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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.
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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.
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Del Canto Peruyera P, Vallina-Victorero Vázquez MJ. A rare cause of deep vein thrombosis: inferior vena cava agenesis. J Vasc Bras 2023; 22:e20220126. [PMID: 37576731 PMCID: PMC10421584 DOI: 10.1590/1677-5449.202201262] [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: 02/16/2023] [Accepted: 05/09/2023] [Indexed: 08/15/2023] Open
Abstract
Inferior vena cava agenesis is a rare condition and is often misdiagnosed. This anomaly is asymptomatic in the majority of cases and is usually diagnosed during imaging tests carried out for other purposes. The most frequent manifestation is deep vein thrombosis (DVT) in lower limbs and anticoagulation therapy is the most frequent treatment option. Other techniques such as thrombolysis and venous bypass are also described. We report two cases diagnosed at our institution during the last year, both of which presented with an episode of DVT. We opted for indefinite anticoagulation therapy and both patients remain asymptomatic, after 1 year of surveillance in the first case and 6 months in the second, with no new episodes of DVT. Although it is not a life-threatening anomaly, it is important to make an appropriate diagnosis and provide treatment to improve the symptoms and quality of life of these patients.
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Affiliation(s)
- Pablo Del Canto Peruyera
- Hospital Universitario de Cabueñes - HUCAB, Servicio de Angiología y Cirugía Vascular, Gijón, España
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Lui DH, Williamson HM, Hamilton G, Drebes A, Davies N, Lim CS. Lower Limb Weakness due to Spinal Venous Congestion in Chronic Inferior Vena Cava Occlusion: A Case Report. Vasc Endovascular Surg 2023; 57:175-181. [PMID: 36189730 DOI: 10.1177/15385744221131202] [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: 01/18/2023]
Abstract
CASE REPORT A 31 year-old male presented with a long history of reduced sensation and motor function in his lower limbs upon waking every morning, lasting 30-50 minutes during which he was unable to ambulate. He was involved in a severe road traffic accident as a child, and was born prematurely requiring prolonged neonatal hospitalisation. Both duplex ultrasonography and magnetic resonance venography identified an occlusion of the IVC, with patent common femoral and iliac veins draining into large spinal collaterals. No other cause was identified for his symptoms. After appropriate multidisciplinary team discussion and patient counselling, the patient proceeded to have endovenous recanalization of his IVC and common iliac veins with dedicated venous stents. Post-operatively, the patient reported an immediate resolution of neurological symptoms, with an improvement in quality of life questionnaire scores and with stent patency at 9-month follow up. CONCLUSION IVC occlusion with symptomatic spinal venous congestion is a rare condition which may be successfully treated with endovascular iliocaval recanalization, although long-term outcomes of this treatment are still unknown.
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Affiliation(s)
- Dennis H Lui
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
| | | | - George Hamilton
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
| | - Anja Drebes
- Department of Haematology, 4965Royal Free Hospital, UK
| | - Neil Davies
- Department of Interventional Radiology, 4965Royal Free Hospital, UK
| | - Chung S Lim
- Department of Vascular Surgery, 4965Royal Free Hospital, UK.,Division of Surgery and Interventional Science, 919University College London, UK
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Role of Inferior Vena Cava (IVC) Recanalization in Patients with Back Pain, Secondary to IVC Obstruction in Budd-Chiari Syndrome. Diagnostics (Basel) 2023; 13:diagnostics13030438. [PMID: 36766542 PMCID: PMC9914368 DOI: 10.3390/diagnostics13030438] [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: 12/26/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 01/27/2023] Open
Abstract
PURPOSE To study the prevalence of back pain in patients of Budd-Chiari syndrome (BCS) with inferior vena cava (IVC) obstruction, and to evaluate the role of IVC recanalization in resolution of back pain. METHODS All patients with BCS and IVC obstruction who underwent IVC recanalization between January 2018 and October 2022 were included. Patients with degenerative spine disease or other identifiable causes for back pain were excluded; remaining patients were assessed for the presence of back pain. In patients with back pain, pain relief was assessed at 24 h following IVC recanalization. RESULTS Fifty-eight patients with BCS and IVC occlusion were identified, of which six with degenerative spine diseases were excluded. Of the remaining 52 patients, 34 (65.4%) had back pain, with pain score between 3 and 9. Engorged epidural venous plexus on preprocedural imaging (p = 0.002), and degree of luminal narrowing (p = 0.021) had a significant association with back pain. Twenty-nine of thirty-four patients (85.3%) with back pain had pain relief immediately following IVC recanalization, more so in patients with engorged epidural venous plexus on preprocedural imaging (p < 0.001). CONCLUSION Back pain is one of the under-reported symptoms of IVC obstruction in BCS. IVC recanalization by IVC angioplasty with or without stenting relieves back pain due to the decompression of engorged epidural veins.
