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Ju Z, Chen W, Min X, Dai K, Zheng H, Qiu J. Acute right extremity deep vein thrombosis and left-sided inferior vena cava thrombosis treated by percutaneous mechanical thrombectomy (PMT) combined with catheter directed thrombolysis (CDT): A case report. Medicine (Baltimore) 2024; 103:e37849. [PMID: 38640270 PMCID: PMC11029992 DOI: 10.1097/md.0000000000037849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/02/2024] [Accepted: 03/20/2024] [Indexed: 04/21/2024] Open
Abstract
INTRODUCTION Left-sided inferior vena cava (IVC) is an uncommon condition with a prevalence rate of 0.2% to 0.5%. Most of them remain asymptomatic and are discovered incidentally. The patient condition in this case is critical, and conventional procedures are not applicable. The surgical approach being considered is innovative, but it carries significant risks and uncertain therapeutic efficacy. PATIENT CONCERNS A 42-year-old male presented with acute right lower extremity pain with swelling for 2 days. DIAGNOSIS The patient was subsequently diagnosed with acute right lower extremity deep vein thrombosis, inferior vena cava thrombosis, and a left-sided IVC. INTERVENTIONS Based on the treatment guidelines for lower extremity deep venous thrombosis. OUTCOMES We successfully cured him with percutaneous mechanic thrombectomy (PMT) combined with catheter directed thrombolysis (CDT). CONCLUSION AND SIGNIFICANCE The relatively low incidence of left-sided IVC does not diminish the significance of its identification. PMT combined with CDT is a safe way to treat acute thrombosis. It provides a new approach for similar patients in the future.
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Affiliation(s)
- Zhinan Ju
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Wei Chen
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Xixi Min
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Kanghui Dai
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Henan Zheng
- Medical College of Nanchang University, Nanchang, Jiangxi Province, P.R.China
| | - Jiehua Qiu
- Department of Vascular Surgery, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, P.R.China
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Manjatika AT, Mazengenya P, Davimes JG. Bilateral duplicated inferior vena cava associated with aberrant internal iliac and gonadal veins: A case-based narrative review. Ann Anat 2024; 253:152223. [PMID: 38295909 DOI: 10.1016/j.aanat.2024.152223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/09/2023] [Accepted: 01/25/2024] [Indexed: 02/05/2024]
Abstract
BACKGROUND The left side anterior retroperitoneal approach is preferred for the management of lumbosacral spine disorders as there is reduced risk for vascular injury. The presence of multiple and uncommon venous variations on either side of the spine, like the bilateral duplicated inferior vena cava (DIVC), may complicate surgery in this region. The current study describes two rare cases of bilateral duplicated inferior vena cava associated with internal iliac and gonadal veins. METHODS The cases were identified during routine human dissections of the posterior abdominal wall of 89 (45 males, 44 females) individuals. The course, relations and morphometry of each duplicated inferior vena cava were examined and recorded. RESULTS Two (2.2%) of the 89 (1 male, 1 female) dissected individuals showed the presence of bilateral duplicated infrarenal segments of the inferior vena cava. In both cases, the pre-aortic trunk (vein) was the largest and the left inferior vena cava was the smallest. Both cases of bilateral DIVC presented with anomalous interiliac communicating veins, internal iliac veins, and drainage sites of the left gonadal veins. CONCLUSIONS The duplicated inferior vena cava may present with associated venous anomalies like those related to the gonadal and internal iliac veins. Knowledge of the duplicated inferior vena cava and its associated venous anomalies may be essential for accurately identifying and diagnosing vascular dysfunction and improving radiological interpretation across multiple surgical specialities.
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Affiliation(s)
- Arthur Tsalani Manjatika
- School of Anatomical Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa; School of Life Sciences, Anatomy Division, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Pedzisai Mazengenya
- College of Medicine, Ajman University, Ajman, United Arab Emirates; Center of Medical and Bio-allied Health Sciences Research, Ajman University, Ajman, United Arab Emirates; Faculty of Health Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa.
