Abstract
Objective
A megacava (vena cava with a diameter of 28 mm or greater) requires a particular filter to avoid migration. However, caval morphologies are variable. As the inferior vena cava (IVC) usually adopts a circular geometry after a filter is inserted, this study aims (a) to classify caval geometry and orientation; (b) to compare discrepancy between anterioposterior projective diameter (PD) and circumference-based calculated diameter (CD) measurements on cross-sectional computed tomography (CT) images; (c) if a discrepancy exists, determine how often it can affect IVC filter selection.
Methods
A total of 1503 patients were retrospectively reviewed. Caval morphology was classified. PD and CD were measured at infrarenal IVC. Differences between the PD and CD were assessed by the Wilcoxon signed-rank test or paired t test (if appropriate). The scatterplot of PD vs. CD was used to show whether one is consistently larger than the other.
Results
The PD was significantly larger than the CD (22.3 ± 3.5 vs. 20.4 ± 2.8, p < 0.001). The caval morphologies were divided into five types. Type 1 was oval IVC oriented left-anterior-oblique to the horizontal line with an angle (n = 999, 66.5%), type 2 was round IVC (n = 49, 3.3%), type 3 was oval IVC with a vertical long axis (n = 8, 0.5%), type 4 was oval IVC with a horizontal long axis (n = 75, 5.0%), and type 5 was irregularly shaped IVC (n = 372, 24.7%).
Conclusion
Patients with round IVC are rare. Measurement of CD may be better to assess maximum IVC diameter compared with PD for the purpose of IVC filter placement.
Key Points
• Five types of IVC orientation are described in this paper: type 1 (n = 999, 66.5%), type 2 (n = 49, 3.3%), type 3 (n = 8, 0.5%), type 4 (n = 75, 5.0%), and type 5 (n = 372, 24.7%).
• The incidence of megacava (vena cava with a diameter of 28 mm or greater) measured on anterioposterior projective imaging may be overestimated.
• As an IVC will adopt a circular geometry following filter placement, circumference-based calculated diameter may be an appropriate approach for caval size determination.
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Abbreviations
- CD:
-
Calculated diameter
- CT:
-
Computed tomography
- CCC:
-
Concordance correlation coefficient
- IVC:
-
Inferior vena cava
- PD:
-
Projective diameter
- PE:
-
Pulmonary embolism
References
Andreoli JM, Thornburg BG, Hickey RM (2016) Inferior vena cava filter-related thrombus/deep vein thrombosis: data and management. Semin Intervent Rad 33:101–104
Sarosiek S, Crowther M, Sloan JM (2013) Indications, complications, and management of inferior vena cava filters. JAMA Intern Med 173:513–517
Prince MR, Novelline RA, Athanasoulis CA, Simon M (1983) The diameter of the inferior vena cava and its implications for the use of vena caval filters. Radiology 149:687–689
Jia ZZ, Wu A, Tam M, Spain J, McKinney JM, Wang WP (2015) Caval penetration by inferior vena cava filters a systematic literature review of clinical significance and management. Circulation 132:944–952
Hicks ME, Malden ES, Vesely TM, Picus D, Darcy MD (1995) Prospective anatomic study of the inferior vena cava and renal veins: comparison of selective renal venography with cavography and relevance in filter placement. J Vasc Interv Radiol 6:721–729
Dewald CL, Jensen CC, Park YH et al (2000) Vena cavography with CO2 versus with iodinated contrast material for inferior vena cava filter placement: a prospective evaluation. Radiology 216:752–757
Holtzman RB, Lottenberg L, Bass T, Saridakis A, Bennett VJ, Carrillo EH (2003) Comparison of carbon dioxide and iodinated contrast for cavography prior to inferior vena cava filter placement. Am J Surg 185:364–368
Carrafiello G, Mangini M, Fontana F et al (2012) Suprarenal inferior vena cava filter implantation. Radiol Med 117:1190–1198
Murphy EH, Arko FR, Trimmer CK, Phangureh VS, Fogarty TJ, Zarins CK (2009) Volume associated dynamic geometry and spatial orientation of the inferior vena cava. J Vasc Surg 50:835–843
Kaura DR, Gray RR, Sadler DJ, So CB, Saliken JC (1999) Value of frontal caval measurement in the placement of inferior vena cava filters. Can Assoc Radiol J 50:301–305
Brown DB, Labuski MR, Cardella JF, Singh H, Waybill PN (1999) Determination of inferior vena cava diameter in the angiography suite: comparison of three common methods. J Vasc Interv Radiol 10:143–147
Jaskolka JD, Kwok RPW, Gray SH, Mojibian HR (2010) The value of preprocedure computed tomography for planning insertion of inferior vena cava filters. Can Assoc Radiol J 61:223–229
Baron HC, Klapholz A, Nagy AA, Wayne M (1999) Bilateral iliac vein filter deployment in a patient with megacava. Ann Vasc Surg 13:634–636
Van Ha TG, Dillon P, Funaki B et al (2011) Use of retrievable filters in alternative common iliac vein location in high-risk surgical patients. J Vasc Interv Radiol 22:325–329
Acknowledgements
This manuscript has been accepted as an oral presentation in the 2018 European Congress of Radiology.
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The authors state that this work has not received any funding.
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The scientific guarantor of this publication is Zi-shu Zhang.
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The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.
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No complex statistical methods were necessary for this paper.
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Written informed consent was obtained from all subjects (patients) in this study.
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Institutional Review Board approval was obtained.
Methodology
• retrospective
• cross sectional study
• performed at one institution
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Xiao, Yd., Zhang, Zs. & Ma, C. Cavographic vs. cross-sectional measurement of the inferior vena cava diameter before filter placement: are we routinely oversizing?. Eur Radiol 29, 3281–3286 (2019). https://doi.org/10.1007/s00330-018-5820-5
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DOI: https://doi.org/10.1007/s00330-018-5820-5