William T Kuo

Vascular and Interventional Radiology, Chicago, Illinois, United States

Are you William T Kuo?

Claim your profile

Publications (35)118.55 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: To optimize surveillance schedules for the detection of recurrent hepatocellular carcinoma (HCC) after liver-directed therapy. New methods have emerged that allow quantitative analysis and optimization of surveillance schedules for diseases with substantial rates of recurrence such as HCC. These methods were applied to 1,766 consecutive chemoembolization, radioembolization, and radiofrequency ablation procedures performed on 910 patients between 2006 and 2011. Computed tomography or magnetic resonance imaging performed just before repeat therapy was set as the time of "recurrence," which included residual and locally recurrent tumor as well as new liver tumors. Time-to-recurrence distribution was estimated by Kaplan-Meier method. Average diagnostic delay (time between recurrence and detection) was calculated for each proposed surveillance schedule using the time-to-recurrence distribution. An optimized surveillance schedule could then be derived to minimize the average diagnostic delay. Recurrence is 6.5 times more likely in the first year after treatment than in the second. Therefore, screening should be much more frequent in the first year. For eight time points in the first 2 years of follow-up, the optimal schedule is 2, 4, 6, 8, 11, 14, 18, and 24 months. This schedule reduces diagnostic delay compared with published schedules and is cost-effective. The calculated optimal surveillance schedules include shorter-interval follow-up when there is a higher probability of recurrence and longer-interval follow-up when there is a lower probability. Cost can be optimized for a specified acceptable diagnostic delay or diagnostic delay can be optimized within a specified acceptable cost. Copyright © 2014 SIR. Published by Elsevier Inc. All rights reserved.
    Journal of vascular and interventional radiology: JVIR 11/2014; · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: A 48-year-old man presented with symptomatic inferior vena cava (IVC) occlusion from a chronically thrombosed and embedded Vena Tech LGM filter resulting in exercise intolerance from diminished cardiac preload and postthrombotic syndrome from chronic venous insufficiency. The patient was treated using a new PRIME technique-Piecemeal Removal by Intentional MEchanical fracture-to achieve successful filter retrieval 16 years after implantation. Removal of the obstructing filter permitted endovascular IVC recanalization with restoration of venous outflow and alleviation of venous obstructive symptoms. Cardiac preload was restored, allowing the patient to resume long-distance running, and he successfully completed a half-marathon 3 months after treatment.
    Journal of vascular and interventional radiology: JVIR 11/2013; 24(11):1731-7. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND: ALTHOUGH CHRONICALLY IMPLANTED INFERIOR VENA CAVA FILTERS MAY RESULT IN FILTER-RELATED MORBIDITY, THERE IS CURRENTLY NO ROUTINE OPTION FOR REMOVING SUCH FILTERS WHEN THEY BECOME FIRMLY EMBEDDED ALONG THE VENA CAVA ENDOTHELIUM.METHODS AND RESULTS: DURING A 3-YEAR PERIOD, 100 CONSECUTIVE PATIENTS WERE PROSPECTIVELY ENROLLED IN A SINGLE-CENTER STUDY. THERE WERE 42 MEN AND 58 WOMEN (MEAN AGE, 46 YEARS; LIMITS, 1876 YEARS). RETRIEVAL INDICATIONS INCLUDED FILTER-RELATED ACUTE INFERIOR VENA CAVA THROMBOSIS, CHRONIC INFERIOR VENA CAVA OCCLUSION, AND PAIN FROM RETROPERITONEAL OR BOWEL PENETRATION. FILTER RETRIEVAL WAS ALSO PERFORMED TO PREVENT RISKS FROM PROLONGED IMPLANTATION AND TO POTENTIALLY ELIMINATE THE NEED FOR LIFELONG ANTICOAGULATION. AFTER STANDARD METHODS FAILED, PHOTOTHERMAL TISSUE ABLATION WAS ATTEMPTED WITH A LASER