| | - Joshua Gabriel Davimes
- School of Anatomical Sciences, University of the Witwatersrand, Parktown, Johannesburg, South Africa
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3
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Higashi Y, Togami S, Kobayashi H. Para-aortic lymphadenectomy in endometrial cancer patients with left-sided inferior vena cava: A case report and literature review. Taiwan J Obstet Gynecol 2024; 63:98-102. [PMID: 38216280 DOI: 10.1016/j.tjog.2023.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/22/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE The incidence of left-sided inferior vena cava (IVC) is extremely low. However, without a preoperative diagnosis of left-sided IVC, the risk of intraoperative vascular injury during para-aortic lymph node (PAN) lymphadenectomy is high. CASE REPORT Herein, we present two cases in which left-sided IVCs were diagnosed using preoperative imaging. PAN lymphadenectomies were safely performed in these patients with endometrial cancer. In the first case, the left-sided IVC crossed the abdominal aorta after the left renal and gonadal veins had drained into it and joined the right renal vein. In the second case, the left-sided IVC crossed the abdominal aorta after the left renal and gonadal veins flowed into it and the ascending lumbar vein flowed into the right side. CONCLUSION These cases demonstrate that even in the presence of vascular malformations, PAN lymphadenectomy can be performed safely by employing preoperative anatomical imaging analysis and judicious intraoperative surgical maneuvers to avoid vascular injury.
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Affiliation(s)
- Yuriko Higashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
| | - Shinichi Togami
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan.
| | - Hiroaki Kobayashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, 8-35-1 Sakuragaoka, Kagoshima 890-8520, Japan
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Sharma A, Bhatia H, Naganur SH, Singhal M. Complete Duplication of Inferior Vena Cava Coexisting with Double Superior Vena Cava In Situ Solitus: Hitherto Unreported Pattern. Indian J Radiol Imaging 2024; 34:177-180. [PMID: 38106868 PMCID: PMC10723943 DOI: 10.1055/s-0043-1775796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023] Open
Abstract
Congenital anomalies of inferior vena cava are increasingly being recognized with the technical advancements and increased utilization of cross-sectional imaging techniques. Duplication of inferior vena cava classically involves duplication of the infrarenal segment, where both inferior vena cava ascend on either side of the abdominal aorta until they form a confluence at the level of the renal veins. It has been extensively described in literature with few reports of more complex variation in the form of duplicated infrarenal inferior vena cava with azygos or hemiazygos continuation. This article describes extremely rare complete duplication of inferior vena cava involving both suprarenal and infrarenal segments. Moreover, the complete duplication of inferior vena cava is seen in association with concomitant double superior vena cava, in a patient with visceroatrial situs solitus and associated congenital heart disease, which to the best of our knowledge, has not been reported so far in literature. This study also highlights the utility of multidetector computed tomography in accurate identification of such anomalies.
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Affiliation(s)
- Arun Sharma
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimran Bhatia
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Manphool Singhal
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Schoephoerster CT, Rajaei MH, Gonzalez LS, Brown KR, Mitchell ME, Rossi PJ. Left-sided Inferior Vena Cava Implications for Cardiopulmonary Bypass Cannulation in Open Thoracoabdominal Aortic Aneurysm Repair. J Vasc Surg Cases Innov Tech 2023; 9:101166. [PMID: 37152906 PMCID: PMC10160780 DOI: 10.1016/j.jvscit.2023.101166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/28/2023] [Indexed: 03/31/2023] Open
Abstract
A left-sided inferior vena cava poses a unique challenge when cannulating for cardiopulmonary bypass during thoracoabdominal aortic aneurysm repair, and how to effectively and safely do so has not been previously described. A 51-year-old woman with a history of Loeys-Dietz syndrome and a left-sided inferior vena cava underwent open Crawford extent II thoracoabdominal aortic aneurysm repair. Cardiopulmonary bypass cannulation was performed using the right axillary artery, left common femoral artery, and right internal jugular vein. The patient's repair was successful, and she was ultimately discharged back to her home.
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6
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Moosavi J, Sadeghipour P, Mohebbi B, Rezaei-Kalantari K, Khalilipur E. A rare case of left inferior vena cava presenting with May-Thurner syndrome. CVIR Endovasc 2022; 5:31. [PMID: 35776262 PMCID: PMC9249960 DOI: 10.1186/s42155-022-00305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/07/2022] [Indexed: 11/21/2022] Open
Abstract
Background May–Thurner anomaly is characterized as external venous compression by the arterial framework against hard bony structures. This chronic anatomical lesion infrequently leads to deep vein thrombosis in the lower extremity, and it may lead to leg swelling as a long-term post-thrombotic complication. Left iliac vein compression may not be as uncommon as was previously thought, and it typically occurs in women more than men. Congenital anomalies of venous tree are not rare; they exist in 8.7% of the general population. Case-presentation We herein present the first case of right-sided May Thurner Syndrome in a patient with IVC anomalies. In our patient, both common iliac veins formed the left-sided IVC, which extended to the hemiazygos vein and the superior vena cava. Additionally, there was a right-sided suprarenal IVC, which extended to the right atrium. Conclusion Understanding the proper anatomy in May-Thurner syndrome helps in better decision making for management of disease pathophysiology.
