"Marsupial cava" and ruptured abdominal aortic aneurysm. A case report and review of the literature

Infected Aortic Aneurysm with Infective Spondylitis in a Patient with Pre-Aortic Confluence of the Iliac Veins: An Unusual Triple Combination

It is uncommon for infective spondylitis to coexist with an infected aneurysm of the adjacent abdominal aorta. Also, pre-aortic confluence of the iliac veins or marsupial vena cava is a rare anatomical variant, which increases the potential for venous injury and hemorrhage during an emergency operation. Herein, we report the case of a 57-year-old male with these three pathologies, who was successfully treated with emergency open surgery. During surgery, we noted this anomaly and extensive destruction of the lumbar vertebral bodies. We discuss options to treat these rare pathologies with literature review.

Right Double Inferior Vena Cava (IVC) with Preaortic Iliac Confluence - Case Report and Review of Literature

Anomalies of the inferior vena cava (IVC) are uncommon and most of them remain asymptomatic. Though rare, anomalies of IVC can lead to severe hemorrhagic complications especially during aortoiliac surgery. Prior knowledge of these variations facilitates proper interpretation of radiological images and safe performance of interventional procedures and surgeries. During routine anatomical dissection of abdomen in a female cadaver we observed the presence of right sided duplication of IVC. Both IVCs were present on the right side of abdominal aorta, one ventral and the other more dorsal in position and named ventral right IVC and dorsal right IVC. The ventrally and medially placed IVC, which appeared to be the main IVC was formed by the union of two common iliac veins in front of the right common iliac artery (Preaortic iliac confluence-"Marsupial Cava"). The right external iliac vein continued as the more dorsally and laterally placed dorsal right IVC. The right internal iliac vein after receiving a transverse anastomotic vein from the external iliac continued as the right common iliac vein. This transverse anastomosis was present behind the right common iliac artery. The narrower dorsal right IVC joined the wider ventral right IVC just below the level of renal veins to form a single IVC. The abdominal aorta presented a convexity to the left.

Preaortic left primitive iliac vein: two case studies

Although congenital abnormalities of the inferior vena cava (IVC) are rare, they can lead to serious hemorrhagic complications, especially during aortoiliac surgery. The most frequent complications include the double IVC, left-sided IVC, and the left retroaortic renal vein isolated or associated with a preaortic renal vein forming a periaortic venous collar. Preaortic primitive iliac vein represents an exceptional anatomic entity and only a few cases have been reported in previously published data (Ruemenapf et al., J Vasc Surg 1998;27:767-771; Schiavetta et al., J Vasc Surg 1998;28:719-722; Shindo et al., Ann Vasc Surg 2000;14:393-396; Balbridge and Canos, Arch Surg 1987;122:1184-1188; Honkasalo et al., Acta Chir Scand 1983;149:717-719; Brener et al., Arch Surg 1974;108:159-165; Vohra and Leiberman, Eur J Vasc Surg 1991;5:209-211; McClure and Huntington, Am Anat Memoirs 1929;15:1-55). In this study, we report two cases of preaortic left primitive iliac vein. The first patient was a male who was operated on for an aortobiiliac aneurysm. The second was of a female patient who was operated on for an interaortocaval lymphadenopathy that resulted from ganglion curettage performed for ovarian cancer.

Preaortic iliac confluence (marsupial vena cava): report of 4 cases

Congenital anomalies of the inferior vena cava (IVC) can represent a difficult for abdominal surgeries, and the radiologist must be aware even of the less common of these anatomical variations. Preaortic iliac venous confluence, also known as marsupial vena cava, is a rare congenital anomaly of the development of the IVC in which the IVC or the left common iliac vein is located anterior to the aortic bifurcation or the right common iliac artery. We report 4 cases of marsupial vena cava detected on multidetector computed tomography examinations in asymptomatic patients and discuss that this congenital anomaly can be recognized more frequently with the use of this new technique based on thinner images.

Aneurysm of the inferior vena cava in a 5-year-old boy

The authors present a case of an aneurysm of the inferior vena cava in a 5-year-old boy. The boy suffered from acute pulmonary and paradoxical cerebral embolism after a minor abdominal trauma. Magnetic resonance angiography was the key for correct diagnosis of the retroperitoneal process and helped develop a strategy for surgery. The boy underwent resection of the aneurysm and a prosthetic replacement of the distal inferior vena cava. Aneurysms of the inferior vena cava are very rare conditions. The diagnosis is difficult because they may mimic a retroperitoneal tumor. Thrombosis and embolism are common complications of aneurysms of the vena cava.

Retroaortic left renal vein and its implications in abdominal aortic surgery

The embryological development of the retroperitoneal venous system is a complex process. As a result, the anatomy of the inferior vena cava (IVC) and renal veins shows extensive variability. Improper completion of this process may lead to six anatomical variants: retroaortic left renal vein (LRV) types I and II, circumaortic venous collar, duplication of the IVC, transposition or left-sided IVC, and preaortic iliac confluence. All six are infrequent, but may be encountered during abdominal aortic reconstruction and pose challenging problems to the operating surgeon. Failure to appreciate these anomalies can lead to inadvertent injury and major venous bleeding. Preoperative diagnosis can be made on a CT scan, but this is not always performed prior to aortic surgery. In this report, we analyze two cases of retroaortic LRV complicating abdominal aortic aneurysmectomy, describe the most common infrarenal venous anomalies encountered during aortic surgery, and briefly review the literature.