SHEATH POWERED BY A 308-NM XENON CHLORIDE EXCIMER LASER. APPLIED FORCES WERE RECORDED WITH A DIGITAL TENSION METER BEFORE AND DURING LASER ACTIVATION. LASER-ASSISTED RETRIEVAL WAS SUCCESSFUL IN 98.0% (95% CONFIDENCE INTERVAL [CI], 93.0%99.8%) WITH MEAN IMPLANTATION OF 855 DAYS (LIMITS, 376663 DAYS; 18 YEARS). GNTHER-TULIP (N=34), CELECT (N=12), OPTION (N=17), OPTEASE (N=20, 1 FAILURE), TRAPEASE (N=6, 1 FAILURE), SIMON-NITINOL (N=1), 12F STAINLESS STEEL GREENFIELD (N=4), AND TITANIUM GREENFIELD (N=6). THE AVERAGE FORCE DURING FAILED STANDARD RETRIEVALS WAS 7.2 VERSUS 4.6 POUNDS DURING LASER-ASSISTED RETRIEVALS (P0.0001). THE MAJOR COMPLICATION RATE WAS 3.0% (95% CI, 0.6%8.5%), THE MINOR COMPLICATION RATE WAS 7.0% (95% CI, 0.3%13.9%), AND THERE WERE 4 ADVERSE EVENTS (2 COAGULOPATHIC HEMORRHAGES, 1 RENAL INFARCTION, AND 1 CHOLECYSTITIS; 4.0%; 95% CI, 1.1%9.9%) AT MEAN FOLLOW-UP OF 500 DAYS (LIMITS, 841079 DAYS). SCAR TISSUE ABLATION WAS HISTOLOGICALLY CONFIRMED IN 96.0% (95% CI, 89.9%98.9%). SUCCESSFUL RETRIEVAL ALLOWED CESSATION OF ANTICOAGULATION IN 30 OF 30 (100%) PATIENTS AND ALLEVIATED MORBIDITY IN 23 OF 24 PATIENTS (96%).CONCLUSIONS: EXCIMER LASERASSISTED REMOVAL IS EFFECTIVE IN REMOVING EMBEDDED INFERIOR VENA CAVA FILTERS REFRACTORY TO STANDARD RETRIEVAL AND HIGH FORCE. THIS METHOD CAN BE SAFELY USED TO PREVENT AND ALLEVIATE FILTER-RELATED MORBIDITY.CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01158482.
    Circulation Cardiovascular Interventions 09/2013; · 6.54 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: To evaluate clinical outcomes, characterize adherent tissue, and analyze inferior vena cava (IVC) filter fractures in patients undergoing complex retrieval for management of filter-related complications. To elucidate mechanisms of filter fracture by radiographic and electron microscopic (EM) evaluation. MATERIALS AND METHODS: Over 2.5 years, 50 consecutive patients with fractured and/or penetrating filter components were prospectively enrolled into a single-center study. There were 19 men and 31 women (mean age, 42 y; range, 15-73 y). All patients underwent complex filter retrieval after failure of standard methods, and retrieval indications along with resultant clinical outcomes were evaluated. Specimens with adherent tissue underwent histologic analysis, and all fractured components were studied with EM. RESULTS: Retrieval was successful in all 50 cases (mean implantation, 815 d; range, 20-2,599 d) among the following filters: G2X (n = 23),G2 (n = 9), Eclipse (n = 3), Recovery (n = 4), ALN (n = 1), Celect (n = 7), OptEase (n = 2), and Simon Nitinol (n = 1). Mean indwell time in fractured filters (n = 31) was 1,082 days, versus 408 days in nonfractured filters (n = 19; P = .00169). Neointimal hyperplasia/fibrosis was seen in 46 of 48 specimens with adherent tissue (96%). Among 61 fractured components from conical filters, 35 had extravascular penetration whereas 26 remained intravascular (11 free-floating in IVC, 15 embolized centrally), and EM revealed fracture modes of high-cycle fatigue (n = 53), overload (n = 6), and indeterminate (n = 2). Following retrieval, previously prescribed lifelong anticoagulation was discontinued in 30 of 31 patients (97%). Filter-related symptoms from IVC occlusion, component embolization, and penetration-induced abdominal pain, duodenal injury, and/or small-bowel volvulus were alleviated in all 26 cases (100%). There were no long-term complications at a mean follow-up of 371 days (range, 67-878 d). CONCLUSIONS: The risk of filter fracture increases after 408 days (ie,>1 y) of implantation and is associated with symptomatic extravascular penetration and/or intravascular embolization. Complex methods can be used to safely remove these devices, alleviate filter-related morbidity, and allow cessation of anticoagulation.
