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Kisling A, Basile S, Dagher A, Sexton J, Twerdahl E. Multimodal imaging assessment for feasibility of endovascular reconstruction in cases of inferior vena cava atresia. Clin Case Rep 2024; 12:e8831. [PMID: 38799541 PMCID: PMC11126911 DOI: 10.1002/ccr3.8831] [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: 03/21/2024] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 05/29/2024] Open
Abstract
Inferior vena cava atresia is a rare condition with highly variable anatomy due to the complexity of caval embryology. When endovascular venovenous reconstruction is considered for severe persistent sequelae, multimodality imaging with CT and invasive venography is used to determine the appropriateness of intervention and for procedural planning.
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Affiliation(s)
- Adam Kisling
- Department of CardiologyWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Sean Basile
- Department of CardiologyWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Adelle Dagher
- Department of SurgeryWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Jonathan Sexton
- Department of Vascular SurgeryWalter Reed National Military Medical CenterBethesdaMarylandUSA
| | - Eric Twerdahl
- Department of Vascular SurgeryWalter Reed National Military Medical CenterBethesdaMarylandUSA
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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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Atay M, Kocakoc E. Inferior Vena Cava Agenesis Associated with Urogenital Anomalies: A Case Report. Curr Med Imaging 2022; 18:1240-1243. [PMID: 35346001 DOI: 10.2174/1573405618666220328094509] [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: 12/10/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Inferior vena cava (IVC) agenesis, ectopic ureterocele and ureteral duplication are very rare congenital anomalies. CASE PRESENTATION A-25-year-old female patient was referred with right flank pain, chills and dysuria. Laboratory tests and CT showed findings consistent with acute pyelonephritis. There were only frequent urinary tract infections and Factor V Leiden mutation in her medical history. Patient was treated with antibiotherapy. CT examination demonstrated IVC agenesis (IVCA). Urogenital anomalies such as vaginal ectopic ureterocele, ureteral duplication and septate uterine anomaly were also present. CONCLUSION We report the first occurrence of IVC agenesis associated with multiple urogenital anomalies in the literature.
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Affiliation(s)
- Musa Atay
- Department of Radiology, Bagcilar Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ercan Kocakoc
- Department of Radiology, Medical Park Bahçelievler Hospital, Istanbul- Turkey
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Shahrouki P, Lee EW, Ruehm S. Polysplenia syndrome and sickle cell trait: extensive deep venous thrombosis from venous stasis and hypercoagulability. Clin Imaging 2021; 82:127-131. [PMID: 34813990 DOI: 10.1016/j.clinimag.2021.11.017] [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: 07/11/2021] [Revised: 10/24/2021] [Accepted: 11/15/2021] [Indexed: 11/29/2022]
Abstract
Deep venous thrombosis is a hitherto under-recognized complication occurring in patients with polysplenia syndrome, despite the high prevalence of venous anomalies such as interrupted inferior vena cava (IVC) with azygos/hemiazygos continuation. Here we report the first case of concurrent polysplenia (as evidenced by interrupted IVC with azygos/hemiazygos continuation, multiple left-sided spleens, bowel malrotation with inverted mesenteric veins, preduodenal portal vein, and pancreatic hypoplasia/partial agenesis of the dorsal pancreas) and sickle cell trait, complicated by extensive deep venous thrombosis refractory to medical and interventional radiologic management.
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Affiliation(s)
- Puja Shahrouki
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA.
| | - Edward Wolfgang Lee
- Division of Interventional Radiology, Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Stefan Ruehm
- Department of Radiological Sciences, University of California Los Angeles, Los Angeles, CA, USA
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5
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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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Abstract
SummaryA case of bilateral iliofemoral thrombosis in a 17-year-old [male] patient is presented. It was only revealed during bilateral transfemoral thrombectomy that the thrombosis was due to previous inferior vena cava occlusion. This required a complex interventional reconstruction of the vena cava with secondary stenting of both renal veins. The postoperative venogram showed blood outflow from the left renal vein into the portal vein and from the right renal vein into the inferior vena cava via collaterals. At follow-up presentation, the patient was asymptomatic with normal findings on computed tomography scanning.
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7
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Elevated risk of thrombophilia in agenesis of the vena cava as a factor for deep vein thrombosis. Orphanet J Rare Dis 2015; 10:3. [PMID: 25604085 PMCID: PMC4308084 DOI: 10.1186/s13023-014-0223-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2014] [Accepted: 12/30/2014] [Indexed: 11/29/2022] Open
Abstract
Background Congenital absence of the inferior vena cava (AIVC) is a rare malformation which may be associated with an increased risk for deep vein thrombosis (DVT). However, the role of thrombophilia in AIVC and DVT is unknown. Methods Between 1982 and 2013 41 patients (12 female, 29 male, mean age 28 S.D. 11 years) were detected at the University of Düsseldorf, Germany, with AIVC. Based on medical history, clinical examination, imaging and coagulation studies, we performed on this collective a risk characterisation. Extensive literature research added further 123 published cases during 1993 and 2013. AIVC-patients were compared with iliocaval DVT-patients without AIVC (n = 168) treated during the same period in our clinic (90 female, 78 male, mean age 38 S.D. 17 years). Results In contrast to classical DVT younger men were more often affected. Factor-V-Leiden-mutation, 5,10-methylenetetrahydrofolate reductase (MTHFR) polymorphism and hyperhomocysteinemia individually are associated with an increased risk of DVT in patients with AIVC. Aplasia/hypoplasia of the right or left kidney is also associated with IVCA. Conclusions AIVC should be considered in young patients who present with DVT involving the vena cava. Analysis of publications with AIVC and our patients yielded a typical spectrum of AIVC-associated DVT characteristics: AIVC occurs in young male adults, is revealed by proximal DVT, not necessarily accused by precipitating factors like immobilisation, and is mostly located bilateral. Hereditary coagulation abnormalities seem to be more often a contributing factor for DVT in AIVC. Electronic supplementary material The online version of this article (doi:10.1186/s13023-014-0223-4) contains supplementary material, which is available to authorized users.