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Li WR, Feng H, Jin L, Chen XM, Zhang ZW. Duplication of the inferior vena cava: a case series. J Int Med Res 2022; 50:3000605221100771. [PMID: 35607249 PMCID: PMC9134440 DOI: 10.1177/03000605221100771] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
The inferior vena cava (IVC) may develop abnormally because of its complex embryogenesis. An understanding of congenital variants such as duplication of the IVC is essential for clinical interventions, particularly those performed by surgeons and radiologists. We herein describe five patients who were diagnosed with duplication of the IVC by computed tomography or angiography and summarize their imaging and clinical features. All five patients were men aged 46 to 78 years. Two of the patients had pulmonary embolism and deep vein thrombosis and were treated by placement of an IVC filter and catheter-directed thrombolysis. The IVC in all patients ascended on either side of the abdominal aorta. All left IVCs terminated in the left renal vein, which crossed the aorta and joined the right IVC. The average follow-up time was 29 months (range, 14-46 months), and no patients developed venous thromboembolism or recurrence of thrombosis. Duplication of the IVC can be diagnosed by computed tomography and angiography. Its course and relationship with the renal vein must be identified for accurate planning of IVC filter placement in the setting of deep vein thrombosis and pulmonary embolism.
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Affiliation(s)
- Wen-rui Li
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
| | - Hai Feng
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
| | - Lei Jin
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
| | - Xue-ming Chen
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
| | - Zhi-wen Zhang
- Department of Vascular Surgery, Beijing Friendship
Hospital, Capital Medical University, Beijing 100050, China
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Das D, Das T, Pramanik S. An unusual association of left-sided inferior vena cava with slow-fast atrioventricular reentrant tachycardia. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_46_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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9
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Jiang L, Yang CF, Lin J. Filter implantation for double inferior vena cava: A case report and literature review. World J Emerg Med 2021; 12:332-334. [PMID: 34512835 DOI: 10.5847/wjem.j.1920-8642.2021.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 07/10/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lei Jiang
- Department of Emergency, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
| | - Chuan-Feng Yang
- Department of Emergency, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
| | - Jie Lin
- Department of Emergency, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Yiwu 322000, China
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10
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Nabri M, Alromaih NJ, Othman SA, Alghusnah ES, Abu Al Ola H, Elbagir A, Nasr AO. Blunt Abdominal Trauma Leading to an Incidental Finding of Duplicate Inferior Vena Cava (DIVC): A Case Report and Literature Review. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e929198. [PMID: 34061818 PMCID: PMC8183301 DOI: 10.12659/ajcr.929198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND With a prevalence of about 2% to 3%, duplication is the most common anomaly associated with the inferior vena cava (IVC). In general, systemic venous anomalies are being more frequently diagnosed in asymptomatic patients. We report the case of a young man with an incidental finding of an asymptomatic duplicated IVC, along with a literature review. CASE REPORT A 36-year-old man was brought to our Emergency Department (ED) following a high-speed motor vehicle collision (MVC), reporting right flank and hip pain. Upon examination, the "seatbelt sign" was noticed, along with abrasions over his right side. He sustained a small-bowel mesenteric injury, for which he was admitted and was treated conservatively. A CT scan incidentally revealed a duplicate IVC (DIVC). He later underwent a laparotomy with limited right hemi-colectomy and was discharged home in good condition. CONCLUSIONS Undiscovered and asymptomatic DIVCs pose a potential risk to patients during clinical interventions. Advancements in diagnostic imaging contribute greatly to the incidental discoveries of inferior vena cava duplication.
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Affiliation(s)
- Mamoun Nabri
- Department of General Surgery, King Fahad Hospital of University, College of Medicine, and Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Norah J Alromaih
- Department of General Surgery, King Fahad Hospital of University, College of Medicine, and Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Sharifah A Othman
- Department of General Surgery, King Fahad Hospital of University, College of Medicine, and Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Elham S Alghusnah
- Department of General Surgery, King Fahad Hospital of University, College of Medicine, and Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Hossain Abu Al Ola
- Department of Radiology, King Fahad Hospital of University, College of Medicine, and Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Adel Elbagir
- Department of General Surgery, King Fahad Hospital of University, College of Medicine, and Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Ayman O Nasr
- Department of General Surgery, King Fahad Hospital of University, College of Medicine, and Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
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Charach R, Cohen SM, Yagel S, Valsky DV. It takes two great vessels to tango: fetal nutcracker phenomenon. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2021; 57:1017-1019. [PMID: 33524214 DOI: 10.1002/uog.23602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Affiliation(s)
- R Charach
- Fetal Medicine & Ultrasound Unit, Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S Yagel
- Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D V Valsky
- Fetal Medicine & Ultrasound Unit, Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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12
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Zhang L, Guan WK. Deep vein thrombosis in patient with left-sided inferior vena cava draining into the hemiazygos vein: A case report. World J Clin Cases 2021; 9:672-676. [PMID: 33553407 PMCID: PMC7829718 DOI: 10.12998/wjcc.v9.i3.672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 11/22/2020] [Accepted: 12/06/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Abnormalities of the inferior vena cava (IVC) are uncommon, and in many cases they are asymptomatic. Even so, it is vital that clinicians be aware of such anomalies prior to surgery in affected individuals. In the present report, we describe a rare anatomical variation of the IVC.