    Journal of vascular and interventional radiology: JVIR 03/2013; · 1.81 Impact Factor
  • William T Kuo
    Journal of vascular and interventional radiology: JVIR 01/2013; 24(1):24-6. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Compression of the left common iliac vein (CIV; LCIV) is a known risk factor for lower-extremity deep vein thrombosis (DVT). This study was performed to model the probability of DVT based on LCIV diameter and apply this to a quantitative DVT risk factor scoring system. Medical records were used to identify female patients younger than 45 years of age who were diagnosed with lower-extremity DVT (n = 21) and age-matched control subjects (n = 26) who presented to the emergency department with abdominal pain. Minimum CIV diameters were measured on computed tomography. Based on published reporting standards, 13 risk factors were scored for patients diagnosed with left-sided DVT and for control subjects. The association between vein diameter and DVT was examined by Mann-Whitney test. Odds of DVT based on vein diameter was assessed by logistic regression. Mean minimum LCIV diameters were 4.0 mm for patients with DVT and 6.5 mm for patients without DVT (P = .001). The odds of left DVT increased by a factor of 1.68 for each millimeter decrease in LCIV diameter (odds ratio = 1.68; P = .006; 95% confidence interval, 1.16-2.43). As the risk factor score increased, the relationship between diameter and risk for DVT became stronger; identical LCIV diameters were associated wtih a higher probability of developing DVT if the risk factor score was higher. Stenosis of the LCIV was found to be a strong independent risk factor for development of DVT. Moreover, each millimeter decrease in CIV diameter increased the odds of DVT by a factor of 1.68.
    Journal of vascular and interventional radiology: JVIR 11/2012; 23(11):1467-72. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To determine the feasibility and efficacy of applying an established innovation process to an active academic interventional radiology (IR) practice. The Stanford Biodesign Medical Technology Innovation Process was used as the innovation template. Over a 4-month period, seven IR faculty and four IR fellow physicians recorded observations. These observations were converted into need statements. One particular need relating to gastrostomy tubes was diligently screened and was the subject of a single formal brainstorming session. Investigators collected 82 observations, 34 by faculty and 48 by fellows. The categories that generated the most observations were enteral feeding (n = 9, 11%), biopsy (n = 8, 10%), chest tubes (n = 6, 7%), chemoembolization and radioembolization (n = 6, 7%), and biliary interventions (n = 5, 6%). The output from the screening on the gastrostomy tube need was a specification sheet that served as a guidance document for the subsequent brainstorming session. The brainstorming session produced 10 concepts under three separate categories. This formalized innovation process generated numerous observations and ultimately 10 concepts to potentially to solve a significant clinical need, suggesting that a structured process can help guide an IR practice interested in medical innovation.
    Journal of vascular and interventional radiology: JVIR 04/2012; 23(4):488-94. · 1.81 Impact Factor
  • William T Kuo
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute pulmonary embolism (PE) is the third most common cause of death among hospitalized patients. Treatment escalation beyond anticoagulation therapy is necessary in patients with massive PE (defined by hemodynamic shock) as well as in many patients with submassive PE (defined by right ventricular strain). The best current evidence suggests that modern catheter-directed therapy to achieve rapid central clot debulking should be considered as an early or first-line treatment option for patients with acute massive PE; and emerging evidence suggests a catheter-directed thrombolytic infusion should be considered as adjunctive therapy for many patients with acute submassive PE. This article reviews the current approach to endovascular therapy for acute PE in the context of appropriate diagnosis, risk stratification, and management of acute massive and acute submassive PE.
    Journal of vascular and interventional radiology: JVIR 12/2011; 23(2):167-79.e4; quiz 179. · 1.81 Impact Factor
  • Lawrence V Hofmann, William T Kuo
    The Lancet 12/2011; 379(9810):3-4. · 39.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To review the clinical course of patients with acute cholecystitis treated by percutaneous cholecystostomy, and to identify risk factors retrospectively that predict outcome. A total of 106 patients diagnosed with acute cholecystitis were treated by percutaneous cholecystostomy during a 10-year period. Seventy-one (67%) presented to the emergency department (ED) specifically for acute cholecystitis, and 35 (23%) were inpatients previously admitted for other conditions. Outcomes of the two groups were compared with respect to severity of illness, leukocytosis, bile culture, liver function tests, imaging features, time intervals from onset of symptoms to medical and percutaneous intervention, and whether surgical cholecystectomy was later performed. Overall, 72 patients (68%) showed an improvement clinically, whereas 34 (32%) showed no improvement or a clinically worsened condition after cholecystostomy. Patients who presented to the ED primarily with acute cholecystitis fared better (84% of patients showed improvement) than inpatients (34% showed improvement; P < .0001). Gallstones were identified in 54% of patients who presented to the ED, whereas acalculous cholecystitis was more commonly diagnosed in inpatients (54%). Patients with sepsis had worse outcomes overall (P < .0001). Bacterial bile cultures were analyzed in 95% of patients and showed positive results in 52%, with no overall effect on outcome. There was no correlation between the time of onset of symptoms until antibiotic therapy or cholecystostomy in either group. Long-term outcomes for both groups were better for those who later underwent cholecystectomy (P < .0001). Outcomes after percutaneous cholecystostomy for acute cholecystitis are better when the disease is primary and not precipitated by concurrent illness.
