Inferior vena cava syndrome

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Inferior vena cava syndrome
Inferiorvenacava.png
Inferior vena cava
Specialty Cardiology   OOjs UI icon edit-ltr-progressive.svg
Frequency5-10 out of 100,000 (From 1 in 10,000-20,000)

Inferior vena cava syndrome (IVCS) is a very rare constellation of symptoms resulting from either an obstruction, or stenosis of the inferior vena cava. It can be caused by physical invasion or compression by a pathological process or by thrombosis within the vein itself. It can also occur during pregnancy. Pregnancy leads to high venous pressure in the lower limbs, decreased blood return to the heart, decreased cardiac output due to obstruction of the inferior vena cava, sudden rise in venous pressure which can lead to placental separation, and a decrease in kidney function. All of these issues can arise from lying in the supine position during late pregnancy which can cause compression of the inferior vena cava by the uterus. [1] Symptoms of late pregnancy inferior vena cava syndrome consist of intense pain in the right hand side, muscle twitching, hypotension, and fluid retention. [2]

Contents

Signs and symptoms

IVCS presents with a wide variety of signs and symptoms, making it difficult to diagnose clinically.[ citation needed ]

Causes

the causes for this condition are the following:[ citation needed ]

Diagnosis

The diagnosis can be made clinically by observing the patient when in the right sided position where you can see multiple dilated veins over abdomen due to collaterals. [3] Ultrasound with Doppler flow measurement may be used to assess the IVC and circulatory system.[ citation needed ]

Treatment

Treatment will vary depending on the cause of the vena cava compression or interruption. Often, treatment includes positional changes, avoidance of supine positioning, especially on the right side. In pregnancy, definitive management of the IVCS is to deliver the baby. In other conditions, medical or surgical treatment to remove or relieve the offending structure will relieve symptoms.[ citation needed ]

Frequency

Epidemiological data is elusive owing to the wide variety of clinical presentation. In the U.S., incidence is estimated to be at 5–10 cases per 100,000 per year. Minor compression of the inferior vena cava during pregnancy is a relatively common occurrence. It is seen most commonly when women lie on their back or right side. [4] 90% of women lying in the supine position during pregnancy experience some form of inferior vena cava syndrome; however, not all of the women display symptoms. [4]

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<span class="mw-page-title-main">Edema</span> Accumulation of excess fluid in body tissue

Edema, also spelled oedema, and also known as fluid retention, dropsy, hydropsy and swelling, is the build-up of fluid in the body's tissue. Most commonly, the legs or arms are affected. Symptoms may include skin which feels tight, the area may feel heavy, and joint stiffness. Other symptoms depend on the underlying cause.

<span class="mw-page-title-main">Superior vena cava</span> One of two veinous trunks bringing deoxygenated blood back to the heart

The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vein that receives venous return from the upper half of the body, above the diaphragm. Venous return from the lower half, below the diaphragm, flows through the inferior vena cava. The SVC is located in the anterior right superior mediastinum. It is the typical site of central venous access via a central venous catheter or a peripherally inserted central catheter. Mentions of "the cava" without further specification usually refer to the SVC.

<span class="mw-page-title-main">Inferior vena cava</span> One of two veinous trunks bringing deoxygenated blood back to the heart

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<span class="mw-page-title-main">Deep vein thrombosis</span> Formation of a blood clot (thrombus) in a deep vein

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<span class="mw-page-title-main">May–Thurner syndrome</span> Medical condition

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<span class="mw-page-title-main">Nutcracker syndrome</span> Medical condition

The nutcracker syndrome (NCS) results most commonly from the compression of the left renal vein (LRV) between the abdominal aorta (AA) and superior mesenteric artery (SMA), although other variants exist. The name derives from the fact that, in the sagittal plane and/or transverse plane, the SMA and AA appear to be a nutcracker crushing a nut.

<span class="mw-page-title-main">Compression stockings</span> Compression garment

Compression stockings are a specialized hosiery designed to help prevent the occurrence of, and guard against further progression of, venous disorders such as edema, phlebitis and thrombosis. Compression stockings are elastic compression garments worn around the leg, compressing the limb. This reduces the diameter of distended veins and increases venous blood flow velocity and valve effectiveness. Compression therapy helps decrease venous pressure, prevents venous stasis and impairments of venous walls, and relieves heavy and aching legs.

<span class="mw-page-title-main">Aortocaval compression syndrome</span> Medical condition

Aortocaval compression syndrome also known as Supine hypotensive syndrome is compression of the abdominal aorta and inferior vena cava by the gravid uterus when a pregnant woman lies on her back, i.e. in the supine position. It is a frequent cause of low maternal blood pressure (hypotension), which can result in loss of consciousness and in extreme circumstances fetal demise.

<span class="mw-page-title-main">Venography</span>

Venography is a procedure in which an X-ray of the veins, a venogram, is taken after a special dye is injected into the bone marrow or veins. The dye has to be injected constantly via a catheter, making it an invasive procedure. Normally the catheter is inserted by the groin and moved to the appropriate site by navigating through the vascular system.

Emergency ultrasound employing point-of-care ultrasound (POCUS) is the application of ultrasound at the point of care to make immediate patient-care decisions. It is performed by the health care professional caring for the injured or ill persons. This point-of-care use of ultrasound is often to evaluate an emergency medical condition, in settings such as an emergency department, critical care unit, ambulance, or combat zone.

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<span class="mw-page-title-main">Chronic venous insufficiency</span> Medical condition

Chronic venous insufficiency (CVI) is a medical condition in which blood pools in the veins, straining the walls of the vein. The most common cause of CVI is superficial venous reflux which is a treatable condition. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. If the impaired vein function causes significant symptoms, such as swelling and ulcer formation, it is referred to as chronic venous disease. It is sometimes called chronic peripheral venous insufficiency and should not be confused with post-thrombotic syndrome in which the deep veins have been damaged by previous deep vein thrombosis.

<span class="mw-page-title-main">Ovarian vein syndrome</span> Medical condition

Ovarian vein syndrome is a rare condition in which a dilated ovarian vein compresses the ureter. This causes chronic or colicky abdominal pain, back pain and/or pelvic pain. The pain can worsen on lying down or between ovulation and menstruation. There can also be an increased tendency towards urinary tract infection or pyelonephritis. The right ovarian vein is most commonly involved, although the disease can be left-sided or affect both sides. It is currently classified as a form of pelvic congestion syndrome.

<span class="mw-page-title-main">Congenital stenosis of vena cava</span> Medical condition

Congenital stenosis of vena cava is a congenital anomaly in which the superior vena cava or inferior vena cava has an aberrant interruption or coarctation.

References

  1. D.B. Scott; M.G. Kerr (1963). "Inferior vena cave pressure in late pregnancy". BJOG. 70 (6): 1044–1049. doi:10.1111/j.1471-0528.1963.tb15051.x. PMID   14100067. S2CID   26906521.
  2. B. Howard; J. Goodson; W. Mengert (1953). "Supine hypotensive syndrome in late pregnancy". Obstetrics and Gynecology. 1 (4): 371–377. PMID   13055188.
  3. Parikh, Rohan; Beedkar, Amey (2018). "Inferior Vena Cava: Chronic Total Occlusion". Mayo Clinic Proceedings. 93 (4): 548. doi: 10.1016/j.mayocp.2018.03.001 . PMID   29622107.
  4. 1 2 M.G. Kerr; D.B. Scott; Eric Samuel (1964). "Studies of the inferior vena cava in late pregnancy". British Medical Journal. 1 (5382): 532–533. doi:10.1136/bmj.1.5382.522. PMC   1813561 . PMID   14101999.