1
|
Saab K, Brahmandam AS, Brackett AL, Desai MM, Dardik A, Guzman RJ, Chaar CIO. Systematic review of inferior vena cava atresia. J Vasc Surg Venous Lymphat Disord 2023; 11:1253-1264. [PMID: 37453547 DOI: 10.1016/j.jvsv.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVE Inferior vena cava (IVC) atresia is a rare venous anomaly characterized by absence of the IVC. It has been associated with deep vein thrombosis (DVT) and other congenital anomalies. The aim of the present study is to provide a comprehensive summary of the literature on IVC atresia and discuss the presentation and outcomes of patients with IVC atresia. METHODS A systematic review of the English literature up to April 2020 was performed. The presentations and treatments reported were noted and compared between the two sexes. The IVC atresia cases were further stratified into isolated IVC atresia and IVC atresia associated with other congenital anomalies. RESULTS A total of 412 abstracts were screened, with 178 reports included. A total of 376 patients were analyzed. Overall, males seem to be more affected than females, with a ratio of almost 2:1 (male, 227 [64.1%]; vs female, 127 [35.8%]). However, females were more likely to have congenital IVC atresia compared with males (46.1% vs 21.3%; P < .001). The mean age at presentation was 27.9 ± 18.0 years (range, 0-77 years), with no differences between the sexes. Most patients with IVC atresia presented with DVT (n = 242 of 376; 64.3%), with the iliac veins most often affected (n = 159 of 242; 65.7%). No difference was found in the reported proportion of patients presenting with DVT between the two sexes. The symptom presentation was similar, with leg pain and swelling the most common in both sexes. The patients were treated either medically with anticoagulation or surgically (open or endovascular). No mortality was reported with isolated IVC atresia in either treatment group. However, the mortality of patients with IVC atresia associated with other congenital anomalies was 11.7%. CONCLUSIONS IVC atresia is more common in males but seems to have a predilection for females in the setting of other congenital anomalies. Most patients present with leg pain and swelling related to the development of DVT. Open and endovascular surgical interventions to treat IVC atresia have been reported in 18.3% of patients reviewed, with acceptable mid-term results in terms of patency and symptomatic relief.
Collapse
Affiliation(s)
- Karim Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Anand S Brahmandam
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Alexandria L Brackett
- Clinical Research and Education, Harvey Cushing/John Hay Whitney Medical Library, Yale University School of Medicine, New Haven, CT
| | - Mayur M Desai
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT
| | - Alan Dardik
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Raul J Guzman
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT
| | - Cassius Iyad Ochoa Chaar
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Yale School of Medicine, New Haven, CT.
| |
Collapse
|
2
|
Kwan KJ, Li HL, Chan YC, Huang JX, Cui DZ, Cheng SW. Venous Thromboembolism in a Patient with Interrupted Inferior Vena Cava and Compressed Azygos Continuation: A Case Report and Review of Literature. Vasc Endovascular Surg 2023:15385744231165213. [PMID: 36922360 DOI: 10.1177/15385744231165213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
We report an unusual case of a 40-year-old male patient who experienced painful swelling of the left lower limb that persisted for 1 week. Imaging modalities not only confirmed the diagnosis of acute iliofemoral venous thrombosis and pulmonary embolism (PE), but also an incidental finding of interrupted inferior vena cava (IVC). This congenital anomaly is uncommon but rarely associated with venous thromboembolism (VTE). The azygos continuation was compressed by the descending aorta against the 11th thoracic vertebrae, which was identified as the cause of VTE. He was treated successfully with anticoagulation and compression therapy. The patient was discharged with lifelong oral Rivaroxaban and remained asymptomatic. In the literature, only 9 cases of interrupted IVC-associated PE were identified but none was due to significant venous compression.
