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Erin H. Murphy, MD, Frank R. Arko, MD, Clayton K

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1 Volume associated dynamic geometry and spatial orientation of the inferior vena cava 
Erin H. Murphy, MD, Frank R. Arko, MD, Clayton K. Trimmer, DO, Varinder S. Phangureh, BS, Thomas J. Fogarty, MD, Christopher K. Zarins, MD  Journal of Vascular Surgery  Volume 50, Issue 4, Pages (October 2009) DOI: /j.jvs Copyright © 2009 Society for Vascular Surgery Terms and Conditions

2 Fig 1 Diameters were measured in the minor and major axis at 1 and 5 cm below the lowest renal vein on orthonormal axial computed tomographic (CT) images. Lumen was bounded and area assessed. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

3 Fig 2 Volume of the infrarenal inferior vena cava (IVC) segment was calculated from areas and diameters according to Smalian's formula for calculating the volume of a tapered elliptical cylinder [V = (A1 + A2)/2 × L]. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

4 Fig 3 On standard computed tomographic (CT) axial images, the obliquity of the infrarenal inferior vena cava (IVC) was measured as the angle of the major axis (a) from the horizontal (b). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

5 Fig 4 Utilizing the standard axial computed tomographic (CT) image, we assumed the venographic diameter to be equivalent to the horizontal line as this is the view that would be seen on standard anterior-posterior view seen under fluoroscopy. However, angle-corrected orthonormal views on CT would be the true representation of the major axis. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

6 Fig 5 Anisotropic movement of the inferior vena cava (IVC). Greater expansion of the minor axis, compared with the major axis, was seen in all patients in response to volume expansion of the infrarenal segment of the IVC. Each row above contains images from a single patient in the hypovolemic (image left) and fluid resuscitated (image middle) states. The schematics to the far right demonstrate the magnitude of change experienced by each patient's IVC in the minor and major axes in response to changes in intravascular volume (blue: hypovolemic; red: fluid resuscitated). Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

7 Fig 6 Anisotropic movement of the inferior vena cava (IVC). Images above represent the same individual's IVC in the hypovolemic (images left) and resuscitated (images right) states. When looking at the frontal view of the IVC, which visualizes a reflection of the major axis, the IVC looks identical in the hypovolemic and resuscitated states. However, when looking at the lateral view, which visualizes a reflection of the minor axis, it is observed that, in fact, the minor axis of the IVC is collapsed during hypovolemia and expanded after initial resuscitation. This anisotropic movement is also seen in the axial images obtained at 1 cm (images above) and 5 cm (images below) below the renal veins. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

8 Fig 7 Obliquity of the inferior vena cava (IVC). The major axis of the IVC was oriented left-anterior oblique in all patients. Each row above represents the infrarenal IVC of one patient, at the same location, on admission (image left) and follow-up (image right) computed tomographic (CT) imaging. Note that the orientation of the infrarenal IVC remains constant in both patients, regardless of apparent increases in intravascular volume status between scans. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

9 Fig 8 Venographic diameters. Representations of the maximum diameter of the inferior vena cava (IVC), as would be seen on standard anterior-posterior venogram, were compared with measurements of the maximum diameter of the IVC in the major axis on orthonormal axial computed tomographic (CT) images. Due to the oblique lie of the IVC, the venographic representations consistently undersized the IVC, compared with the true maximum IVC dimensions. Journal of Vascular Surgery  , DOI: ( /j.jvs ) Copyright © 2009 Society for Vascular Surgery Terms and Conditions

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