    Journal of vascular and interventional radiology: JVIR 11/2011; 23(1):83-8.e1. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To perform embolization of parasitized extrahepatic arteries (EHAs) before radioembolization to reestablish intrahepatic arterial supply to large, peripheral tumors, and to evaluate the technical and clinical outcomes of this intervention. Among 201 patients retrospectively analyzed, embolization of 73 parasitized EHAs in 35 patients was performed. Most embolization procedures were performed during preparatory angiography using large particles and coils. Digital subtraction angiography (DSA), C-arm computed tomography (CT), and technetium-99m macroaggregated albumin ((99m)TcMAA) scintigraphy were used to evaluate the immediate perfusion via intrahepatic collateral channels of target tumor areas previously supplied by parasitized EHAs. Follow-up imaging of differential regional tumor response was used to evaluate microsphere distribution and clinical outcome. After embolization, reestablishment of intrahepatic arterial supply was confirmed by both DSA and C-arm CT in 94% of territories and by scintigraphy in 96%. In 32% of patients, the differential response of treatment could not be evaluated because of uniform disease progression. However, symmetric regional tumor response in 94% of evaluable patients indicated successful delivery of microspheres to the territories previously supplied by parasitized EHAs. Reestablishment of intrahepatic arterial inflow to hepatic tumors by embolization of parasitized EHAs is safe and effective and results in successful delivery of yttrium-90 microspheres to tumors previously perfused by parasitized EHAs.
    Journal of vascular and interventional radiology: JVIR 10/2011; 22(10):1355-62. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Before yttrium-90 ((90)Y) radioembolization administration, the authors consolidated arterial inflow by embolizing variant hepatic arteries (HAs) to make microsphere delivery simpler and safer. The present study reviews the technical and clinical success of these consolidation procedures. Preparatory and treatment angiograms were retrospectively analyzed for 201 patients. Variant HAs were coil-embolized during preparatory angiography to simplify arterial anatomy. Collateral arterial perfusion of territories previously supplied by variant HAs was evaluated by digital subtraction angiography (DSA), C-arm computed tomography (CT), and technetium-99m ((99m)Tc)-macroaggregated albumin (MAA) scintigraphy, and by follow-up evaluation of regional tumor response. A total of 47 variant HAs were embolized in 43 patients. After embolization of variant HAs, cross-perfusion into the embolized territory was depicted by DSA and by C-arm CT in 100% of patients and by (99m)Tc-MAA scintigraphy in 92.7%. Uniform progressive disease prevented evaluation in 33% of patients, but regional tumor response in patients who responded supported successful delivery of microspheres to the embolized territories in 95.5% of evaluable patients. Embolization of variant HAs for consolidation of hepatic supply in preparation for (90)Y radioembolization promotes treatment of affected territories via intrahepatic collateral channels.
