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Fior D, Pileri M, Rovere A, Moramarco LP, Santucci D, Grasso RF, Faiella E. Endovascular management of KILT syndrome and COVID-19-related extensive deep vein thrombosis in a pregnant patient: A case report. Radiol Case Rep 2024; 19:2277-2281. [PMID: 38559648 PMCID: PMC10978467 DOI: 10.1016/j.radcr.2024.02.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 02/28/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
We report on a 20-year-old pregnant woman who tested positive for SARS-CoV-2 and was diagnosed with KILT syndrome, a rare condition that increases the risk of thrombotic events. The patient showed signs of deep vein thrombosis that extended from the bilateral iliac vein to the inferior vena cava (IVC), which was treated with placement of an IVC filter and endovascular thromboaspiration/thrombolysis. The IVC was successfully recanalized; however, during follow-up, thrombotic restenosis occurred at the filter level, requiring filter removal. This case highlights the potential benefits of endovascular thromboaspiration/thrombolysis and IVC filter placement in patients with KILT syndrome presenting with acute thrombotic events.
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Affiliation(s)
- Davide Fior
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Matteo Pileri
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Antonio Rovere
- Department of Diagnostic Radiology, San Gerardo Hospital, ASST Monza, Via Gian Battista Pergolesi 33, 20900, Monza, Italy
| | - Lorenzo Paolo Moramarco
- Department of Radiology, Sant'Anna Hospital, ASST Lariana, Via Ravona 20, San Fermo della Battaglia, 22042 Como, Italy
| | - Domiziana Santucci
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Rosario Francesco Grasso
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
| | - Eliodoro Faiella
- Operative Research Unit of Radiology and Interventional Radiology, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo 200, 00128 Rome, Italy
- Research Unit of Radiology and Interventional Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21, 00128 Roma, Italy
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2
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Varvarousi G, Barba C, Protopapas A, Pavlidis M, Valsamidis D. Agenesis of inferior vena cava in pregnancy: A case report and narrative review. Eur J Obstet Gynecol Reprod Biol 2024; 299:22-25. [PMID: 38823309 DOI: 10.1016/j.ejogrb.2024.05.030] [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: 01/09/2024] [Revised: 05/20/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024]
Abstract
Agenesis of inferior vena cava (AIVC) is an extremely rare congenital abnormality. In AIVC, venous flow from the lower extremities enter superior vena cava mainly through the azygous and hemiazygous system, forming anastomotic collateral vessels. A global increase in intra-abdominal pressure by the gravid uterus may further stress the collateral system, increase venous stasis and decrease venous return. We present the management of a 37-year old pregnant woman with AIVC who underwent caesarean section with norepinephrine infusion and general anaesthesia. She presented with shortness of breath when seated, episodes of dizziness while walking or sitting upright with subsequent tachycardia. Cardiac status was monitored using an arterial pulse contour CO monitor. We did not observe large fluctuations in CO, SV, MAP during induction and intubation as well as during delivery. We believe that administration of an infusion of norepinephrine from induction to anaesthesia through caesarean section contributed to this result. Sympathetic activation caused venoconstriction, which significantly increased venous return and maintained haemodynamic stability.
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Affiliation(s)
- G Varvarousi
- Department of Anaesthesiology, ''Alexandra" General Hospital, Athens, Greece.
| | - C Barba
- Department of Anaesthesiology, ''Alexandra" General Hospital, Athens, Greece
| | - A Protopapas
- Department of Obstetrics & Gynecology, ''Alexandra" General Hospital, University of Athens, Athens, Greece
| | - M Pavlidis
- Department of Anaesthesiology, ''Alexandra" General Hospital, Athens, Greece
| | - D Valsamidis
- Department of Anaesthesiology, ''Alexandra" General Hospital, Athens, Greece
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3
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Montoya C, Polanía-Sandoval C, Almeida JI. Azygos vein stenting as an alternate route for inferior vena cava obstruction. J Vasc Surg Cases Innov Tech 2023; 9:101351. [PMID: 38106354 PMCID: PMC10725062 DOI: 10.1016/j.jvscit.2023.101351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/26/2023] [Indexed: 12/19/2023] Open
Abstract
Chronic venous insufficiency, caused by inferior vena cava occlusion, can lead to thromboembolic complications and tissue loss. We present two cases of azygos vein stenting (AVS) in which vena cava recanalization techniques were exhausted. In the first case, the left iliac vein and vena cava were recanalized and stented; however, the right iliac vein had been previously resected and required AVS. Conventional recanalization attempts from the right and left iliac systems failed in the second patient with congenital inferior vena cava occlusion; therefore, AVS was chosen to establish in-line drainage.
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Affiliation(s)
- Christopher Montoya
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL
| | - Camilo Polanía-Sandoval
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL
| | - Jose I. Almeida
- Division of Vascular Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, FL
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4
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Du X, Wu Z. Venous Ulcer in a 5-Year-Old Girl. Adv Skin Wound Care 2023; 36:275-277. [PMID: 37079791 DOI: 10.1097/01.asw.0000922692.30997.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Agenesis of the inferior vena cava (IVC) is an extremely rare congenital malformation. Although IVC dysplasia can present with symptoms, because of the low prevalence of this disease, it is often omitted from routine examination. Most reports on this topic have described the absence of the IVC; the absence of both a deep venous system and the IVC is even rarer. Chronic venous hypertension and varicosities leading to venous ulcers have been reported in patients with absent IVC that could be surgically bypassed; however, the absence of iliofemoral veins precluded any bypass procedure in the present patient. CASE PRESENTATION The authors report a case of IVC below renal vein hypoplasia in a 5-year-old girl who presented bilaterally with venous stasis dermatitis and ulcers in the lower extremity limb area. Ultrasonography revealed no clear IVC and iliofemoral venous system under the renal venous plane. Magnetic resonance venography subsequently confirmed the same findings. The patient's ulcers were healed by compression therapy and routine wound care. CONCLUSIONS This is a rare case of venous ulcer in a pediatric patient stemming from congenital IVC malformation. With this case, the authors demonstrate the etiology of the appearance of venous ulcers in children.