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Nagarajan K, Amuthabharathi M, Sathiaprabhu A. Epidural and paraspinal varices seen in inferior vena cava agenesis causing lumbar radiculopathy. J Neurosci Rural Pract 2023; 14:184-186. [PMID: 36891104 PMCID: PMC9945397 DOI: 10.25259/jnrp-2022-1-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/30/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Krishnan Nagarajan
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Mohan Amuthabharathi
- Department of Radio-Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Anbazhagan Sathiaprabhu
- Department of Neurosurgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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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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Campione A, Agresta G, Locatelli D, Pozzi F. Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment. J Neurosurg Spine 2021. [DOI: 10.3171/2020.7.spine20625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation.
A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention. She was initially diagnosed with L4–5 lumbar disc protrusion. However, contrast-enhanced lumbar MRI scan showed the presence of epidural varices in the L3–S1 tract. Given the absence of vascular anomalies amenable to resection, etiological conservative treatment was addressed. Therefore, a complete diagnostic workup was performed and revealed deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis. Oral anticoagulant therapy was initiated and prompt resolution of CES was observed. To the authors’ knowledge, this is the first report of CES secondary to epidural varicosis in the setting of acute portal vein thrombosis and extrahepatic portal vein obstruction (EHPVO). In cases of epidural varicosis, conservative etiological treatment is the most appropriate choice as CES may be the epiphenomenon of underlying systemic pathophysiological processes.
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Affiliation(s)
- Alberto Campione
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
| | - Gianluca Agresta
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
| | - Davide Locatelli
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
- Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell’Insubria, Varese, Italy
| | - Fabio Pozzi
- Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi—ASST Settelaghi; and
- Department of Neurosurgery, Università degli Studi dell’Insubria, and
- Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell’Insubria, Varese, Italy
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Campione A, Agresta G, Locatelli D, Pozzi F. Cauda equina syndrome secondary to portal vein thrombosis: case report of favorable outcome with conservative treatment. J Neurosurg Spine 2021:1-6. [PMID: 33386000 DOI: 10.3171/2020.6.spine20625] [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: 04/19/2020] [Accepted: 07/31/2020] [Indexed: 11/06/2022]
Abstract
Epidural varicosis is a rare though well-known cause of cauda equina syndrome (CES). Although inferior vena cava (IVC) obstruction is the most common finding in such cases, portal vein hypertension can lead to epidural venous plexus engorgement by means of lumbar portocaval shunt activation.A 40-year-old woman presented with right-sided sciatica, which progressed to right foot drop and a 3-day history of vesical tenesmus and fecal retention. She was initially diagnosed with L4-5 lumbar disc protrusion. However, contrast-enhanced lumbar MRI scan showed the presence of epidural varices in the L3-S1 tract. Given the absence of vascular anomalies amenable to resection, etiological conservative treatment was addressed. Therefore, a complete diagnostic workup was performed and revealed deep vein thrombosis (DVT), pulmonary embolism, and portal vein thrombosis. Oral anticoagulant therapy was initiated and prompt resolution of CES was observed. To the authors' knowledge, this is the first report of CES secondary to epidural varicosis in the setting of acute portal vein thrombosis and extrahepatic portal vein obstruction (EHPVO). In cases of epidural varicosis, conservative etiological treatment is the most appropriate choice as CES may be the epiphenomenon of underlying systemic pathophysiological processes.
