Related Experiment Video
Updated: Aug 6, 2026
Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
Preoperative Ultrasonographic Assessment of Caval-Aortic Index and Inferior Vena Cava Collapsibility Index for
Enes Eskin1, Ali Sait Kavakli2, Firdevs Pelin Eskin3
1Department of Anesthesiology and Reanimation, Antalya City Hospital, Antalya, Turkey.
Objectives:
This study aimed to compare the predictive performance of the inferior vena cava collapsibility index (IVC-CI) and the caval-aortic (IVC:Ao) index for postinduction hypotension.
Design:
Prospective observational study.
Setting:
Tertiary care university hospital.
Participants:
One hundred adult patients scheduled for elective surgery under general anesthesia.
Interventions:
Before anesthetic induction, ultrasonographic measurements of the inferior vena cava and abdominal aorta were obtained in the supine position. The IVC-CI and IVC:Ao index were calculated using standard definitions. Mean arterial pressures were recorded every 2 minutes for 10 minutes following induction of anesthesia.
Measurements And Main Results:
Postinduction hypotension occurred in 68 patients (68%). The IVC:Ao index demonstrated excellent discriminative performance (area under the curve [AUC], 0.971; 95% confidence interval [CI], 0.916-0.994) and significantly outperformed the IVC-CI (AUC, 0.846; 95% CI, 0.760-0.910; p = 0.025). An IVC:Ao index cutoff value ≤1.1 yielded a sensitivity of 94.1% and a specificity of 93.8%, with a narrow gray zone (values yielding both sensitivity and specificity <90%) including 10% of patients, compared with 53% for the IVC-CI. In multivariable analyses, each 0.1-unit decrease in the IVC:Ao index was associated with increased odds of hypotension (odds ratio, 4.95; 95% CI, 2.43-10.09; p < 0.001). Similarly, each 10-point increase in the IVC-CI was independently associated with hypotension (odds ratio, 6.17; 95% CI, 2.66-14.31; p < 0.001).
Conclusions:
Preoperative ultrasonographic assessment of the IVC:Ao index provides superior predictive performance and a substantially narrower gray zone compared with the IVC-CI for identifying patients at risk of postinduction hypotension.