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Affiliation(s)
- Xiaojiong Du
- Xiaojiong Du, MD, and Zhoupeng Wu, MD, are Associate Professors, Department of Vascular Surgery, West China Hospital, Chengdu, Sichuan Province, China
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5
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Mentesidou L, Dettoraki A, Michalopoulou A, Pergantou H, Malama A, Gavra M, Bachou T. Inferior Vena Cava agenesis presenting as deep vein thrombosis in an eight year-old girl. Blood Coagul Fibrinolysis 2023; 34:206-210. [PMID: 36730712 DOI: 10.1097/mbc.0000000000001178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Agenesis of vena cava inferior (AVCI) is a rare congenital malformation with a prevalence of 0.0005-1% in the general population. High level of suspicion is required in young patients with deep vein thrombosis (DVT), particularly bilateral. We present an 8-year-old girl with AVCI presenting as bilateral lower extremity DVT and a review of the literature in pediatric cases with AVCI and DVT.
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Affiliation(s)
- Lida Mentesidou
- 1 Department of Pediatrics, 'Panagiotis and Aglaia Kiriakou' Children's Hospital
| | | | | | | | - Astero Malama
- Department of Radiology, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Maria Gavra
- Department of Radiology, 'Aghia Sophia' Children's Hospital, Athens, Greece
| | - Theodora Bachou
- 1 Department of Pediatrics, 'Panagiotis and Aglaia Kiriakou' Children's Hospital
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6
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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.
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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
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7
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Gerges P, Mian A, Singh G, Aziz M, Guirguis S, Koteish A. Agenesis of the Intrahepatic Inferior Vena Cava: A Case Report and Literature Review. Cureus 2023; 15:e35589. [PMID: 37007382 PMCID: PMC10062435 DOI: 10.7759/cureus.35589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
Abstract
Anomalies of the inferior vena cava (IVC) are an uncommon finding in the general population. A wide range of IVC anomalies has been described in the literature, the majority of which lack clinical significance. Agenesis of the IVC (AIVC) is a rare anomaly of the IVC in the general population. This anomaly may involve either complete agenesis of the IVC or agenesis of a segment of the IVC. Agenesis of the suprarenal segment is the most commonly occurring variant, while agenesis of the infrarenal and hepatic segments is less common. Here we report a case of agenesis of the intrahepatic segment of the IVC.
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8
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Iarossi M, Hermans C. Direct Oral Anticoagulants for Inferior Vena Cava Agenesis. Clin Appl Thromb Hemost 2023; 29:10760296231200224. [PMID: 37671416 PMCID: PMC10483963 DOI: 10.1177/10760296231200224] [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: 06/16/2023] [Revised: 08/12/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
Deep vein thrombosis (DVT) is common in the general population, with an annual incidence of 1 to 2 per 1000 people. Inferior vena cava agenesis (IVCA) increased the risk of developing DVT and is found in approximately 5% of young adults (20-40-year-olds) diagnosed with unprovoked proximal DVT. IVCA can be caused by a defective embryological process, or be a result of intrauterine or perinatal thrombosis. Its estimated incidence in the general population ranges from 0.0005% to 1%, usually involving a partial absence of one of the four segments of the inferior vena cava (IVC). The management during the extended phase of patients with DVT associated with IVCA is not yet harmonized, as it is poorly described in the literature. Patients with IVCA are considered to be at high risk of DVT occurrence, prompting physicians to continue extended anticoagulation, often using vitamin K antagonists. In this retrospective study, we present a cohort of 11 patients diagnosed with IVCA following a DVT, who subsequently received extended treatment with a direct oral anticoagulants. These findings offer reassuring insights into the extended utilization of direct oral anticoagulants, demonstrating both antithrombotic efficacy and a favorable safety profile.
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Affiliation(s)
- Michael Iarossi
- Division of Haematology, Haemostasis and Thrombosis Unit, Saint-Luc University Hospital, Université catholique de Louvain (UCLouvain), Brussels, Belgium
| | - Cedric Hermans
- Division of Haematology, Haemostasis and Thrombosis Unit, Saint-Luc University Hospital, Université catholique de Louvain (UCLouvain), Brussels, Belgium
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9
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Kinariwala D, Liles A, Williams DM, Khaja MS. Iliocaval Reconstruction: Review of Technique, Challenges, and Outcomes. Semin Intervent Radiol 2022; 39:464-474. [PMID: 36561935 PMCID: PMC9767777 DOI: 10.1055/s-0042-1757936] [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: 12/24/2022]
Abstract
Iliocaval thrombosis is a major source of morbidity for patients, with a range of clinical presentations, including recurrent lower extremity deep venous thrombosis and postthrombotic syndrome. Endovascular reconstruction of chronic iliocaval occlusion has been demonstrated to be a technically feasible procedure that provides long-lasting symptom relief in combination with antithrombotic therapy and close clinical monitoring. Herein, we describe the etiologies of iliocaval thrombosis, patient assessment, patient management prior to and after intervention, procedural techniques, and patient outcomes.
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Affiliation(s)
- Dhara Kinariwala
- Division of Vascular and Interventional Radiology, Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, Virginia
| | - Amber Liles
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
| | - David M. Williams
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
| | - Minhaj S. Khaja
- Division of Vascular and Interventional Radiology, Department of Radiology, University of Michigan - Michigan Medicine, Ann Arbor, Michigan
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10
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Verma M, Pandey NN, Ojha V, Kumar S, Ramakrishnan S. Developmental Anomalies of the Inferior Vena Cava and its Tributaries: What the Radiologist Needs to Know? Indian J Radiol Imaging 2022; 32:355-364. [PMID: 36177287 PMCID: PMC9514898 DOI: 10.1055/s-0042-1744522] [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: 11/18/2022] Open
Abstract
Inferior vena cava (IVC) can be involved by a wide gamut of developmental anomalies owing to its complex embryogenesis. Developmental anomalies of the IVC are not infrequent, seen in approximately 8.7% of the general population. Although most of the anatomical variations are asymptomatic, identification of these variations is important before planning any vascular surgery or interventional procedure in relation to the IVC to avoid inadvertent complications. Conventional venography has largely been replaced by noninvasive cross-sectional imaging modalities for detecting IVC abnormalities. Ultrasonography, often used for initial evaluation, is highly operator-dependent and the infrarenal part of IVC is often obscured by bowel gases. While magnetic resonance imaging is devoid of radiation risks, its use is limited due to limited availability and the frequent need for sedation. Computed tomography (CT) venography plays a pivotal role in the detection of these anomalies as it has an excellent spatial resolution along with availability of multiple postprocessing tools such as multiplanar reconstruction with generation of maximum intensity projection and volume-rendered images. This pictorial review focuses on the embryogenesis of IVC, various developmental anomalies of the IVC and its tributaries, their appearance on CT venography and conceivable clinical relevance.