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Affiliation(s)
- Alberto Campione
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
| | - Gianluca Agresta
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
| | - Davide Locatelli
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
- 3Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, Varese, Italy
| | - Fabio Pozzi
- 1Department of Neurosurgery, Ospedale di Circolo Fondazione Macchi-ASST Settelaghi; and
- 2Department of Neurosurgery, Università degli Studi dell'Insubria, and
- 3Head and Neck Surgery & Forensic Dissection Research Center, Department of Biotechnology and Life Sciences, Università degli Studi dell'Insubria, Varese, Italy
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Hallan DR, McNutt S, Reiter GT, Thamburaj K, Specht CS, Knaub M. Dilated Epidural Venous Plexus Causing Radiculopathy: A Report of 2 Cases and Review of the Literature. World Neurosurg 2020; 144:231-237. [PMID: 32961358 DOI: 10.1016/j.wneu.2020.09.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/23/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND A dilated epidural venous plexus (DEVP) is a rare cause of radiculopathy, back pain, cauda equina syndrome, and other neurological symptoms. This vascular mass can be secondary to inferior vena cava obstruction, portal hypertension, vascular agenesis, and hypercoagulable states. Although rare, DEVP should be considered in the differential diagnosis for patients who present with lumbar radiculopathy. CASE DESCRIPTION We present 2 cases involving patients with lumbar DEVP as well as a literature review of the role of hypercoagulability, vascular anatomy, and inferior vena cava thrombosis in the development of DEVP. The first patient had a history of recurrent deep vein thrombosis, systemic lupus erythematosus, and antiphospholipid syndrome. The diagnosis of DEVP was determined after intraoperative biopsy. The patient reported symptom resolution at her 6-month postoperative appointment. The second patient developed DEVP associated with Klippel-Trenaunay syndrome. She presented with back pain and leg weakness, and DEVP was diagnosed via magnetic resonance imaging. A neurosurgeon is currently following the patient. We believe this is the first case of Klippel-Trenaunay syndrome associated with DEVP. CONCLUSIONS If a patient presents with an enhancing epidural lesion on magnetic resonance imaging and neurological symptoms, DEVP should be considered in the differential diagnosis. Additionally, a search for inferior vena cava thrombosis should be performed as well as risk factors for venous hypertension and hypercoagulable states.
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Affiliation(s)
- David R Hallan
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA.
| | - Sarah McNutt
- Department of Pennsylvania State College of Medicine, Hershey, Pennsylvania, USA
| | - G Timothy Reiter
- Department of Neurosurgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Krishnamoorthy Thamburaj
- Department of Neuroradiology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Charles S Specht
- Department of Pathology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Mark Knaub
- Department of Orthopaedic Surgery, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Intramedullary Spinal Cord Metastasis from Renal Cell Carcinoma: A Systematic Review of the Literature. BIOMED RESEARCH INTERNATIONAL 2018; 2018:7485020. [PMID: 30643818 PMCID: PMC6311310 DOI: 10.1155/2018/7485020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/28/2018] [Accepted: 11/28/2018] [Indexed: 12/27/2022]
Abstract
Intramedullary spinal cord metastases from renal cell carcinomas (RCCs) are rare and can cause serious diagnostic and therapeutic dilemmas. The related reports are very few. This review was aimed to perform an analysis of all reported cases with intramedullary spinal cord metastases from RCCs. In January 2018, we performed a literature search in PubMed database using a combination of the keywords “intramedullary spinal cord metastasis” and “renal cell carcinoma”. In addition, we present the clinical, neuroradiological, and histopathological findings in our patient with an intramedullary metastasis from a RCC. 17 cases were generated in our research. The mean interval from diagnosis of RCC to diagnosis of ISCM was 22 months. The median survival of surgically treated patients was 8.6 months and 8 months in patients who underwent radical surgery. Based on our review, RCCs can invade the medulla of the spinal cord several years after removal of the primary lesion. The prognosis of ISCMs from RCCs was poor. Retrograde passage of tumor cells into the spinal cord from the inferior vena cava via the epidural venous sinuses may have been the pathological mechanism for ISCM in our patient. Radical resection and radiation are effective ways of achieving recovery of neurologic function and improving quality of life. More reports are needed to enable exploration of the mechanisms of metastasis and the optimal forms of therapy.