Collapse
Affiliation(s)
- Kristine Js Kwan
- International School, 47885Jinan University, Guangzhou, China.,Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China
| | - Hai-Lei Li
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China
| | - Yiu Che Chan
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China.,Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China
| | - Jian-Xiong Huang
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China
| | - Dong-Zhe Cui
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China
| | - Stephen Wk Cheng
- Division of Vascular Surgery, Department of Surgery, 444333The University of Hong Kong - Shenzhen Hospital, China.,Division of Vascular and Endovascular Surgery, Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, China
| |
Collapse
|
3
|
Pichon M, Hij A, Wifaq B, Abderrahmane M, El Jarrari M, Menn AM. [Deep venous thrombosis caused by congenital inferior vena cava agenesis]. JOURNAL DE MEDECINE VASCULAIRE 2019; 44:79-85. [PMID: 30770086 DOI: 10.1016/j.jdmv.2018.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 11/18/2018] [Indexed: 06/09/2023]
Abstract
Congenital agenesis of the inferior vena cava, although rare, is found preferentially in young patients with proximal deep venous thrombosis. Exact diagnosis can be made thanks to enhanced computed tomography scan and/or magnetic resonance imaging, while Doppler ultrasonography is insufficient to establish an inferior vena cava malformation. A consensus has not yet been established for the treatment but lifelong anticoagulation with elastic stocking support to prevent post-thrombotic syndrome is commonly considered in most cases. We report a case of an unprovoked deep venous thrombosis caused by a congenital agenesis of the inferior vena cava localized to the infrarenal segment, in a 24-year-old man. An anticoagulation with low molecular weight heparin was started and prolonged oral anticoagulation was prescribed. In the absence of the usual thrombotic risk factors, the presence of an inferior vena cava anomaly should be considered.
Collapse
Affiliation(s)
- M Pichon
- Service de médecine polyvalente, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France.
| | - A Hij
- Service de médecine interne et pathologie vasculaire, hôpital Saint-Louis, 1, avenue Claude-Vellefaux, 75010 Paris, France
| | - B Wifaq
- Service de médecine polyvalente, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - M Abderrahmane
- Service de médecine polyvalente, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - M El Jarrari
- Service de radiologie, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| | - A-M Menn
- Service de médecine polyvalente, centre hospitalier Victor-Dupouy, 69, rue du Lieutenant-Colonel Prudhon, 95100 Argenteuil, France
| |
Collapse
|
4
|
Menezes T, Haider EA, Al-Douri F, El-Khodary M, Al-Salmi I. Pelvic congestion syndrome due to agenesis of the infrarenal inferior vena cava. Radiol Case Rep 2018; 14:36-40. [PMID: 30305863 PMCID: PMC6174840 DOI: 10.1016/j.radcr.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 04/02/2018] [Indexed: 11/05/2022] Open
Abstract
The inferior vena cava (IVC) is the main conduit of venous return to the right atrium from the lower extremities and abdominal organs. Agenesis of the IVC has an incidence of <1% in the general population [1], although it has been reported in the literature as occurring in up to 8.7% of the population [2]. Patients with absent IVC may present with symptoms of lower extremity venous insufficiency [6], idiopathic deep venous thrombosis [7], or pelvic congestion syndrome. To our knowledge there have only been a few cases reported in the literature of agenesis of the IVC associated with pelvic congestion syndrome [3,10,11]. We present another interesting case of pelvic congestion syndrome due to absent IVC.
Collapse
Affiliation(s)
- Terence Menezes
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Ehsan A Haider
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada.,Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Faten Al-Douri
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada.,Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohamed El-Khodary
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada.,Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Ishaq Al-Salmi
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| |
Collapse
|
5
|
Thein OS, Braganza Menezes DA, Moran E. Pyrexia of unknown origin: inferior vena cava agenesis. BMJ Case Rep 2018; 2018:bcr-2018-224739. [PMID: 29936445 DOI: 10.1136/bcr-2018-224739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 26-year-old woman presented with a 5-day history of fever after returning from Bali. She denied sexual contact abroad. On examination, there was suprapubic tenderness and a widespread maculopapular rash. Malaria serology was negative and blood tests were normal except for an elevated C reactive protein. Treatment was initially with ceftriaxone, metronidazole and doxycycline, but her symptoms failed to improve. A CT pelvis suggested a possible tubo-ovarian abscess, a suspected inferior vena cava (IVC) anomaly and left internal iliac/femoral venous thrombosis. A gynaecology review demonstrated left tubo-ovarian tenderness and fullness. An MRI suggested pelvic inflammatory disease and thrombophlebitis affecting the pelvic veins; deep vein thrombosis (DVT) treatment was commenced. Further family history revealed thrombosis throughout multiple generations. Further imaging analysis demonstrated agenesis of the IVC with compensatory dilation of pelvic collaterals and an acute DVT of the deep pelvic venous system. The patient was discharged with direct oral anticoagulant therapy.