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Affiliation(s)
- Mansi Verma
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Vineeta Ojha
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Department of Cardiovascular Radiology and Endovascular Interventions, All India Institute of Medical Sciences, New Delhi, India
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11
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Alexiou VG, Ntanika A, Pappas G, Vassiliou A, Palialexis K, Geroulakos G. Conservative treatment vs thrombus removal for Iliofemoral vein thrombosis in patients with congenital abnormalities of the inferior vena cava: a case report and systematic review of the literature. J Thromb Thrombolysis 2022; 54:230-254. [PMID: 35829838 DOI: 10.1007/s11239-022-02674-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 10/17/2022]
Abstract
Congenital abnormalities of the Inferior Vena Cava (IVC) should be suspected in cases of Deep Venous Thrombosis (DVT), especially in young patients, with no other risk factors and apparent causes. Currently, there is no guidance regarding the management of such patients. We report a case of Iliofemoral vein thrombosis in a young patient with congenital absence of the IVC that was successfully treated with catheter-directed thrombolysis (CDT) and perform a systematic review of the literature to identify evidence about the epidemiology, clinical presentation, management, and prognosis of this rare cause of DVT. A total of 42 studies reporting on 56 cases were included in the review. The mean age of the patients at the presentation of their first DVT episode is 23.6 years, 83.9% of patients were males, conservative management with anticoagulation was used in 68% of the reported cases, and thrombolysis was used in 32% of the cases. Only 10.7% of patients presented with PE potentially justified by the abnormal anatomy of the deep veins which makes the propagation of thrombi into the pulmonary arteries less possible. Comparing the long-term outcomes of the two treatment groups; 42.3% of the patients treated conservatively vs 15.4% of the patients treated with thrombolysis developed chronic symptoms (residual heaviness, pain, swelling, and cramping). 11.5% of patients who received conservative treatment developed post-thrombotic syndrome. None of the patients treated with thrombolysis developed post-thrombotic syndrome. There were no procedure-related complications and thrombolysis was well tolerated by the entirety of the thrombolysis treatment group. Recurrence of DVT occurred in 13% of the patients treated conservatively and in 7.7% of patients treated with thrombolysis. Thrombus removal by means of thrombolysis is the recommended treatment and can offer excellent short and long-term results. Anticoagulation with NOACs may be prescribed for life to prevent recurrence or for at least 6 months and then reconsidered following further evaluation of patients' bleeding risk. It may be of value to organise an international registry for such patients. Guidelines issued by the relevant scientific societies will then be able to make a clear recommendation about the management of such patients.
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Affiliation(s)
- Vangelis G Alexiou
- Department of Surgery - Vascular Surgery Unit, Faculty of Medicine, University of Ioannina, Niarxou Avenue, 45500, Ioannina, Greece. .,Alfa Institute of Biomedical Sciences (AIBS), Athens, Greece.
| | - Anna Ntanika
- Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - Georgios Pappas
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - Areti Vassiliou
- Department of Surgery - Vascular Surgery Unit, Faculty of Medicine, University of Ioannina, Niarxou Avenue, 45500, Ioannina, Greece
| | - Konstantinos Palialexis
- Department of Interventional Radiology, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - George Geroulakos
- Department of Vascular Surgery, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
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12
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Extensive deep venous thrombosis in a young male with absent infrarenal inferior vena cava. J Vasc Surg Cases Innov Tech 2022; 8:146-150. [PMID: 35330898 PMCID: PMC8938606 DOI: 10.1016/j.jvscit.2022.01.001] [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: 10/18/2021] [Accepted: 01/06/2022] [Indexed: 11/21/2022] Open
Abstract
A previously well, independent 20-year-old man presented with a 4-day history of progressive left lower limb pain with associated phlegmasia cerulea dolens. Duplex venous ultrasound examination and computed tomography venogram revealed extensive deep vein thrombus from the left popliteal vein to abnormal venous vasculature proximally. Notably, no infrarenal inferior vena cava was detected, with distal venous return channeled through lumbar and visceral collateral channels into the azygous system. Treatment included systemic anticoagulation, catheter-directed thrombolysis, and prolonged therapeutic anticoagulation. In the absence of other risk factors, anatomical abnormalities should be considered in young, well patients presenting with lower limb venous thrombosis.
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13
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Pasqui E, de Donato G, Camarri S, Molinari R, Cascinelli I, Pelini V, Abate L, Palasciano G. Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis. Front Surg 2022; 9:832336. [PMID: 35392062 PMCID: PMC8980272 DOI: 10.3389/fsurg.2022.832336] [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: 12/09/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Anomalies in inferior vena cava represent an uncommon finding with a prevalence of 0. 3 to 0.5% among healthy patients. Specifically, the condition characterized by the agenesis of the inferior vena cava (IVC; AIVC) has been observed among the 0.0005 to 1% of the general population. AIVC is strongly related to deep vein thrombosis (DVT) of the lower limb and pelvic district, especially in young patients. The rarity of the presented condition could relate to an underestimation of its impact on a particular clinical setting leading to a delayed diagnosis and inaccurate early- and long-term management. Report We presented a case of this anomaly regarding a 31-year-old man presenting with bilateral symptomatic proximal DVT. Duplex vascular ultrasound and subsequent CT-angiography revealed the complete occlusion of the right external and common iliac vein, as well as partial occlusion of the contralateral external iliac vein, in the patient. The exam also revealed the interruption of IVC in its infrarenal part. At the level of renal veins coalescence, IVC appeared again in its usual position. A dilatated portal system, hepatic veins, and azygos and hemiazygos systems were also highlighted. Anticoagulation was promptly started with the administration of Fondaparinux (7.5 mg/die). In addition, compression stocking was initiated within 24 h from diagnosis. After 3 weeks, the anticoagulation regimen was shifted toward the administration of a direct oral anticoagulant (Apixaban; 5 mg two times a day). At 1-month follow-up, a vascular duplex ultrasound revealed a complete resolution of the iliac veins' thrombosis. Conclusion It is important to consider the eventuality of IVC anomalies in a young adult presenting with unexplained, extensive, or bilateral DVT. Accurate diagnostic evaluation is necessary to fully identify this condition that could represent a real challenge.