    Journal of vascular and interventional radiology: JVIR 10/2011; 22(10):1364-1371.e1. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To prospectively evaluate the impact of C-arm CT on radiation exposure to hepatocellular carcinoma (HCC) patients treated by chemoembolization. Patients with HCC (N = 87) underwent digital subtraction angiography (DSA; control group) or combined C-arm CT/DSA (test group) for chemoembolization. Dose-area product (DAP) and cumulative dose (CD) were measured for guidance and treatment verification. Contrast agent volume and C-arm CT utility were also measured. The marginal DAP increase in the test group was offset by a substantial (50%) decrease in CD from DSA. Use of C-arm CT allowed reduction of DAP and CD from DSA imaging (P = .007 and P = .017). Experienced operators were more efficient in substituting C-arm CT for DSA, resulting in a negligible increase (7.5%) in total DAP for guidance, compared with an increase of 34% for all operators (P = .03). For treatment verification, DAP from C-arm CT exceeded that from DSA, approaching that of conventional CT. The test group used less contrast medium (P = .001), and C-arm CT provided critical or supplemental information in 20% and 17% of patients, respectively. Routine use of C-arm CT can increase stochastic risk (DAP) but decrease deterministic risk (CD) from DSA. However, the increase in DAP is operator-dependent, thus, with experience, it can be reduced to under 10%. C-arm CT provides information not provided by DSA in 33% of patients, while decreasing the use of iodinated contrast medium. As with all radiation-emitting modalities, C-arm CT should be used judiciously.
    Journal of vascular and interventional radiology: JVIR 08/2011; 22(11):1535-43. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Patients with autogenous native vessel portosystemic shunts, whether surgical or congenital, may experience complications of excess shunt flow, including hepatopulmonary syndrome (HPS), hepatic encephalopathy (HE), and hepatic insufficiency. The authors explored endovascular reduction or occlusion of autogenous portosystemic shunts using methods commonly employed in transjugular intrahepatic portosystemic shunt (TIPS) reduction in four pediatric patients. Before treatment, the patients had hypoplastic, atrophic, or thrombosed portal veins. Following intervention, symptoms of overshunting resolved or improved in all patients without major complications. The innate plasticity of the pediatric portal venous system allowed for hypertrophy or development and maturation of cavernous transformations to accommodate increased hepatopetal blood flow and pressure.
    Journal of vascular and interventional radiology: JVIR 08/2011; 22(8):1199-205. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the study was to determine whether women with significant left common iliac vein stenosis who also use combined oral contraceptives (COCs) have a combined likelihood of deep vein thrombosis (DVT) greater than each independent risk. This was a case-control study comparing 35 women with DVT against 35 age-matched controls. Common iliac vein diameters were measured from computed tomography and magnetic resonance imaging. Logistic regression modeling was used with adjustment for risk factors. DVT was associated with COC use (P = .022) and with increasing degrees of common iliac vein stenosis (P = .004). Compared with women without venous stenosis or COC use, the odds of DVT in women with a 70% venous stenosis who also use COCs was associated with a 17-fold increase (P = .01). Venous stenosis and COC use are independent risk factors for DVT. Women concurrently exposed to both have a multiplicative effect resulting in an increased risk of DVT. We recommend further studies to investigate this effect and its potential clinical implications.
    American journal of obstetrics and gynecology 07/2011; 205(6):537.e1-6. · 3.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate the safety and effectiveness of the excimer laser sheath technique for removing embedded inferior vena cava (IVC) filters. Over 12 months, 25 consecutive patients undergoing attempted IVC filter retrieval with a laser-assisted sheath technique were prospectively enrolled into an institutional review board-approved study registry. There were 10 men and 15 women (mean age 50 years, range 20-76 years); 18 (72%) of 25 patients were referred from an outside hospital. Indications for retrieval included symptomatic filter-related acute caval thrombosis (with or without acute pulmonary embolism), chronic IVC occlusion, and bowel penetration. Retrieval was also performed to remove risks from prolonged implantation and potentially to eliminate need for lifelong anticoagulation. After failure of standard methods, controlled photothermal ablation of filter-adherent tissue with a Spectranetics laser sheath and CVX-300 laser system was performed. All patients were evaluated with cavography, and specimens were sent for histologic analysis. Laser-assisted retrieval was successful in 24 (96%) of 25 patients as follows: 11 Günther Tulip (mean 375 days, range 127-882 days), 4 Celect (mean 387 days, range 332-440 days), 2 Option (mean 215 days, range 100-330 days), 4 OPTEASE (mean 387 days, range 71-749 days; 1 failed 188 days), 2 TRAPEASE (mean 871 days, range 187-1,555 days), and 2 Greenfield (mean 12.8 years, range 7.2-18.3 years). There was one (4%) major complication (acute thrombus, treated with thrombolysis), three (12%) minor complications (small extravasation, self-limited), and one adverse event (coagulopathic retroperitoneal hemorrhage) at follow-up (mean 126 days, range 13-302 days). Photothermal ablation of filter-adherent tissue was histologically confirmed in 23 (92%) of 25 patients. The laser-assisted sheath technique appears to be a safe and effective tool for retrieving embedded IVC filters, including permanent types, with implantation ranging from months to > 18 years.
