,김승환,유인술,유승 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.3

Purpose: Body fluid status of patients in an emergency room environment is a very important parameter during clinical evaluation. In this study, we wanted to know the relationship between the diameter of the inferior vena cava and the diameter of the (IVC/Ao index) and central venous pressure (CVP) in hemodynamically unstable patients. Methods: This study was done prospectively in an emergency medical center of a hospital from January to August,2009. We compared the diameter of the IVC, the diameter of inferior vena cava/the body surface area index (IVC/BSA index), the IVC/Ao index, and other variables. Before and after hydration of patients with a systolic blood pressure less than 90 mmHg and who had a central venous catheter in place. Then, we calculated the correlation coefficient for ΔCVP, ΔIVC/Ao index, and other indexes. Results: Fifty-nine patients were enrolled in the study. The mean IVC diameter before hydration was 14.3±2.7 mm; it was 15.6±2.7 mm after hydration (p<0.01). The IVC/BSA index before hydration was 8.75±1.72 and 9.55±1.79after hydration (p<0.01). The IVC/Ao index before hydration was 1.08±0.23; it was 1.16±0.25 after hydration (p<0.01). The correlation coefficient for ΔCVP and ΔIVC was 0.37(p<0.01); for ΔCVP vs. the ΔIVC/BSA index it was 0.37(p<0.01); for the ΔIVC/Ao index it was 0.27 (p=0.04). Conclusion: CVP has a higher correlation to IVC diameter and to IVC/BSA index than to the IVC/Ao index. Hence, we should estimate the IVC/Ao index and use that estimate along with other indexes to evaluate body fluid status when dealing with hemodynamically unstable patients.

완전순환정지술의 심장질환 이외의 임상적 적용

원용순,백완기,안혁,Won, Yong-Sun,Baek, Wan-Ki,Ahn, Hyuk 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.10

Hypothermia and circulatory arrest is efficatious adjunct in the surgical treatment of conventionally difficult or otherwise inoperable lesion. This technique was utilized in 5 patients, 3 with membraneous obstruction of inferior vena cava[MOVC] and 1 with giant middle cerebral artery aneurysm and 1 with renal cell carcinoma invading inferior vena cava. All membraneous obstruction of inferior vena cava patients had excellent results but the others died of operative complications. The rationale for the use of complete cardiac arrest with hypothermia is reviewed and the use of these technique in selected patients is warrented.

소아환자에서 대복재정맥을 통한 하대정맥도관법의 유용성

김승환,김성민,오정탁,한석주,최승훈,Kim, Seung-Hwan,Kim, Seong-Min,Oh, Jung-Tak,Han, Seok-Joo,Choi, Seung-Hoon 대한소아외과학회 2006 소아외과 Vol.12 No.2

Central venous catheter (CVC) for long-term venous access is indispensable for various reasons including hyperalimentation, frequent blood sampling, frequent IV drug use in pediatric patients. We report clinical experience of surgical neonates in whom CVC was inserted primarily via great saphenous vein into suprarenal inferior vena cava. From March 2004 to March 2006, we performed CVC insertion via saphenous vein - contralateral side to main wound - into suprarenal inferior vena cava in surgeries of neonates. 2.7Fr or 4.2Fr, single lumen, tunneled Broviac catheters (Bard Access system, Inc, Salt Lake City, Utah) were used. Skin exit site of tunneled catheter was located in ipsilateral flank area just below edge lower rib. At the end of the procedure, location of the catheter tip was confirmed by plain radiography of abdomen. We retrospectively reviewed the admission records of the patients including nursing staff charts. Nine (50.0 %) patients were male and nine (50.0%) were female. Median gestational age was 38 weeks (range, 29-42 weeks) and median birth weight was 3,105 gm (range, 1,040-3,720 gm). Median age at catheter insertion was 38.5 days (range, 1-236 days). The purpose of CVC insertion was short-and long-term hyperalimentation in nine (50.0 %) patients. CVC insertion was performed in operation room under general anesthesia in sixteen (88.9 %) patients (in these cases, CVC insertion was performed just prior to concurrent operation) and neonatal intensive care unit (NICU) under local anesthesia with adequate sedation in two (11.2%). During the admission period (total catheter-indwelling time: 553 days), CVC functioned well without any significant side effects. Transient swelling of the ipsilateral leg (n=1, 5.6 %) and transient migration of catheter tip (n=1, 5.6 %) were noted, which did not affect function of the indwelled CVC. Mean catheter-indwelling time was 30.7days (range, 3-72 days). All catheters were removed electively except two mortality case. Complications, such as thrombosis, infection, kinking or extravasation of drugs, were not observed in our study period. Tunneled trans-great saphenous vein inferior vena cava catheters are not only comparable to cervical CVCs in terms of function and complication rates, but also very beneficial in selected patients, especially those in whom cervical approach is technically impossible or contraindicated.