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Affiliation(s)
- Edoardo Pasqui
- Department of Vascular Surgery, University of Siena, Siena, Italy
- *Correspondence: Edoardo Pasqui ;
| | | | - Silvia Camarri
- Division of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, Italy
| | - Raffaele Molinari
- Division of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, Italy
| | - Irene Cascinelli
- Division of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, Italy
| | - Veronica Pelini
- Division of Radiology, Associated Hospitals in Val di Chiana, Montepulciano, Italy
| | - Luigi Abate
- Division of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, Italy
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14
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Klaib M, Alsmadi TH, Momani M, Alsmadi TH. Kidney and Inferior Vena Cava Abnormalities With Leg Thrombosis (KILT) Syndrome in a 24-Year-Old Man. Cureus 2021; 13:e20568. [PMID: 35103147 PMCID: PMC8772620 DOI: 10.7759/cureus.20568] [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] [Accepted: 12/21/2021] [Indexed: 11/23/2022] Open
Abstract
Here, we present a case of kidney and inferior vena cava abnormalities with leg thrombosis (KILT) syndrome, which consists of the triad of congenital kidney anomalies, inferior vena cava anomalies, and deep venous thrombosis. KILT syndrome is usually an incidental finding while investigating other conditions.
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15
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Prado VE, Rey-Mendoza JP, Wakefield CJ, Aqeel SB, Kumssa A. Infrarenal inferior vena cava agenesis and recurrent deep vein thrombosis: a case report and literature review. Oxf Med Case Reports 2021; 2021:omaa104. [PMID: 33469470 DOI: 10.1093/omcr/omaa104] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/20/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022] Open
Abstract
Inferior vena cava agenesis is a rare congenital vascular defect often diagnosed as an incidental finding in asymptomatic patients. When symptoms arise, it can present with chronic venous stasis or unprovoked deep vein thrombosis (DVT). A 42-year-old man with history of unprovoked right lower extremity (RLE) DVTs was admitted for swelling, pain and erythema to the RLE, concerning for new DVT. Venous Doppler ultrasound showed a chronic DVT of the right proximal femoral vein in addition to an acute DVT of the distal femoral vein. Extensive thrombophilia workup was negative and additional imaging with abdominal computed tomography scan revealed the absence of the infrarenal inferior vena cava. Patient was treated with oral anticoagulation and compression stockings and discharged with clinical improvement. At 3-month follow-up, patient was completely asymptomatic. Recurrent unprovoked DVTs in young patients require exhaustive work up including imaging studies to rule out vascular anomalies.
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Affiliation(s)
- Victor E Prado
- Division of Internal Medicine, Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Juan Pablo Rey-Mendoza
- Division of Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - Sheeba Ba Aqeel
- Division of Internal Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Admasu Kumssa
- Division of Internal Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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Tarazi M, Bashir A, Khan K, Kakani N, Murray D, Serracino-Inglott F. A Literature Review and Case Series of DVT Patients with Absent IVC Treated with Thrombolysis. Ann Vasc Surg 2020; 67:521-531. [PMID: 32234401 DOI: 10.1016/j.avsg.2020.03.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 03/19/2020] [Accepted: 03/21/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Congenital absence of the inferior vena cava is related to deep venous thrombosis (DVT) in 5% of cases with no other risk factors. DVT is normally diagnosed by Duplex, whereas computerized tomography or magnetic resonance imaging is required to visualize this absence, and so, it is often missed but ought to be considered in young patients. There are many existing cases in the literature illustrating this link, but these patients were often managed conservatively with anticoagulation. CASE SERIES We report five cases presenting with a DVT who were found to have an absent inferior vena cava after imaging and were treated successfully with thrombolysis and consequently managed with lifelong anticoagulation, between January 2014 and January 2019. CONCLUSIONS Anomalies of the inferior vena cava can cause unprovoked DVT. These anomalies are often incidental findings after CT but could change the management plan in these patients. Treatment can be with anticoagulants only, thrombolysis, thrombectomy, balloon angioplasty or stents, and long-term or lifelong anticoagulation to prevent DVT recurrence.
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Affiliation(s)
- Munir Tarazi
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK.
| | - Ammani Bashir
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Kamran Khan
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Nirmal Kakani
- Department of Vascular Interventional Radiology, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - David Murray
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
| | - Ferdinand Serracino-Inglott
- Department of Vascular Surgery, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
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The use of rivaroxaban in deep venous thrombosis associated with vena cava inferior agenesis. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2020; 27:583-585. [PMID: 32082931 DOI: 10.5606/tgkdc.dergisi.2019.17672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 04/08/2019] [Indexed: 11/21/2022]
Abstract
Inferior vena cava agenesis is a rare anomaly which may result in deep vein thrombosis. There is no clear scientific evidence for the most effective therapeutic management, optimal duration, or the choice of anticoagulant therapy. Herein, we report an 18-year-old male case with deep vein thrombosis associated with inferior vena cava agenesis who was on rivaroxaban as a lifelong anticoagulation treatment for symptoms of venous stasis and the presence of heterozygotic thrombophilic mutations.
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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.
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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
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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.
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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
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Adachi Y, Sakakura K, Okochi T, Mase T, Matsumoto M, Wada H, Fujita H, Momomura SI. A Pitfall in the Diagnosis of Bilateral Deep Vein Thrombosis in a Young Man. Int Heart J 2018; 59:451-454. [PMID: 29563380 DOI: 10.1536/ihj.17-159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 32-year-old man with a history of bronchial asthma was referred for low back pain and bilateral femur pain. Vascular sonography revealed bilateral deep vein thrombosis (DVT) from the femoral veins to the popliteal veins. Computed tomography revealed hypoplasia of the inferior vena cava (IVC) and dilated lumbar veins, ascending lumbar veins, and azygos vein as collaterals. There was no evidence of malignant neoplasm. The results of the thrombophilia tests were within normal limits. Hypoplasia of the IVC is a rare cause of DVT. This anomaly should be considered as a cause of bilateral and proximal DVT, in particular, in young patients without major risk factors.
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Affiliation(s)
- Yusuke Adachi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Tomohisa Okochi
- Department of Radiology, Saitama Medical Center, Jichi Medical University
| | - Takaaki Mase
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Mitsunari Matsumoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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Yoon JW, Ganaha S, Watridge C. Vertebral Venous Collaterals with Underlying Agenesis of the Inferior Vena Cava: Implications for Spinal Surgery. World Neurosurg 2018; 114:63-67. [PMID: 29545223 DOI: 10.1016/j.wneu.2018.03.008] [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: 01/09/2018] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Congenital agenesis of the inferior vena cava (IVC) can lead to the development of a prominent venous collateral system within and around the spine due to the development of venous collaterals. In such patients, surgery can carry a risk of catastrophic bleeding or decompensation of a delicate venous drainage pattern during spinal manipulation or even epidural exploration. CASE DESCRIPTION A 49-year-old man with a congenital agenesis of the IVC presented with signs and symptoms of an L5 radiculopathy. A computed tomography scan of the lumbar spine showed the characteristic finding of fenestrated or "holey" pedicles within the lumbar spine, due to chronic venous engorgement within the pedicles. CONCLUSIONS To our knowledge, this is the first report to describe the characteristic sign of "holey" pedicles on radiographic imaging in a patient with an underdeveloped IVC. This finding may be useful for the detection of abnormal spinal venous anatomy. In such patients, spinal surgery may carry greater risks and requires special consideration.