    Journal of vascular and interventional radiology: JVIR 06/2011; 22(6):813-23. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We evaluated the safety and effectiveness of alternative endovascular methods to retrieve embedded optional and permanent filters in order to manage or reduce risk of long-term complications from implantation. Histologic tissue analysis was performed to elucidate the pathologic effects of chronic filter implantation. We studied the safety and effectiveness of alternative endovascular methods for removing embedded inferior vena cava (IVC) filters in 10 consecutive patients over 12 months. Indications for retrieval were symptomatic chronic IVC occlusion, caval and aortic perforation, and/or acute PE (pulmonary embolism) from filter-related thrombus. Retrieval was also performed to reduce risk of complications from long-term filter implantation and to eliminate the need for lifelong anticoagulation. All retrieved specimens were sent for histologic analysis. Retrieval was successful in all 10 patients. Filter types and implantation times were as follows: one Venatech (1,495 days), one Simon-Nitinol (1,485 days), one Optease (300 days), one G2 (416 days), five Günther-Tulip (GTF; mean 606 days, range 154-1,010 days), and one Celect (124 days). There were no procedural complications or adverse events at a mean follow-up of 304 days after removal (range 196-529 days). Histology revealed scant native intima surrounded by a predominance of neointimal hyperplasia and dense fibrosis in all specimens. Histologic evidence of photothermal tissue ablation was confirmed in three laser-treated specimens. Complex retrieval methods can now be used in select patients to safely remove embedded optional and permanent IVC filters previously considered irretrievable. Neointimal hyperplasia and dense fibrosis are the major components that must be separated to achieve successful retrieval of chronic filter implants.
    CardioVascular and Interventional Radiology 05/2011; 35(3):588-97. · 2.09 Impact Factor
  • Journal of vascular and interventional radiology: JVIR 04/2011; 22(4):575-7. · 1.81 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To test the hypothesis that a common iliac vein (CIV) stenosis may impair embolization of a large deep venous thrombosis (DVT) to the lungs, decreasing the incidence of a symptomatic pulmonary embolism (PE). Between January 2002 and August 2007, 75 patients diagnosed with unilateral DVT were included in a single-institution case-control study. Minimum CIV diameters were measured 1 cm below the inferior vena cava (IVC) bifurcation on computed tomography (CT) images. A significant stenosis in the CIV ipsilateral to the DVT was defined as having either a diameter 4 mm or less or a greater than 70% reduction in lumen diameter. A symptomatic PE was defined as having symptoms and imaging findings consistent with a PE. The odds of symptomatic PE versus CIV stenosis were assessed using logistic regression models. The associations between thrombus location, stenosis, and symptomatic PE were assessed using a stratified analysis. Of 75 subjects, 49 (65%) presented with symptomatic PE. There were 17 (23%) subjects with a venous lumen 4 mm or less and 12 (16%) subjects with a greater than 70% stenosis. CIV stenosis of 4 mm or less resulted in a decreased odds of a symptomatic PE compared with a lumen greater than 4 mm (odds ratio [OR] 0.17, P = .011), whereas a greater than 70% stenosis increased the odds of DVT involving the CIV (OR 7.1, P = .047). Among patients with unilateral DVT, those with an ipsilateral CIV lumen of 4 mm or less have an 83% lower risk of developing symptomatic PE compared with patients with a CIV lumen greater than 4 mm.
    Journal of vascular and interventional radiology: JVIR 02/2011; 22(2):133-41. · 1.81 Impact Factor
  • William T Kuo, Lawrence V Hofmann
    Journal of vascular and interventional radiology: JVIR 11/2010; 21(11):1776-7. · 1.81 Impact Factor

Publication Stats

297 Citations
118.55 Total Impact Points

Institutions

  • 2010–2013
    • Vascular and Interventional Radiology
      Chicago, Illinois, United States
  • 2008–2013
    • Stanford Medicine
      • • Division of Interventional Radiology
      • • Department of Radiology
      • • Department of Surgery
      Stanford, California, United States
  • 2006–2013
    • Stanford University
      • • Division of Interventional Radiology
      • • Department of Radiology
      Palo Alto, CA, United States
  • 2012
    • Weill Cornell Medical College
      New York City, New York, United States