응급실에 내원한 환자의 체액량 평가를 위한 중심정맥압과 하대정맥 대 하행대동맥 지표의 비교

서정현,윤유상,김양원,박득현,차지훈,최준철 대한응급의학회 2012 대한응급의학회지 Vol.23 No.1

Purpose: Central venous pressure (CVP) is used almost universally to evaluate patient body fluid status. But historical and more recent data suggest that this approach may be flawed. In this study, we compared the accuracy of CVP versus the inferior vena cava/aorta diameter index (IVC/Ao index), a new approach to assessing body fluid status. Methods: This study was carried out prospectively with subjects over 18 years of age who visited the emergency department between November 2010 and January 2011. A central venous catheter (CVC) was inserted into patients undergoing computed tomography (CT). IVC and aortic diameter were measured below the renal vein using the CT in axial view. To determine the exact CVP, we measured the distance from the tip of the CVC to the superior vena cava/right atrium (SVC/RA) junction in coronal and axial CT views, and placed the tip of a CVC at the SCV/RA junction. We analyzed the correlation between the CVP, IVC diameter and the IVC/Ao index. Results: A total of 65 patients were enrolled in this study. The mean CVP was 9.25±5.99 mmH2O, IVC diameter was 1.456±0.568 cm and IVC/Ao index was 0.854±0.316. The correlation coefficient for CVP and IVC diameter was 0.625 (p<0.01) and for CVP and IVC/aorta index it was 0.711 (p<0.01). Coefficient of variations (CVs) of the IVC/Ao index was 0.76 at CVP 5 mmH2O and 0.14 at CVP 17cmH2O. The correlation coefficient for CVP and IVC/Ao index in the group with a CVP result of less than 8 cmH2O was 0.330, and in the group with a CVP result greater than 8 cmH2O, it was 0.660 (p<0.01). Conclusion: The CVP results had a higher correlation to the IVC/aorta index than to the IVC diameter. The coefficient of variant (CV) tended to increase as CVP decreased. It is best not to use a single value of CVP or IVC/Ao index to evaluate the body fluid state, as some kind of dynamic parameter should be used.

하대정맥에 거치된 폐동맥 카테터 - 증례보고

신예진(Yejin Shin),정기태(Ki Tae Jung) 조선대학교 의학연구원 2023 The Medical Journal of Chosun University Vol.48 No.2

A 60-year-old male patient underwent liver transplantation surgery due to autoimmune cirrhosis and hepatocellular carcinoma. Placing a pulmonary arterial catheter (PAC) for hemodynamic monitoring was challenging despite using ultrasound and multiple adjustments. The PAC anomalously lodged in the inferior vena cava despite corrective attempts, influencing the surgical approach. To avoid possible complications, it was decided to remove the PAC. No subsequent complications related to PAC misplacement were observed, and the patient recovered post-surgery without incident. This case underscores the importance of following the precision in PAC insertion procedures, such as waveform analysis.

외상 환자의 하대정맥 대 하행 대동맥 직경 비의 유용성

손강호,김미란,김양원,윤유상 대한응급의학회 2010 大韓應急醫學會誌 Vol.21 No.1

Purpose: An accurate assessment of body fluid status is a significant challenge during every clinical examination. In many disorders, the therapy and its effectiveness depend on appropriate evaluation of body fluid state, especially in the trauma patient. The purpose of this study was to evaluate the clinical significance of the IVC/aorta diameter index on abdominal CT scans and to determine whether? The IVC/aorta diameter index was useful for predicting the outcome of trauma patients in the emergency department. Methods: This study was a retrospective analysis of data acquired between December 2008 and April 2009. We included 108 trauma patients who received abdominal CT in the emergency department. Persons who had a major medical problem such as liver cirrhosis, or who were transferred from other hospitals for ICU care, or who were younger than 15 years, were excluded. IVC and aorta were measured below the infrarenal vein in the abdominal CT in an axial view. Clinical assessment included the patient’s final diagnosis, blood pressure, heart rate, weight and whether he was dead or not. Receiver operating characteristic (ROC) curves were used to find the value of the IVC/aorta diameter index that maximized the sum of the sensitivity and specificity. Statistical analysis was performed using SPSS 17.0. Results: We studied 135 patients (trauma 108 and non trauma 27). The mean IVC/aorta diameter index of nontrauma patients was 1.26±0.17; for trauma patients it was 0.80±0.33. The average IVC/aorta index in the shock group at arrival were significantly smaller than in the non shock group (0.57±0.27 versus 0.89±0.3). Conclusion: The inferior vena cava/aorta diameter index in trauma patients is useful in assessment of injury severity and prognosis.

전산화단층촬영을 이용한 하대정맥/대동맥 지표와 중심정맥압의 상관관계 - 후향적연구

오세광,조용철,구도현,유승,김승환,유연호,유인술,이진웅 대한응급의학회 2010 대한응급의학회지 Vol.21 No.5

Purpose: To evaluate whether the inferior vena cava/aorta diameter index correlates with central venous pressure (CVP) in the emergency department. Methods: We selected patients who had computed tomography and had their central venous pressure checked between September 2008 and December 2008. Measurement of the IVC and aorta diameters was performed in conjunction with computed tomography. Subjects were divided into two groups: those with a CVP of less than 8 cm H2O (group A), and those with a CVP greater than 8cm H2O (group B). Data collected included the patient's age, sex, height, systolic blood pressure, heart rate, hemoglobin level, IVC diameter and aorta diameter. We analyzed the correlation between the IVC/aorta index and the CVP. Results: A total of 80 patients were enrolled in the study. Of the 80, 39 patients were assigned to group A and 41 to group B. The mean IVC diameter in group A was 14.98±2.58 mm; in group B it was and 18.84±3.01 (p<0.01). The IVC/aorta index in group A was 0.72±0.12; in group B it was 0.96±0.20 (p<0.01). The correlation coefficient for CVP and IVC was 0.72 (p<0.01); for CVP and aorta it was -1.5 (p=0.17); for CVP and the IVC/aorta index it was 0.69(p<0.01)Conclusion: The IVC/aorta index is related to the CVP. There is a difference in the IVC diameter and IVC/aorta index between groups A and B. The IVC/aorta index may be a predictor of body fluid status in the emergency department.