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Affiliation(s)
- Jang W Yoon
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Sara Ganaha
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA
| | - Clarence Watridge
- Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
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Bilateral spontaneous thrombosis of the pampiniform plexus; A rare etiology of acute scrotal pain: A case report and review of literature. AFRICAN JOURNAL OF UROLOGY 2018. [DOI: 10.1016/j.afju.2017.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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23
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Agenesis of right and existence of left inferior vena cava associated with posterior nutcracker syndrome. POLISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 14:280-281. [PMID: 29354183 PMCID: PMC5767781 DOI: 10.5114/kitp.2017.72235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 07/16/2017] [Indexed: 11/17/2022]
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Kim S, Kunkel S, Browske K. Absent Inferior Vena Cava Leading to Recurrent Lower Extremity Deep Vein Thrombosis in a United States Marine. Mil Med 2018; 183:e172-e174. [PMID: 29401342 DOI: 10.1093/milmed/usx041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 10/20/2017] [Indexed: 11/14/2022] Open
Abstract
Introduction Anomalies of the inferior vena cava (AIVC) are rare but well-recognized anatomic abnormalities that can lead to clinically significant deep vein thrombosis (DVT) in a subset of otherwise healthy patients. This report illustrates an uncommon congenital anomaly that military clinicians should consider when evaluating unprovoked DVT in young patients. Materials and Methods Single case report and literature review. Results We describe a case of a 24-yr-old United States Marine who presented with abdominal pain for 2 wk. After conservative therapy failed, a contrast-enhanced abdominal computed tomography (CT) scan was performed. The CT scan revealed an absent inferior vena cava with evidence of right venous thrombophlebitis. We include four contrast-enhanced helical CT scans that illustrate this phenomenon. Conclusion Due to the lack of available studies and data, we do not know the relative risk of DVT in patients with AIVC. However, the literature review suggests that there is a pro-thrombogenic effect of this congenital anomaly. Clinicians should include AIVC in their differential when treating young, otherwise healthy patients with unprovoked DVT. This population is much more likely to have an AIVC than the general population. In addition to thrombophilia markers, a contrast-enhanced CT scan should be considered as part of the initial workup.
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Affiliation(s)
- Sang Kim
- U.S. Navy Aviation Medicine, Marine Aircraft Group 14, PO Box 8051, Cherry Point, NC 28533.,Naval Hospital Clinic Cherry Point, 4389 Beaufort Road, Havelock, NC 28532
| | - Scott Kunkel
- Department of Emergency Medicine, Medical College of Wisconsin Affiliated Hospitals, 9200 West Wisconsin Avenue, Milwaukee, WI 53226
| | - Kristin Browske
- U.S. Navy Aviation Medicine, Marine Aircraft Group 14, PO Box 8051, Cherry Point, NC 28533.,Naval Hospital Clinic Cherry Point, 4389 Beaufort Road, Havelock, NC 28532
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25
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Grøtta O, Enden T, Sandbæk G, Gjerdalen G, Slagsvold CE, Bay D, Kløw NE, Rosales A. Patency and Clinical Outcome After Stent Placement for Chronic Obstruction of the Inferior Vena Cava. Eur J Vasc Endovasc Surg 2017; 54:620-628. [DOI: 10.1016/j.ejvs.2017.07.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 07/06/2017] [Indexed: 10/19/2022]
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26
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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 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.
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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
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Phair J, Trestman E, Stableford J. Venous status ulcers due to congenital agenesis of the inferior vena cava in a 16-year-old male. Vascular 2015; 24:106-8. [PMID: 25972026 DOI: 10.1177/1708538115587453] [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] [Indexed: 11/17/2022]
Abstract
We report a case of agenesis of the infrarenal inferior vena cava in a 16-year-old male presenting with venous stasis dermatitis and ulceration in the gaiter region bilaterally. Duplex imaging was performed revealing absence of infrarenal inferior vena cava and iliofemoral venous system. Magnetic resonance venography then confirmed the above findings along with revealing extensive lumbar and pelvic collateralization. This patient's condition has been successfully managed conservatively with compression therapy and wound care. This case is a rare example of a congenital malformation of the inferior vena cava and represents the only reported case with presenting symptoms of venous stasis ulceration in a pediatric patient.
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Affiliation(s)
- J Phair
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - E Trestman
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - J Stableford
- Division of Vascular and Endovascular Surgery, Department of Cardiovascular and Thoracic Surgery, Montefiore Medical Center, Bronx, New York, USA
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28
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Kalicki B, Sadecka M, Wawrzyniak A, Kozinski P, Dziekiewicz M, Jung A. Absence of inferior vena cava in 14-year old boy associated with deep venous thrombosis and positive Mycoplasma pneumoniae serum antibodies--a case report. BMC Pediatr 2015; 15:40. [PMID: 25880637 PMCID: PMC4399418 DOI: 10.1186/s12887-015-0357-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 03/26/2015] [Indexed: 01/08/2023] Open
Abstract
Background Absence of the inferior vena cava is a rare vascular anomaly, which usually remains asymptomatic in childhood. It is recognized as the risk factor for deep venous thrombosis, since the collateral circulation does not provide adequate drainage of the lower limbs. Mycoplasma pneumoniae is a common cause of community-acquired pneumonia in school-aged children and adolescents. Mycoplasma pneumoniae infection might be associated with deep venous thrombosis but its pathophysiology remains unknown. According to previous reports, deep venous thrombosis due to Mycoplasma pneumoniae infection is associated with positive serum anticardiolipin antibodies. To our knowledge, we describe the first case of deep venous thrombosis associated with Mycoplasma pneumoniae serum antibodies indicating early stage of infection with negative anticardiolipin serum antibodies in adolescent with absence of inferior vena cava. Case presentation 14-year old boy was admitted to the pediatric unit few days after the appendectomy complaining with pain of the left hip that caused him unable to walk. The pain was accompanied with subfebrile temperature. After clinical examination and additional tests, the boy was diagnosed with a deep venous thrombosis. Computed tomography revealed absence of the vena cava inferior distally to the hepatic veins and varices of the collateral circulation in the pelvis. Anticardiolipin IgM and IgG antibodies and antinuclear antibodies were not detected. Additionally, the Mycoplasma pneumoniae antibodies in classes IgM, IgA and IgG were detected in serum as another risk factor of thrombosis. After the initial treatment with low-molecular-weight heparin in combination with clarithromycin the clinical condition of the patient improved. The patient became a candidate for life-long anticoagulation therapy. Conclusions In this case Mycoplasma pneumoniae antibodies were associated with deep venous thrombosis in child with congenital absence of inferior vena cava. Uncommonly for deep venous thrombosis due to Mycoplasma pneumoniae infection, anticardiolipin antibodies were not detected in serum. It is important to remember in clinical practice that Mycoplasma pneumoniae affects coagulability and may trigger thrombosis, especially in the presence of other risk factors. The pathophysiology of this process remains unknown.