CASE SUMMARY A 66-year-old male was admitted to the hospital due to deep vein thrombosis of the right lower extremity. Upon contrast-enhanced computed tomography imaging, we found that this patient presented with a case of left-sided IVC draining into the hemiazygos vein, while his hepatic vein was directly draining into the atrium.
CONCLUSION Cases of left-sided IVC can increase patient susceptibility to thromboembolism owing to the resultant changes in blood flow and/or associated vascular compression.
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Affiliation(s)
- Li Zhang
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou 635000, Sichuan Province, China
| | - Wei-Kang Guan
- Department of Vascular Surgery, Dazhou Central Hospital, Dazhou 635000, Sichuan Province, China
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13
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Rossi FH, Rodrigues TO, Izukawa NM, Kambara AM. Best practices in diagnosis and treatment of chronic iliac vein obstruction. J Vasc Bras 2020; 19:e20190134. [PMID: 34290748 PMCID: PMC8276648 DOI: 10.1590/1677-5449.190134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Accepted: 05/15/2020] [Indexed: 11/24/2022] Open
Abstract
Iliac vein obstruction occurs in 20-30% of the general population. In patients with severe chronic venous insufficiency, this prevalence can be even higher, reaching 50-90% when the obstruction is investigated using intravascular ultrasound. Less invasive methods, such as venous Duplex Scanning, and even invasive ones such as venography may fail to diagnose the condition. Endovascular treatment of these obstructions is effective, safe, and associated with excellent clinical outcomes and stent patency rates, provided that fundamental anatomical and technical principles are considered and applied.
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Affiliation(s)
- Fabio Henrique Rossi
- Instituto Dante Pazzanese de Cardiologia de São Paulo - IDPC-SP, São Paulo, SP, Brasil
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14
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Wu WW, Sharma G, Menard MT. Anterior nutcracker syndrome in the setting of a duplicated inferior vena cava. JOURNAL OF VASCULAR SURGERY CASES INNOVATIONS AND TECHNIQUES 2020; 6:121-125. [PMID: 32095671 PMCID: PMC7033460 DOI: 10.1016/j.jvscit.2020.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 01/12/2020] [Indexed: 12/24/2022]
Abstract
Nutcracker syndrome is a rare vascular disorder that involves compression of the left renal vein (LRV), most often at the level of the aortomesenteric angle. In some cases, this compression syndrome arises in the setting of unusual vascular anatomic variants. We describe the case of a 43-year-old woman with a duplicated inferior vena cava who was found to have LRV compression on magnetic resonance angiography and venography with intravascular ultrasound. The patient was successfully treated with concurrent transposition of the LRV and left-sided inferior vena cava, with complete resolution of symptoms.
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Affiliation(s)
- Winona W Wu
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.,Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Mass
| | - Gaurav Sharma
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass
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15
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Liu C, Zhai J, Yuan Q, Zhang Y, Xu H. A patient with left-sided inferior vena cava who received oblique lumbar interbody fusion surgery: a case report. J Med Case Rep 2020; 14:21. [PMID: 31983346 PMCID: PMC6983968 DOI: 10.1186/s13256-020-2342-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 01/02/2020] [Indexed: 12/29/2022] Open
Abstract
Background Oblique lateral interbody fusion surgery has become increasingly popular for lumbar degenerative diseases. The oblique corridor is between the psoas muscle and the retroperitoneal vessels, and its use could result in decreased tissue trauma, minimal blood loss, and short operation times. Patients who undergo oblique lateral interbody fusion surgery are always placed in the right lateral position to avoid damage to the inferior vena cava, which is typically a right-sided vessel. There is a substantial risk of vascular injury during the operation if there are anatomical variations in the vessels. Case presentation A 77-year-old man, of the Han nationality, with lumbar spinal stenosis underwent stand-alone oblique lateral interbody fusion surgery. Transverse magnetic resonance imaging of the lumbar spine indicated that his inferior vena cava was left-sided. A three-dimensional reconstructed image of abdominal computed tomography angiography showed that the inferior vena cava was located on the left side. Finally, the surgeon decided to change the position of our patient from a right lateral position to a left lateral position before the surgery. Conclusions To date, this is the first reported case where a patient underwent oblique lateral interbody fusion surgery in a left lateral decubitus position due to a left-sided inferior vena cava. This case demonstrates that carefully reading radiological results is important for operation planning and avoiding anatomical complications.
