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ORIGINAL ARTICLE  VENOUS DISEASE Freefree

International Angiology 2019 April;38(2):90-5

DOI: 10.23736/S0392-9590.19.04021-5

Copyright © 2019 EDIZIONI MINERVA MEDICA

language: English

Respiratory changes in the length of the vena cava: implications for optimal positioning of inferior vena cava filter

Takeshi HASHIMOTO 1, Jun KOIZUMI 2, Kazuyuki YAMAMOTO 2, Toshiya NISHIBE 3, Alan DARDIK 4, Yuta SHIBAMOTO 1

1 Department of Radiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan; 2 Department of Diagnostic Radiology, Tokai University School of Medicine, Isehara, Japan; 3 Department of Cardiovascular Surgery, Tokyo Medical University, Tokyo, Japan; 4 Department of Surgery, Yale University School of Medicine, New Haven, CT, USA



BACKGROUND: A transjugular temporary inferior vena cava (IVC) filter may change position with respiration, leading to serious complications such as filter migration to the right atrium (RA) or renal veins. We therefore evaluated respiratory changes in the length and diameter of the vena cava using MRI.
METHODS: In 20 volunteers, the length and diameter of the vascular segments from the right brachiocephalic vein (BCV) to infrarenal IVC were measured with MRI.
RESULTS: The mean lengths in mm of the BCV, superior vena cava (SVC), RA, suprarenal IVC, and infrarenal IVC during expiration vs. inspiration were 32.7±7.3 vs. 43.0±8.0, 44.6±9.6 vs. 58.5±12.7, 77.8±12.4 vs. 98.9±10.0, 104.6±19.1 vs. 85.0±14.9, and 49.0±8.7 vs. 33.8±9.7, respectively (all P<0.01). The distances in mm from the BCV to RA, upper confluence of the renal vein, and lower confluence of the renal vein during expiration vs. inspiration were 155.2±18.5 vs. 200.4±20.1, 259.7±28.5 vs. 285.4±23.5, and 308.7±31.6 vs. 319.1±24.9, respectively (all P<0.01). The diameter of the SVC decreased with inspiration, while that of the infrarenal IVC increased. The diameter of the suprarenal IVC did not change significantly with respiration.
CONCLUSIONS: The distances from the BCV to RA, upper, and lower confluences of the renal vein were 4.5, 2.6, and 1.0 cm longer on average at inspiration than at expiration, respectively. These respiratory-associated changes of the vena cava length should be taken into account when deploying an IVC filter to prevent its migration.


KEY WORDS: Vena cava; Filter; Respiration; Migration

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