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Affiliation(s)
- Boleslaw Kalicki
- Department of Pediatrics, Pediatric Nephrology and Allergy, Military Institute of Medicine, ul. Szaserow 128, 04-141, Warsaw, Poland.
| | - Monika Sadecka
- Department of Pediatrics, Pediatric Nephrology and Allergy, Military Institute of Medicine, ul. Szaserow 128, 04-141, Warsaw, Poland.
| | - Agata Wawrzyniak
- Department of Pediatrics, Pediatric Nephrology and Allergy, Military Institute of Medicine, ul. Szaserow 128, 04-141, Warsaw, Poland.
| | - Piotr Kozinski
- Department of Radiology, Military Institute of Medicine, ul. Szaserow 128, 04-141, Warsaw, Poland.
| | - Miroslaw Dziekiewicz
- Department of Vascular and Endovascular Surgery, Military Institute of Medicine, ul. Szaserow 128, 04-141, Warsaw, Poland.
| | - Anna Jung
- Department of Pediatrics, Pediatric Nephrology and Allergy, Military Institute of Medicine, ul. Szaserow 128, 04-141, Warsaw, Poland.
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29
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Chi AC, Hairston JC. Acute right varicocele: a clue to congenital vascular anomaly. Urology 2015; 85:e39-e40. [PMID: 25799175 DOI: 10.1016/j.urology.2015.02.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/25/2014] [Accepted: 02/05/2015] [Indexed: 11/30/2022]
Abstract
Workup of acute unilateral right varicocele should encompass imaging to look for abdominal and retroperitoneal pathology, as well as congenital vascular anomalies. Management of the acute symptomatic varicocele due to upstream venous thrombosis should be primarily medical, with initiation of anticoagulation and early involvement of our hematology colleagues.
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Affiliation(s)
- Amanda C Chi
- Department of Urology, Feinberg School of Medicine at Northwestern University, Chicago, IL.
| | - John C Hairston
- Department of Urology, Feinberg School of Medicine at Northwestern University, Chicago, IL
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Deep Venous Thrombosis of the Leg, Associated with Agenesis of the Infrarenal Inferior Vena Cava and Hypoplastic Left Kidney (KILT Syndrome) in a 14-Year-Old Child. Case Rep Pediatr 2015; 2015:864047. [PMID: 25685585 PMCID: PMC4313679 DOI: 10.1155/2015/864047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 12/16/2014] [Indexed: 11/17/2022] Open
Abstract
Agenesis of the inferior vena cava (IVC) is a rare anomaly which can be identified as incidental finding or can be associated with iliofemoral vein thrombosis. IVC agenesis has a known association with renal anomalies which are mainly confined to the right kidney. We describe a case of a 14-year-old male who presented with left leg swelling and pain. Ultrasonography confirmed the presence of left leg deep vein thrombosis (DVT). No underlying hematologic risk factors were identified. A CT scan was obtained which demonstrated absent infrarenal IVC and extensive thrombosis in the left deep venous system and development of collateral venous flow into the azygous/hemiazygous system, with extension of thrombus into paraspinal collaterals. An additional finding in the patient was an atrophic left kidney and stenosis of an accessory left renal artery. Agenesis of the IVC should be considered in a young patient presenting with lower extremity DVT, especially in patients with no risk factors for thrombosis. As agenesis of the IVC cannot be corrected, one should be aware that there is a lifelong risk of lower extremity DVT.
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31
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Kawata E, Kondoh E, Kawasaki K, Baba T, Ueda A, Kido A, Konishi I. Utero-ovarian varices and absent inferior vena cava in pregnancy. J Obstet Gynaecol Res 2014; 41:631-4. [PMID: 25363024 DOI: 10.1111/jog.12599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Accepted: 08/19/2014] [Indexed: 11/28/2022]
Abstract
Extensively distended and tortuous vessels on both sides of the uterus are rare incidental findings on transvaginal sonography in early pregnancy. A 31-year-old woman with a history of surgical repair for congenital intestinal stenosis was noted to have utero-ovarian varices on a transvaginal ultrasound examination during her first prenatal visit at 6 weeks' gestation. Magnetic resonance imaging revealed dilated ovarian veins along with infrarenal absence of inferior vena cava as well as the absence of external and common iliac veins. Despite concerns regarding spontaneous utero-ovarian vessels rupture, her antenatal course was uneventful. A vaginal delivery was successfully achieved without any postpartum complication. We also demonstrated an intraoperative view of the utero-ovarian vessels during cesarean section in her subsequent pregnancy. Absence of inferior vena cava and pelvic varices can occur in women with a history of neonatal surgery. Although the risk of utero-ovarian varices rupture remains unclear, vaginal delivery may be safely achieved.
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Affiliation(s)
- Etsuko Kawata
- Department of Gynecology and Obstetrics, Kyoto University, Kyoto, Japan
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32
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Haskal ZJ, Potosky DR, Twaddell WS. Percutaneous endovascular creation of an inferior vena cava in a patient with caval agenesis, Budd-Chiari syndrome, and iliofemorocaval thrombosis. J Vasc Interv Radiol 2014; 25:63-9. [PMID: 24365505 DOI: 10.1016/j.jvir.2013.07.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 07/11/2013] [Accepted: 07/11/2013] [Indexed: 11/18/2022] Open
Abstract
A 29-year-old woman with acute iliofemorocaval thrombosis was discovered to have suprarenal caval agenesis with azygous continuation, hepatic congestion, and fibrosis as a result of chronic Budd-Chiari syndrome. Three staged procedures were performed: pharmacomechanical thrombolysis of acute thromboses, transfemoral liver biopsy and hemodynamic assessment, and percutaneous endovascular creation of a "neocava" lined with endografts. Symptomatic improvement and patency were maintained at 12-week follow-up.