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Affiliation(s)
- Chen Liu
- Spine Research Center of Wannan Medical College, Wuhu, 241001, Anhui, China.,Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China
| | - Jian Zhai
- Department of Radiology, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China
| | - Quan Yuan
- Department of Radiology, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China
| | - Yu Zhang
- Spine Research Center of Wannan Medical College, Wuhu, 241001, Anhui, China.,Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China
| | - Hongguang Xu
- Spine Research Center of Wannan Medical College, Wuhu, 241001, Anhui, China. .,Department of Orthopaedics, Yijishan Hospital of Wannan Medical College, No. 2 Zheshan West Road, Wuhu, 241001, Anhui, China.
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16
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Cattell-Braasch Maneuver: A Gadget to Manipulate Abdominal Aortic Aneurysm in a Patient with a Left-Sided Inferior Vena Cava. Case Rep Surg 2019; 2019:9789670. [PMID: 31929935 PMCID: PMC6939422 DOI: 10.1155/2019/9789670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 12/02/2019] [Accepted: 12/04/2019] [Indexed: 11/28/2022] Open
Abstract
A 76-year-old man was diagnosed with abdominal aortic aneurysm and a left-sided inferior vena cava. He underwent open surgery, and we employed the Cattell-Braasch maneuver to approach the abdominal aortic aneurysm from the right side. This enabled securing of the abdominal aortic aneurysm neck without mobilizing or dissecting the inferior vena cava. His postoperative course was uneventful. Although abdominal aortic aneurysm is typically approached from the left side in open surgery, approaching from the right side is beneficial in patients with abdominal aortic aneurysm and a left-sided inferior vena cava.
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17
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Mukai Y, Nozawa S, Suzuki T. Double venous compression due to duplicated inferior vena cava-induced right common iliac vein thrombosis. BMJ Case Rep 2018; 2018:bcr-2017-223610. [PMID: 29627780 DOI: 10.1136/bcr-2017-223610] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Venous compression syndromes are caused by extrinsic venous compression of anatomical structures, such as the adjacent arteries and bones. Chronic venous compression and pulsative vibratory arterial pressure accelerate the development of deep vein thrombosis. Herein, we report the first case of double venous compressions due to a duplicated inferior vena cava-induced right-sided common iliac vein thrombosis. The thrombus was induced by left-sided inferior vena cava entrapment and right-sided common iliac vein compression, resembling nutcracker syndrome and May-Thurner syndrome, respectively. Bypass flow of the right inferior vena cava rendered the right lower extremity asymptomatic. Once daily anticoagulation edoxaban was effective. Congenital venous anomalies and bypass formations should be considered when a common iliac vein thrombus without symptoms in the lower extremities is observed, and a lifelong periodical follow-up is mandatory, even after remission.
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Affiliation(s)
- Yuichi Mukai
- Department of Respiratory Medicine, National Hospital Organization Matsumoto Medical Center, Matsumoto, Nagano, Japan
| | - Shuhei Nozawa
- Department of Respiratory Medicine, National Hospital Organization Matsumoto Medical Center, Matsumoto, Nagano, Japan
| | - Toshiro Suzuki
- Department of Respiratory Medicine, National Hospital Organization Matsumoto Medical Center, Matsumoto, Nagano, Japan
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Liu Y, Guo D, Li J, Zhang X, He J, Huang M, Dai J, Cai H. Radiological features of azygos and hemiazygos continuation of inferior vena cava: A case report. Medicine (Baltimore) 2018; 97:e0546. [PMID: 29703035 PMCID: PMC5944491 DOI: 10.1097/md.0000000000010546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
RATIONALE Azygos and hemiazygos continuation of the inferior vena cava (IVC) is uncommon. It is rare especially when it is not associated with congenital heart disease or deep venous thrombosis. PATIENT CONCERNS We report an interesting case of an interstitial lung disease with an interrupted IVC with azygous and hemiazygos continuation. A 67-year-old man suffered from cough and shortness of breath. DIAGNOSES Computed tomography revealed absence of the hepatic segment of the IVC with azygos and hemiazygos continuation. The patient did not have congenital anomalies of the remaining thoracoabdominal vasculature and viscera. The diagnosis of azygos and hemiazygos continuation of IVC was made by inferior venacavography. INTERVENTIONS There was no significant association between interstitial lung disease and expanded azygos and hemiazygos veins. The patient was treated with corticosteroids. OUTCOMES After 6 months of follow-up, the patient was asymptomatic. LESSONS It is important to recognize the enlarged azygos vein at the confluence with the superior vena cava and in the retrocrural space to avoid misdiagnosis as a right-sided paratracheal mass or retrocrural adenopathy.
