title: Geometric changes of the inferior vena cava in trauma patients subjected to volume resuscitation.
abstract: OBJECTIVE
  Dynamic changes in anatomic geometry of the inferior vena cava from changes in intravascular volume may cause passive stresses on inferior vena cava filters. In this study, we aim to quantify variability in inferior vena cava dimensions and anatomic orientation to determine how intravascular volume changes may impact complications of inferior vena cava filter placement, such as migration, tilting, perforation, and thrombosis.
  
  
  METHODS
  Retrospective computed tomography measurements of major axis, minor axis, and horizontal diameters of the inferior vena cava at 1 and 5 cm below the lowest renal vein in 58 adult trauma patients in pre-resuscitative (hypovolemic) and post-resuscitative (euvolemic) states were assessed in a blinded fashion by two independent readers. Inferior vena cava perimeter, area, and volume were calculated and correlated with caval orientation.
  
  
  RESULTS
  Mean volumes of the inferior vena cava segment on pre- and post-resuscitation scans were 9.0 cm(3) and 11.0 cm(3), respectively, with mean percentage increase of 48.6% (P < 0.001). At 1 cm and 5 cm below the lowest renal vein, the inferior vena cava expanded anisotropically, with the minor axis expanding by an average of 48.7% (P < 0.001) and 30.0% (P = 0.01), respectively, while the major axis changed by only 4.2% (P = 0.11) and 6.6% (P = 0.017), respectively. Cross-sectional area and perimeter at 1 cm below the lowest renal vein expanded by 61.6% (P < 0.001) and 10.7% (P < 0.01), respectively. At 5 cm below the lowest renal vein, the expansion of cross-sectional area and perimeter were 43.9% (P < 0.01) and 10.7% (P = 0.002), respectively. The major axis of the inferior vena cava was oriented in a left-anterior oblique position in all patients, averaging 20° from the horizontal plane. There was significant underestimation of inferior vena cava maximal diameter by horizontal measurement. In pre-resuscitation scans, at 1 cm and 5 cm below the lowest renal vein, the discrepancy between the horizontal and major axis diameter was 2.1 ± 1.2 mm (P < 0.001) and 1.7 ± 1.0 mm (P < 0.001), respectively, while post-resuscitation studies showed the same underestimation at 1 cm and 5 cm below the lowest renal vein to be 2.2 ± 1.2 mm (P < 0.01) and 1.9 ± 1.0 mm (P < 0.01), respectively.
  
  
  CONCLUSIONS
  There is significant anisotropic variability of infrarenal inferior vena cava geometry with significantly greater expansive and compressive forces in the minor axis. There can be significant volumetric changes in the inferior vena cava with associated perimeter changes but the major axis left-anterior oblique caval configuration is always maintained. These significant dynamic forces may impact inferior vena cava filter stability after implantation. The consistent major axis left-anterior oblique obliquity may lead to underestimation of the inferior vena cava diameter used in standard anteroposterior venography, which may influence initial filter selection.
authors.affiliation: Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA.
authors.forename: Samuel L
authors.initials: SL
authors.lastname: Chen
authors.affiliation: Division of Cardiovascular and Thoracic Imaging, University of California, Irvine, CA.
authors.forename: Mayil S
authors.initials: MS
authors.lastname: Krishnam
authors.affiliation: Division of Cardiovascular and Thoracic Imaging, University of California, Irvine, CA.
authors.forename: Thangavijayan
authors.initials: T
authors.lastname: Bosemani
authors.affiliation: Division of Cardiovascular and Thoracic Imaging, University of California, Irvine, CA.
authors.forename: Sumudu
authors.initials: S
authors.lastname: Dissayanake
authors.affiliation: Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA sgroim@uci.edu.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Sgroi
authors.affiliation: Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA.
authors.forename: John S
authors.initials: JS
authors.lastname: Lane
authors.affiliation: Department of Surgery, Division of Vascular and Endovascular Surgery, University of California, Orange, CA.
authors.forename: Roy M
authors.initials: RM
authors.lastname: Fujitani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001810:Blood Volume; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D020896:Hypovolemia / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016306:Vena Cava Filters / Q000009:adverse effects; D014682:Vena Cava, Inferior / Q000000981:diagnostic imaging / Q000503:physiopathology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D055815:Young Adult
keywords: Inferior vena cava changes secondary to volume status; trauma patients; volume status