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Affiliation(s)
- Ziv J Haskal
- Department of Radiology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201.
| | - Darryn R Potosky
- Department of Medicine, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201
| | - William S Twaddell
- Department of Pathology, University of Maryland School of Medicine, 22 S. Greene St., Baltimore, MD 21201
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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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Abstract
SummaryInferior vena cava agenesis is a rare anomaly in an asymptomatic patient. A 58-year-old female patient with complete absence of the inferior vena cava and aberrant right hepatic vein is presented with radiologic findings. To our best knowledge, such a combination of venous anomalies has not previously been documented in the literature and this is the first case in the literature due to the coincidence of total inferior vena cava agenesis with aberrant hepatic vein.
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Clues to the diagnosis of inferior vena cava agenesis in patients with deep venous thrombosis. Rev Clin Esp 2013. [DOI: 10.1016/j.rce.2013.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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36
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López-Núñez M, Tuneu-Valls A, Jaka-Moreno A, Lopez-Obregon C, Ormaechea-Perez N. Cutaneous aspects of congenital absence of the inferior vena cava in a newborn. Pediatr Dermatol 2013; 30:e18-9. [PMID: 22747743 DOI: 10.1111/j.1525-1470.2012.01774.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present the case of a 9-day-old girl with venous dilatations in lower abdomen and legs associated to cyanosis. Radiological studies revealed a congenital agenesis of the entire inferior vena cava.
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Affiliation(s)
- María López-Núñez
- Dermatology Department, Hospital Donostia, San Sebastián, Spain Dermatology Department, Hospital Marqués de Valdecilla, Santander, Spain.
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Cate-Hoek AJT, Prins MH, Wittens CHA, Cate HT. Postintervention duration of anticoagulation in venous surgery. Phlebology 2013; 28 Suppl 1:105-11. [DOI: 10.1177/0268355513476415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
For a substantial proportion of patients with deep venous thrombosis (DVT), current treatment strategies are suboptimal and new treatment options are needed. Especially for the group of patients who are at the highest risk for post-thrombotic syndrome, new treatment modalities such as catheter-directed thrombolysis and additional stenting are being investigated. With current clinical studies addressing new technical options, the medical management of patients following these interventions deserves attention. The duration of anticoagulant treatment following surgical or radiological interventions for DVT seems not to be influenced by the presence of a venous stent. According to recent ACCP 2012 guidelines the anticoagulant management in patients who have had any method of thrombus removal performed, the same intensity and duration of anticoagulant therapy as in comparable patients who do not undergo thrombosis removal is recommended (Grade 1B). In the acute phase of thrombosis, irrespective of the technique and whether or not stenting is applied, immediate anticoagulation following the procedure is pertinent to reduce the risk of recurrent thrombosis and thrombus propagation. The long-term treatment duration after venous interventions therefore may be tailored based on common risk factors for recurrent thrombosis and the individual risk for bleeding. Selected thrombophilia factors, d-dimer assessment and residual venous thrombosis provide markers for recurrent DVT. Currently, vitamin K antagonists) provide the main anticoagulants for (prolonged) anticoagulation, while the new oral anticoagulants emerge as promising alternatives. In case prolonged anticoagulation after unprovoked DVT is not indicated, cardiovascular risk management is warranted because of an increased rate of arterial thrombotic events after DVT; aspirin may be indicated as secondary prevention against recurrent thrombosis (while providing primary prevention against arterial thrombosis).
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Affiliation(s)
- A J Ten Cate-Hoek
- Departments of Internal medicine and Clinical Epidemiology, Cardiovascular Research Institute Maastricht (CARIM) and School for Public Health and Primary Care (Caphrie), Maastricht University Medical Centere, Maastricht, The Netherlands
| | | | - C H A Wittens
- Departments of Internal medicine and Clinical Epidemiology, Cardiovascular Research Institute Maastricht (CARIM) and School for Public Health and Primary Care (Caphrie), Maastricht University Medical Centere, Maastricht, The Netherlands
- Department of Vascular surgery, University Hospital, Maastricht, the Netherlands
- Department of vascular surgery, Universitäts Klinikum Aachen, Germany
| | - H Ten Cate
- Departments of Internal medicine and Clinical Epidemiology, Cardiovascular Research Institute Maastricht (CARIM) and School for Public Health and Primary Care (Caphrie), Maastricht University Medical Centere, Maastricht, The Netherlands
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Ganzarain Valiente L, Quintana Rivera A, Ávila Puerta C, Ysa Figueras A, Rodríguez Bustabad M, Fonseca Legrand J. Agenesia de la vena cava inferior como causa de trombosis venosa iliacofemoral bilateral en pacientes jóvenes. ANGIOLOGIA 2013. [DOI: 10.1016/j.angio.2012.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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De Maeseneer MG, Hertoghs M, Lauwers K, Koeyers W, de Wolf M, Wittens C. Chronic venous insufficiency in patients with absence of the inferior vena cava. J Vasc Surg Venous Lymphat Disord 2013; 1:39-44.e2. [DOI: 10.1016/j.jvsv.2012.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Revised: 05/02/2012] [Accepted: 05/04/2012] [Indexed: 10/27/2022]
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40
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Kreidy R, Salameh P, Waked M. Lower extremity venous thrombosis in patients younger than 50 years of age. Vasc Health Risk Manag 2012; 8:161-7. [PMID: 22454560 PMCID: PMC3310360 DOI: 10.2147/vhrm.s29457] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim Lower extremity deep venous thrombosis in the young adult is uncommon and has not been well studied in the literature. The aim of this study is to define risk factors for deep venous thrombosis among patients younger than 50 years of age, to compare them with a control group, and to suggest recommendations for the management and treatment of venous thrombosis in this particular group of patients. Methods From January 2003 to January 2011, 66 consecutive Lebanese patients (29 males and 37 females) younger than 50 years, diagnosed in an academic tertiary-care center with lower extremity deep venous thrombosis by color flow duplex scan, were retrospectively reviewed. Their age varied between 21 and 50 years (mean 38.7 years). The control group included 217 patients (86 males and 131 females) older than 50 years (range: 50–96 years; mean 72.9 years). Results The most commonly reported risk factors in the younger age group were inherited thrombophilia (46.9% compared with 13.8% in the control group; P < 0.001), pregnancy (18.2% compared with 0.5%; P < 0.001), treatment with estrogen drugs (13.6% compared with 2.3%; P = 0.001), and family history of venous thromboembolism (9.1% compared with 3.8%; P = 0.084). Conclusion Inherited thrombophilia is the most commonly observed risk factor among patients younger than 50 years, with a prevalence of three times more than the control group. Young adults should be screened for thrombophilia even in the presence of transient acquired risk factors. Pregnancy and treatment with estrogen drugs essentially when associated with inherited thrombophilia represent a frequent cause of venous thrombosis among young female patients. Inferior vena cava abnormalities should be excluded in young patients with spontaneous proximal venous thrombosis especially when recurrent venous thrombosis or resistance to anticoagulation are observed.