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Affiliation(s)
| | - Dan Guo
- Department of General Medicine
| | | | - Xuebin Zhang
- Department of Radiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
| | - Jian He
- Department of Radiology, Drum Tower Hospital, Nanjing University Medical School, Nanjing, China
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Shiraishi J, Okawa K, Muguruma K, Ito D, Kimura M, Kishita E, Nakagawa Y, Hyogo M, Takahashi A, Sawada T. Quadricuspid Aortic Valve Complicated with Severe Aortic Regurgitation and Left-Sided Inferior Vena Cava. J Cardiovasc Ultrasound 2017; 25:34-37. [PMID: 28400934 PMCID: PMC5385316 DOI: 10.4250/jcu.2017.25.1.34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 03/02/2017] [Accepted: 03/02/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Kazunari Okawa
- Department of Cardiovascular Surgery, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Kohei Muguruma
- Department of Emergency Medicine, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Daisuke Ito
- Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Masayoshi Kimura
- Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Eigo Kishita
- Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Yusuke Nakagawa
- Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Masayuki Hyogo
- Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Akiyuki Takahashi
- Department of Cardiovascular Surgery, Kyoto First Red Cross Hospital, Kyoto, Japan
| | - Takahisa Sawada
- Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan
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Levack MM, Keshavamurthy S, Schoenhagen P, Johnston DR. Management of a duplicated inferior vena cava in thoracoabdominal aortic aneurysm repair. J Thorac Cardiovasc Surg 2016; 153:e39-e41. [PMID: 27919457 DOI: 10.1016/j.jtcvs.2016.10.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 10/05/2016] [Accepted: 10/13/2016] [Indexed: 10/20/2022]
Affiliation(s)
- Melissa M Levack
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Suresh Keshavamurthy
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Paul Schoenhagen
- Department of Radiology, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
| | - Douglas R Johnston
- Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
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Kim MH, Jun KW, Moon IS, Kim JI. Clinical importance of congenital anomalies of the inferior vena cava in organ procurement surgery from a deceased donor: two case reports. Ann Surg Treat Res 2016; 91:260-264. [PMID: 27847799 PMCID: PMC5107421 DOI: 10.4174/astr.2016.91.5.260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 03/31/2016] [Accepted: 05/16/2016] [Indexed: 12/04/2022] Open
Abstract
Congenital anomalies of the inferior vena cava (IVC) are rare but important problems in living donors for kidney transplantation, especially in cases of a short left renal vein and accompanying vascular and urological anatomic variations. However, the clinical impacts of IVC anomalies in deceased donors have yet to be reported. The unexpected presence of an IVC in an unusual position poses challenges to surgeons and increases the risk of bleeding during organ removal. Accompanying vascular variations can cause unexpected bleeding and injury and therefore technical complications in procurement and subsequent implantation. During cold perfusion, inadequate venous drainage or insufficient cooling can induce graft damage. Our cases highlight the need for all transplant surgeons to confirm the anatomy of the aorta, IVC, and major vessels early in the surgical procedure and, should an anomaly be detected, know how to manage the problem.
