TY  - JOUR
A1  - Jobs, Alexander
A1  - Vonthein, Reinhard
A1  - König, Inke R.
A1  - Schäfer, Jane
A1  - Nauck, Matthias
A1  - Haag, Svenja
A1  - Fichera, Carlo Federico
A1  - Stiermaier, Thomas
A1  - Ledwoch, Jakob
A1  - Schneider, Alisa
A1  - Valentova, Miroslava
A1  - von Haehling, Stephan
A1  - Störk, Stefan
A1  - Westermann, Dirk
A1  - Lenz, Tobias
A1  - Arnold, Natalie
A1  - Edelmann, Frank
A1  - Seppelt, Philipp
A1  - Felix, Stephan
A1  - Lutz, Matthias
A1  - Hedwig, Felix
A1  - Borggrefe, Martin
A1  - Scherer, Clemens
A1  - Desch, Steffen
A1  - Thiele, Holger
T1  - Inferior vena cava ultrasound in acute decompensated heart failure: design rationale of the CAVA‐ADHF‐DZHK10 trial
JF  - ESC Heart Failure
N2  - Aims
Treating patients with acute decompensated heart failure (ADHF) presenting with volume overload is a common task. However, optimal guidance of decongesting therapy and treatment targets are not well defined. The inferior vena cava (IVC) diameter and its collapsibility can be used to estimate right atrial pressure, which is a measure of right‐sided haemodynamic congestion. The CAVA‐ADHF‐DZHK10 trial is designed to test the hypothesis that ultrasound assessment of the IVC in addition to clinical assessment improves decongestion as compared with clinical assessment alone.

Methods and results
CAVA‐ADHF‐DZHK10 is a randomized, controlled, patient‐blinded, multicentre, parallel‐group trial randomly assigning 388 patients with ADHF to either decongesting therapy guided by ultrasound assessment of the IVC in addition to clinical assessment or clinical assessment alone. IVC ultrasound will be performed daily between baseline and hospital discharge in all patients. However, ultrasound results will only be reported to treating physicians in the intervention group. Treatment target is relief of congestion‐related signs and symptoms in both groups with the additional goal to reduce the IVC diameter ≤21 mm and increase IVC collapsibility >50% in the intervention group. The primary endpoint is change in N‐terminal pro‐brain natriuretic peptide from baseline to hospital discharge. Secondary endpoints evaluate feasibility, efficacy of decongestion on other scales, and the impact of the intervention on clinical endpoints.

Conclusions
CAVA‐ADHF‐DZHK10 will investigate whether IVC ultrasound supplementing clinical assessment improves decongestion in patients admitted for ADHF.
KW  - acute decompensated heart failure
KW  - inferior vena cava
KW  - congestion
KW  - NT‐proBNP
KW  - ultrasound
Y1  - 2020
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-212692
VL  - 7
IS  - 3
SP  - 973
EP  - 983
ER  - 
TY  - JOUR
A1  - Augustin, Anne Marie
A1  - Lucius, Leonie Johanna
A1  - Thurner, Annette
A1  - Kickuth, Ralph
T1  - Malignant obstruction of the inferior vena cava: clinical experience with the self-expanding Sinus-XL stent system
JF  - Abdominal Radiology
N2  - Purpose
To evaluate the technical and clinical outcome of Sinus-XL stent placement in patients with malignant obstruction syndrome of the inferior vena cava.

Methods
Between October 2010 and January 2021, 21 patients with different malignant primary disease causing inferior vena cava obstruction were treated with Sinus-XL stent implantation. Procedural data, technical and clinical outcome parameters were retrospectively analyzed.

Results
Technical success was 100%. Analysis of available manometry data revealed a significant reduction of the mean translesional pressure gradient following the procedure (p = 0.008). Reintervention rate was 4.8% (1/21). The available follow-up imaging studies showed primary and primary-assisted stent patency rates of 93% (13/14) and 100% (14/14), respectively. Major complications did not occur. The clinical success regarding lower extremity edema was 82.4% (14/17) for the first and 85.7% (18/21) for the last follow-up. Longer lengths of IVC obstruction were associated with reduced clinical improvement after the procedure (p = 0.025). Improvement of intraprocedural manometry results and lower extremity edema revealed only minor correlation. Ascites and anasarca were not significantly positively affected by the procedure.

Conclusion
Sinus-XL stent placement in patients with malignant inferior vena cava obstruction showed high technical success and low complication rates. Regarding the clinical outcome, significant symptom improvement could be achieved in lower extremity edema, whereas ascites and anasarca lacked satisfying symptom relief. Based on our results, this procedure should be considered as a suitable therapy in a palliative care setting for patients with advanced malignant disease.
KW  - endovascular
KW  - inferior vena cava
KW  - interventional procedures
KW  - oncology
KW  - palliative care
KW  - stent
Y1  - 2022
U6  - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-324951
VL  - 47
IS  - 10
ER  -