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Affiliation(s)
- Raghid Kreidy
- Department of Vascular Surgery, Saint George Hospital, University Medical Center, University of Balamand, Beirut, Lebanon.
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41
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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.
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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
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Favourable pregnancy outcome in a pregnant woman with partial hypoplasia of inferior vena cava and homozygous for methylenetetrahydrofolate reductase mutation. Eur J Obstet Gynecol Reprod Biol 2010; 153:108-9. [DOI: 10.1016/j.ejogrb.2010.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 05/30/2010] [Accepted: 06/27/2010] [Indexed: 11/22/2022]
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Pulmonary embolism associated with inferior vena cava interruption: multidetector computed tomography findings. J Thorac Imaging 2010; 25:W131-2. [PMID: 20498625 DOI: 10.1097/rti.0b013e3181c65b0d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We report a patient with congenital interruption of the inferior vena cava complicated by pulmonary embolism. In this study, we review the clinical and imaging features of this entity and also present a review of the literature on this topic. This rare pulmonary embolism complication can be easily detected on multidetector computed tomography using a wider scan range.
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44
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Vasco PG, López AR, Piñeiro ML, Rivera JIG. Deep venous thrombosis caused by congenital inferior vena cava agenesis and heterozygous factor V Leiden mutation - a case report. Int J Angiol 2009; 18:147-9. [PMID: 22477517 DOI: 10.1055/s-0031-1278343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
The unusual clinical presentation, importance of imaging techniques and role of low molecular weight heparin are described for an initial treatment of thrombosis in inferior vena cava agenesis associated with heterozygous factor V Leiden. The patient, a 36-year-old woman, presented to the emergency room with sudden onset of back pain, swelling of the legs and thighs, and claudication while walking. Abdominal ultrasonography was immediately ordered. Anomalies in vascular blood flow were detected. Computed tomography was performed, and initially showed a complete absence of the infrarenal segment of inferior vena cava caudally to the origin of both renal veins. Treatment with enoxaparin (1 mg/kg twice per day) was started. The patient was discharged and returned to her activities of daily living two weeks after admission. This vascular abnormality is mostly incidentally diagnosed in adults and only a few cases are described as being associated with thrombophilia.
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45
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Kreidy R, Irani-Hakime N. Is thrombophilia a major risk factor for deep vein thrombosis of the lower extremities among Lebanese patients? Vasc Health Risk Manag 2009; 5:627-33. [PMID: 19688103 PMCID: PMC2725795 DOI: 10.2147/vhrm.s6184] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Aim Factor V Leiden (R506Q) mutation is the most commonly observed inherited genetic abnormality related to vein thrombosis. Lebanon has one of the highest frequencies of this mutation in the world with a prevalence of 14.4% in the general population. The aim of this study is to define risk factors including inherited genetic abnormalities among Lebanese patients with lower extremity deep vein thrombosis. We report the clinical outcome of patients with thrombophilia. Methods From January 1998 to January 2008, 162 patients (61 males and 101 females) were diagnosed with lower extremity deep vein thrombosis. Mean age was 61 years (range: 21 to 95 years). Results The most frequent risk factors for vein thrombosis were surgery, advanced age, obesity, and cancer. Twenty-five patients had thrombophilia, 16 patients had factor V Leiden (R506Q) mutation, and seven patients had MTHFR C677T mutation. Ninety-two percent of patients screened for thrombophilia were positive. Screening was requested in young patients (16), patients with recurrent (11), spontaneous (8), and extensive (5) venous thrombosis, familial history (5), pregnancy (4), estroprogestative treatment (3), and air travel (1). Nine patients had one, 11 patients had two, and five had three of these conditions. Follow-up (6 to 120 months) of these 25 patients treated with antivitamin K did not reveal recurrences or complications related to venous thromboembolism. Conclusion Factor V Leiden mutation followed by MTHFR mutation are the most commonly observed genetic abnormalities in these series. Defining risk factors and screening for thrombophilia when indicated reduce recurrence rate and complications. Recommendations for thrombophilia screening will be proposed.
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Affiliation(s)
- R Kreidy
- Department of Vascular Surgery, Saint George Hospital, University Medical Center, Youssef Sursock Street, PO Box 166378, Achrafieh, Beirut 11002807, Lebanon.
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Abstract
Musculoskeletal pain is a common symptom among active adolescent in the emergency department. The etiologic list is broad and range from benign to potential life-threatening conditions. Deep vein thrombosis is a rare cause of lower extremity pain in children. We report an adolescent who presented with lower extremity pain and a careful evaluation revealed an abdominal mass. Further investigation determined the presence of iliofemoral deep venous thrombosis and absence of the inferior vena cava. Absence of inferior vena cava is an uncommon congenital malformation in children and is a possible risk factor for the development of venous thrombosis. This case emphasizes the importance of thorough physical examination in children with nonspecific symptoms. If venous thrombosis is identified, especially in patients without any apparent risk factors, congenital anomalies of inferior vena cava should be considered. The pertinent literature is reviewed.
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47
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Clayburgh DR, Yoon JD, Cipriani NA, Ricketts PA, Arora VM. Clinical problem-solving. Collateral damage. N Engl J Med 2008; 359:1048-54. [PMID: 18768949 DOI: 10.1056/nejmcps0708994] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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48
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Martínez-Aguilar E, Medina-Maldonado F, Flórez González A, Varela-Casariego C, Gómez-Penas M, Acín F. Hipoplasia de la vena cava inferior asociada a una trombosis venosa profunda de los miembros inferiores. ANGIOLOGIA 2008. [DOI: 10.1016/s0003-3170(08)01007-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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