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Affiliation(s)
- Mi-Hyeong Kim
- Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Woong Jun
- Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In-Sung Moon
- Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ji-Il Kim
- Division of Vascular and Transplantation Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Nayak SB, Surendran S, Nelluri VM, Kumar N, Aithal AP. A South Indian Cadaveric Study About the Relationship of Hepatic Segment of Inferior Vena Cava with the Liver. J Clin Diagn Res 2016; 10:AC04-7. [PMID: 27656424 DOI: 10.7860/jcdr/2016/19892.8295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/24/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Inferior Vena Cava (IVC) is the largest vein of the body. It runs vertically upwards in the abdomen, behind the liver. Its course is very constant in relation to liver. However, the amount of liver parenchyma related to it can vary from person to person. The data regarding its course and relations may be very useful to radiologists and surgeons during surgical treatment procedures for Budd-Chiari syndrome, liver carcinoma, liver transplant, venous cannulations and many other clinical procedures. AIM Aim of this study was to document the incidence of straight and curved course of IVC in relation to liver and also to note the pattern in which the liver tissue was related to the IVC. MATERIALS AND METHODS In the current study, 95 adult cadaveric livers were observed; specifically to study the course/direction of the hepatic segment of IVC in relation to the liver. The extent of liver tissue related to various aspects of IVC was also studied. The course of the IVC was classified as straight and curved; and the relationship of liver parenchyma to the IVC was classified into 6 categories. The data was expressed as percentage incidence. RESULTS In 78.94% cases, the IVC had a straight course in relation to the liver; whereas in 21.06% cases, it had a left sided curve (concavity of the curve towards the caudate lobe) in its course. In 6.31% cases, IVC travelled in a tunnel, being encircled by the liver parenchyma all around; in 36.84% cases, it was covered by liver parenchyma on front and sides so that only posterior surface of IVC was visible; in 3.15% cases it was covered by liver tissue on front, sides and also partly on posterior aspect; in 50.52% of cases, its anterior surface, sides and left edge of the posterior surface was covered by liver tissue; and in 3.15% cases it was covered only from the front by the liver tissue. CONCLUSION The data being reported here might be useful for surgeons while planning and executing various hepatic surgeries and also to the radiologists in planning and performing venous cannulation and therapeutic procedures. Since in many livers, the curvature of IVC was associated with enlarged caudate lobe, the curved IVC could hint about the increase in the volume of caudate lobe or liver itself.
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Affiliation(s)
- Satheesha B Nayak
- Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
| | - Sudarshan Surendran
- Associate Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
| | - Venu Madhav Nelluri
- Senior Grade Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
| | - Naveen Kumar
- Assistant Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
| | - Ashwini P Aithal
- Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
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Uncommon Complex Anomaly of Inferior Vena Cava and Left Iliac Vein Demonstrated by Multidetector-Row CT Angiography. Int Surg 2016; 99:863-7. [PMID: 25437601 DOI: 10.9738/intsurg-d-13-00132.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Retroperitoneal venous anomalies have clinical importance in retroperitoneal and pelvic surgery. Multidetector-row computed tomography (CT) angiography is an important imaging method to be preferred in evaluating vascular structures in this locality. We describe a complex retroperitoneal venous anomaly with a multidetector-row CT angiography.
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The internal anatomy of the inferior vena cava with specific emphasis on the entrance of the renal, gonadal and lumbar veins. Surg Radiol Anat 2015; 38:107-14. [DOI: 10.1007/s00276-015-1527-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 07/25/2015] [Indexed: 12/18/2022]
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Spentzouris G, Zandian A, Cesmebasi A, Kinsella CR, Muhleman M, Mirzayan N, Shirak M, Tubbs RS, Shaffer K, Loukas M. The clinical anatomy of the inferior vena cava: a review of common congenital anomalies and considerations for clinicians. Clin Anat 2014; 27:1234-43. [PMID: 25042045 DOI: 10.1002/ca.22445] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/27/2014] [Accepted: 07/02/2014] [Indexed: 12/15/2022]
Abstract
Anomalies in the course and drainage of the Inferior Vena Cava (IVC) may complicate normal functioning, correct diagnosis, and therapeutic interventions within the abdomen. Development of the IVC occurs during the 4th to 8th week of gestation, and due to its developmental complexity, there are many opportunities for malformations to occur. Although most IVC anomalies are clinically silent and are usually discovered incidentally on abdominal imaging, aberrations may be responsible for formation of thrombosis, back pain, and anomalous circulation of blood to the heart. In this review, we will discuss the most common variations and abnormalities of the IVC, which include the posterior cardinal veins, the subcardinal veins, the supracardinal veins, persistent left IVC, IVC duplication, situs inversus, left retroaortic renal vein, left circumaortic renal collar, scimitar syndrome, and IVC agenesis. For each abnormality outlined above, we aim to discuss relevant embryology and potential clinical significance with regards to presentation, diagnosis, and treatment as is important for radiologists, surgeons, and clinicians in current clinical practice.