Collapse
Affiliation(s)
- Onn Shaun Thein
- Respiratory Medicine, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Darryl A Braganza Menezes
- Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Heart of England NHS Hospital Trust, Birmingham, UK
| | - Ed Moran
- Department of Infectious Diseases and Tropical Medicine, Birmingham Heartlands Hospital, Heart of England NHS Hospital Trust, Birmingham, UK
| |
Collapse
|
6
|
Singh SN, Bhatt TC. Inferior Vena Cava Agenesis: A Rare Cause of Pelvic Congestion Syndrome. J Clin Diagn Res 2017; 11:TD06-TD08. [PMID: 28511477 PMCID: PMC5427403 DOI: 10.7860/jcdr/2017/24123.9554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 12/20/2016] [Indexed: 11/24/2022]
Abstract
Complete absence of Inferior Vena Cava (IVC) is a rare anomaly with a reported incidence of 0.0005% to 1%. This is often asymptomatic with incidental detection during cross-sectional imaging. It may also present with deep venous thrombosis, pulmonary thromboembolism or compressive symptoms in form of nerve root compression. Pelvic Congestion Syndrome (PCS) is an increasingly recognized entity with well laid out diagnostic criteria and evolving management protocols. Complete absence of IVC is a rare cause of pelvic congestion syndrome. We present a case of young female presenting with symptoms typical of pelvic venous congestion who was found to have complete absence of IVC as the underlying cause. She also had associated small left kidney with compensatory hypertrophy of the right kidney which is another rare association.
Collapse
Affiliation(s)
- Satyendra Narayan Singh
- Surg Cdr and Associate Professor, Department of Radiology, Base Hospital, Delhi Cantt, New Delhi, India
| | - Trilok C Bhatt
- Surg Lt Cdr, Department of Radiology, INHS Kalyani, Visakhapatnam, Andhra Pradesh, India
| |
Collapse
|
7
|
Reslan OM, Raffetto JD, Addis M, Sundick S. Congenital Absence of Inferior Vena Cava in a Young Patient with Iliofemoral Deep Venous Thrombosis Treated with Ultrasound-accelerated Catheter-directed Thrombolysis: Case Report and Review of the Literature. Ann Vasc Surg 2015; 29:1657.e9-15. [DOI: 10.1016/j.avsg.2015.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/20/2015] [Accepted: 05/20/2015] [Indexed: 11/27/2022]
|
8
|
Hagans I, Markelov A, Makadia M. Unique venocaval anomalies: case of duplicate superior vena cava and interrupted inferior vena cava. J Radiol Case Rep 2014; 8:20-6. [PMID: 24967010 DOI: 10.3941/jrcr.v8i1.1354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Venocaval anomalies are uncommon in the general population and often go unrecognized, but physicians should be aware of their significance. Duplicate superior vena cava should be identified during cardiac imaging, surgery, and catheter insertions. While interrupted inferior vena cava can predispose to thrombus formation, they protect against pulmonary embolism from lower extremity deep vein thrombosis. We describe a unique case of a patient in which combined superior vena cava and inferior vena cava anomalies were found incidentally. This is the first reported case of a duplicate superior vena cava and interrupted inferior vena cava in a single patient in English literature. This article also provides a literature review on the topic.
Collapse
Affiliation(s)
- Iris Hagans
- Department of Surgery, Easton Hospital and Drexel University College of Medicine, Philadelphia, PA, USA
| | - Alexey Markelov
- Department of Surgery, Easton Hospital and Drexel University College of Medicine, Philadelphia, PA, USA
| | - Manthan Makadia
- Department of Surgery, Easton Hospital and Drexel University College of Medicine, Philadelphia, PA, USA
| |
Collapse
|
9
|
Monagle P, Chan AKC, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U, Vesely SK. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e737S-e801S. [PMID: 22315277 DOI: 10.1378/chest.11-2308] [Citation(s) in RCA: 958] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Neonates and children differ from adults in physiology, pharmacologic responses to drugs, epidemiology, and long-term consequences of thrombosis. This guideline addresses optimal strategies for the management of thrombosis in neonates and children. METHODS The methods of this guideline follow those described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. RESULTS We suggest that where possible, pediatric hematologists with experience in thromboembolism manage pediatric patients with thromboembolism (Grade 2C). When this is not possible, we suggest a combination of a neonatologist/pediatrician and adult hematologist supported by consultation with an experienced pediatric hematologist (Grade 2C). We suggest that therapeutic unfractionated heparin in children is titrated to achieve a target anti-Xa range of 0.35 to 0.7 units/mL or an activated partial thromboplastin time range that correlates to this anti-Xa range or to a protamine titration range of 0.2 to 0.4 units/mL (Grade 2C). For neonates and children receiving either daily or bid therapeutic low-molecular-weight heparin, we suggest that the drug be monitored to a target range of 0.5 to 1.0 units/mL in a sample taken 4 to 6 h after subcutaneous injection or, alternatively, 0.5 to 0.8 units/mL in a sample taken 2 to 6 h after subcutaneous injection (Grade 2C). CONCLUSIONS The evidence supporting most recommendations for antithrombotic therapy in neonates and children remains weak. Studies addressing appropriate drug target ranges and monitoring requirements are urgently required in addition to site- and clinical situation-specific thrombosis management strategies.