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Wong TW, Gridley DG, Feiz-Erfan I. Epidural venous plexus engorgement due to inferior vena cava thrombosis resulting in cauda equina syndrome: Case report and literature review. Surg Neurol Int 2018; 9:129. [PMID: 30105127 PMCID: PMC6044142 DOI: 10.4103/sni.sni_115_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/18/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Epidural venous plexus congestion at L5-S1 due to inferior vena cava (IVC) thrombosis led to an acute cauda equina syndrome (CES). Laminectomy to rule out an epidural abscess, allowing for resection of the dilated veins, led to immediate symptom resolution. CASE DESCRIPTION A 47-year-old male presented with acute urinary retention and left greater than right lower extremity paresis of 2 weeks duration. Magnetic resonance imaging (MRI) revealed a contrast-enhancing space-occupying anterior epidural L5-S1 level lesion resulting in cauda equina compression. As the patient was septic, he underwent an emergency laminectomy for a presumed epidural abscess. Intraoperative findings, however, documented a markedly dilated epidural venous plexus secondary to a newly diagnosed IVC thrombus. One day postoperatively, the patient was symptom-free and neurologically intact. CONCLUSIONS Here we report a patient who uniquely presented with a CES characterized by acute paraparesis. This was attributed to a massively engorged anterior lumbar epidural venous plexus attributed to newly diagnosed IVC thrombus.
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Affiliation(s)
- Tina W. Wong
- Department of Surgery, Division of Neurosurgery, University of Arizona College of Medicine – Phoenix, Maricopa Medical Center, Phoenix, Arizona, USA
| | - Daniel G. Gridley
- Department of Radiology, University of Arizona College of Medicine – Phoenix, Maricopa Medical Center, Phoenix, Arizona, USA
| | - Iman Feiz-Erfan
- Department of Surgery, Division of Neurosurgery, University of Arizona College of Medicine – Phoenix, Maricopa Medical Center, Phoenix, Arizona, USA
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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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Epidural venous plexus engorgement: what lies beneath? Case Rep Radiol 2015; 2015:965106. [PMID: 25722912 PMCID: PMC4334425 DOI: 10.1155/2015/965106] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 01/26/2015] [Indexed: 11/18/2022] Open
Abstract
Epidural venous plexus engorgement may occur due to several conditions that prevent the normal venous circulation. Inferior vena cava agenesis is a very rare cause of epidural venous enlargement. We present a case with a very thin inferior vena cava and left iliac vein agenesis who presented with back pain due to epidural vein engorgement and lacked other venous problems such as deep vein thrombosis.
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Lamparello BM, Erickson CR, Kulthia A, Virparia V, Thet Z. Congenital anomaly of the inferior vena cava and factor V Leiden mutation predisposing to deep vein thrombosis. Vasc Health Risk Manag 2014; 10:609-13. [PMID: 25395858 PMCID: PMC4226457 DOI: 10.2147/vhrm.s66283] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
A previously healthy 21-year-old man presented with back pain, bilateral extremity pain, and right lower extremity weakness, paresthesias, and swelling. Sonographic examination revealed diffuse deep vein thrombosis (DVT) in the femoral and popliteal venous system. CT imaging revealed hypoplasia of the hepatic inferior vena cava (IVC) segment with formation of multiple varices and collateral veins around the kidneys. Hematologic workup also discovered a factor V Leiden mutation, further predisposing the patient to DVT. The rare, often overlooked occurrence of attenuated IVC, especially in the setting of hypercoagulable state, can predispose patients to significant thrombosis.
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Affiliation(s)
| | | | - Arun Kulthia
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Vasudev Virparia
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
| | - Zeyar Thet
- Department of Medicine, Coney Island Hospital, Brooklyn, NY, USA
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