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Affiliation(s)
- Georgios Spentzouris
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada, West Indies
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Aycock KI, Campbell RL, Manning KB, Sastry SP, Shontz SM, Lynch FC, Craven BA. A Computational Method for Predicting Inferior Vena Cava Filter Performance on a Patient-Specific Basis. J Biomech Eng 2014; 136:1870705. [DOI: 10.1115/1.4027612] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 05/08/2014] [Indexed: 12/19/2022]
Abstract
A computational methodology for simulating virtual inferior vena cava (IVC) filter placement and IVC hemodynamics was developed and demonstrated in two patient-specific IVC geometries: a left-sided IVC and an IVC with a retroaortic left renal vein. An inverse analysis was performed to obtain the approximate in vivo stress state for each patient vein using nonlinear finite element analysis (FEA). Contact modeling was then used to simulate IVC filter placement. Contact area, contact normal force, and maximum vein displacements were higher in the retroaortic IVC than in the left-sided IVC (144 mm2, 0.47 N, and 1.49 mm versus 68 mm2, 0.22 N, and 1.01 mm, respectively). Hemodynamics were simulated using computational fluid dynamics (CFD), with four cases for each patient-specific vein: (1) IVC only, (2) IVC with a placed filter, (3) IVC with a placed filter and model embolus, all at resting flow conditions, and (4) IVC with a placed filter and model embolus at exercise flow conditions. Significant hemodynamic differences were observed between the two patient IVCs, with the development of a right-sided jet, larger flow recirculation regions, and lower maximum flow velocities in the left-sided IVC. These results support further investigation of IVC filter placement and hemodynamics on a patient-specific basis.
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Affiliation(s)
- Kenneth I. Aycock
- Department of Bioengineering, Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802 e-mail:
| | - Robert L. Campbell
- Department of Mechanical and Nuclear Engineering, Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802
| | - Keefe B. Manning
- Department of Bioengineering, The Pennsylvania State University, University Park, PA 16802
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Shankar P. Sastry
- Scientific Computing and Imaging Institute, University of Utah, Salt Lake City, UT 84112
| | - Suzanne M. Shontz
- Department of Mathematics and Statistics, Department of Computer Science and Engineering, Center for Computational Sciences, Graduate Program in Computational Engineering, Mississippi State University, Mississippi State, MS 39762
| | - Frank C. Lynch
- Department of Surgery, Penn State Hershey Medical Center, Hershey, PA 17033
| | - Brent A. Craven
- Department of Mechanical and Nuclear Engineering, Department of Bioengineering, Applied Research Laboratory, The Pennsylvania State University, University Park, PA 16802 e-mail:
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Grubb R. Reply: left-sided and duplicate inferior vena cava: A case series and review. Clin Anat 2014; 27:948-9. [DOI: 10.1002/ca.22175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 09/05/2012] [Indexed: 12/29/2022]
Affiliation(s)
- Robert Grubb
- Division of Urology; Washington University School of Medicine; St. Louis Missouri
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28
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Stimec BV, Ignjatovic D, Fasel JH. Left inferior vena cava-A novel associate (or related) finding. Clin Anat 2013; 26:921. [DOI: 10.1002/ca.22216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 12/10/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Bojan V. Stimec
- Department of Cellular Physiology and Metabolism; Faculty of Medicine Anatomy Sector; University of Geneva Rue Michel-Servet 1; 1211 Geneva Switzerland
| | - Dejan Ignjatovic
- Department of Surgery; Hospital Vestfold Tonsberg; 3103 Tonsberg Norway
- Department of Digestive Surgery; Akershus University Hospital; University of Oslo; N-1478 L⊘renskog Norway
| | - Jean H.D. Fasel
- Department of Cellular Physiology and Metabolism; Faculty of Medicine Anatomy Sector; University of Geneva Rue Michel-Servet 1; 1211 Geneva Switzerland
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Proposal for a new classification of variations in the iliac venous system based on internal iliac veins: a case series and a review of double and left inferior vena cava. Anat Sci Int 2013; 88:183-8. [PMID: 23709295 DOI: 10.1007/s12565-013-0182-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 05/07/2013] [Indexed: 10/26/2022]
Abstract
There are many reports on variations in the inferior vena cava (IVC), particularly double IVC (DIVC) and left IVC (LIVC). However, no systematic report has recorded iliac vein (IV) flow patterns in the DIVC and LIVC. In this study, we examined IV flow patterns in both DIVC and LIVC observed during gross anatomy courses conducted for medical students and in previously reported cases. During the gross anatomy courses, three cases of DIVC and one case of LIVC were found in 618 cadavers. The IV flow pattern from these four cases and all other previously reported cases can be classified into one of the following three types according to the vein into which the internal iliac vein drained: the ipsilateral external IV; confluence of the ipsilateral external IV and IVC; and the communicating vein, which connects the IVC and the contralateral IVC or its iliac branch. This classification, which is based on the internal IV course, is considered to be useful because IV variations have the potential to cause clinical problems during related retroperitoneal surgery, venous interventional radiology, and diagnostic procedures for pelvic cancer.
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