Collapse
Affiliation(s)
- Paul Monagle
- Haematology Department, The Royal Children's Hospital, Department of Paediatrics, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Anthony K C Chan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Neil A Goldenberg
- Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation and Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, Aurora, CO
| | - Rebecca N Ichord
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Janna M Journeycake
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Ulrike Nowak-Göttl
- Thrombosis and Hemostasis Unit, Institute of Clinical Chemistry, University Hospital Kiel, Kiel, Germany
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
| |
Collapse
|
10
|
Baxi K, Shah SK, Clair DG. Complete infrahepatic inferior vena cava occlusion presenting as congenital absence. J Vasc Surg 2011; 53:1716-9. [PMID: 21477965 DOI: 10.1016/j.jvs.2011.01.072] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Revised: 01/14/2011] [Accepted: 01/28/2011] [Indexed: 11/30/2022]
Abstract
Inferior vena cava (IVC) occlusion may have widely varying clinical presentations that overlap with congenital IVC anomalies. Nevertheless, appropriate diagnosis, including differentiation from congenital absence, is mandatory. Endovascular therapy of chronic occlusions appears to yield results comparable to those of open repair. We report a case of infrahepatic IVC occlusion misdiagnosed as congenital absence of the IVC. The IVC occlusion was successfully recanalized and treated with angioplasty and stent placement.
Collapse
Affiliation(s)
- Khanjan Baxi
- University of South Carolina School of Medicine, Columbia, SC, USA
| | | | | |
Collapse
|
11
|
Lambert M, Marboeuf P, Midulla M, Trillot N, Beregi JP, Mounier-Vehier C, Hatron PY, Jude B. Inferior vena cava agenesis and deep vein thrombosis: 10 patients and review of the literature. Vasc Med 2010; 15:451-9. [PMID: 21183652 DOI: 10.1177/1358863x10391355] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Inferior vena cava agenesis (IVCA) is a rare condition, found in almost 5% of patients under 30 years old with unprovoked deep venous thrombosis (DVT). We describe 10 consecutive patients with IVCA-associated DVT and conducted an extensive literature review to investigate the typical spectrum of IVCA-associated DVT. Among our patients (eight men and two women; mean age, 25 ± 4.5 years), DVT followed intense and unusual (major) physical activity for eight of them. DVT was bilateral in six patients and unilateral in four. Ultrasonography was unable to detect IVCA, which was visualized by computed-tomography scans for seven patients, and magnetic resonance imaging and angiography for 10. Hereditary thrombophilia screening, to detect factor V Leiden or prothrombin gene heterozygosity (G20210A mutation), was positive for only two patients. Wearing elastic stockings and taking an indefinite or long-term vitamin K antagonist were prescribed for all 10 patients and nine complied with the latter. To date, 62 patients with IVCA-associated DVT have been reported in the English literature. Analysis of them and our patients yielded a typical spectrum of IVCA-associated DVT characteristics: IVCA occurs in young adults, particularly males, and is revealed by proximal DVT following major physical exertion. All were treated with a prolonged vitamin K antagonist and advised to wear elastic stockings. No precise duration of anticoagulation has been established.
Collapse
Affiliation(s)
- Marc Lambert
- Internal Medicine Department, Université Lille Nord de France, F-59037 Lille, France
| | - Philippe Marboeuf
- Vascular Medicine Department, Université Lille Nord de France, F-59037 Lille, France
| | - Marco Midulla
- Vascular Radiology Department, Université Lille Nord de France, F-59037 Lille, France
| | - Nathalie Trillot
- Hemostasis Laboratory, Centre Hospitalier Universitaire de Lille, Université Lille Nord de France, F-59037 Lille, France
| | - Jean-Paul Beregi
- Vascular Radiology Department, Université Lille Nord de France, F-59037 Lille, France
| | - Claire Mounier-Vehier
- Vascular Medicine Department, Université Lille Nord de France, F-59037 Lille, France
| | - Pierre-Yves Hatron
- Internal Medicine Department, Université Lille Nord de France, F-59037 Lille, France
| | - Brigitte Jude
- Hemostasis Laboratory, Centre Hospitalier Universitaire de Lille, Université Lille Nord de France, F-59037 Lille, France
| |
Collapse
|