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Yugueros X, Alvarez B, Fernández E, Boqué M, Matas M. Compressive Symptoms Due to Thrombosed or Hypertrophic Collateral Circulation in Infrarenal Inferior Vena Cava Agenesis. Ann Vasc Surg 2013; 27:238.e9-238.e13. [DOI: 10.1016/j.avsg.2012.06.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Revised: 03/01/2012] [Accepted: 03/01/2011] [Indexed: 11/25/2022]
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Monagle P, Chan AKC, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U, Vesely SK. Antithrombotic therapy in neonates and children: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest 2012; 141:e737S-e801S. [PMID: 22315277 DOI: 10.1378/chest.11-2308] [Citation(s) in RCA: 950] [Impact Index Per Article: 79.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Neonates and children differ from adults in physiology, pharmacologic responses to drugs, epidemiology, and long-term consequences of thrombosis. This guideline addresses optimal strategies for the management of thrombosis in neonates and children. METHODS The methods of this guideline follow those described in the Methodology for the Development of Antithrombotic Therapy and Prevention of Thrombosis Guidelines: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. RESULTS We suggest that where possible, pediatric hematologists with experience in thromboembolism manage pediatric patients with thromboembolism (Grade 2C). When this is not possible, we suggest a combination of a neonatologist/pediatrician and adult hematologist supported by consultation with an experienced pediatric hematologist (Grade 2C). We suggest that therapeutic unfractionated heparin in children is titrated to achieve a target anti-Xa range of 0.35 to 0.7 units/mL or an activated partial thromboplastin time range that correlates to this anti-Xa range or to a protamine titration range of 0.2 to 0.4 units/mL (Grade 2C). For neonates and children receiving either daily or bid therapeutic low-molecular-weight heparin, we suggest that the drug be monitored to a target range of 0.5 to 1.0 units/mL in a sample taken 4 to 6 h after subcutaneous injection or, alternatively, 0.5 to 0.8 units/mL in a sample taken 2 to 6 h after subcutaneous injection (Grade 2C). CONCLUSIONS The evidence supporting most recommendations for antithrombotic therapy in neonates and children remains weak. Studies addressing appropriate drug target ranges and monitoring requirements are urgently required in addition to site- and clinical situation-specific thrombosis management strategies.
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Affiliation(s)
- Paul Monagle
- Haematology Department, The Royal Children's Hospital, Department of Paediatrics, The University of Melbourne, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Anthony K C Chan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Neil A Goldenberg
- Department of Pediatrics, Section of Hematology/Oncology/Bone Marrow Transplantation and Mountain States Regional Hemophilia and Thrombosis Center, University of Colorado, Aurora, CO
| | - Rebecca N Ichord
- Department of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Janna M Journeycake
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX
| | - Ulrike Nowak-Göttl
- Thrombosis and Hemostasis Unit, Institute of Clinical Chemistry, University Hospital Kiel, Kiel, Germany
| | - Sara K Vesely
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, OK.
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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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12
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Deep Vein Thrombosis, Inferior Vena Cava Interruption and Multiple Thrombophilic Gene Mutations. Am J Med Sci 2011; 342:79-82. [DOI: 10.1097/maj.0b013e3182172758] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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La Spada M, Stilo F, Carella G, Salomone I, Benedetto F, De Caridi G, Spinelli F. Thrombectomy and surgical reconstruction for extensive iliocaval thrombosis in a patient with agenesis of the retrohepatic vena cava and atresia of the left renal vein. Ann Vasc Surg 2011; 25:839.e1-4. [PMID: 21620663 DOI: 10.1016/j.avsg.2010.12.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2010] [Revised: 06/16/2010] [Accepted: 12/27/2010] [Indexed: 11/19/2022]
Abstract
In 80% of the patients presenting with deep-venous thrombosis (DVT), a risk factor can be identified. An absent or hypoplastic infrarenal vena cava is a rare risk factor for DVT in young adults. In these cases, the prevalence of congenital anomalies of the inferior vena cava (IVC) is estimated at 0.5% of the general population, up to 5% in young people. The association with coagulopathy increases the risk of DVT. We report a case of a young man who presented with a massive caval and iliofemoral-popliteal thrombosis in presence of the agenesis of retrohepatic inferior vena cava and atresia of the left renal vein. Open thrombectomy and caval reconstruction with a polytetrafluoroethylene graft were performed. Surgical option with vein reconstruction was preferred to prevent new episodes of thrombosis and the risk of acute renal failure.
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Affiliation(s)
- Michele La Spada
- Unit of Vascular Surgery, Department of Cardiovascular and Thoracic Surgery, University of Messina, Italy
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An adolescent with lower-extremity swelling. Pediatr Emerg Care 2011; 27:49-51. [PMID: 21206258 DOI: 10.1097/pec.0b013e3182045f5c] [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: 11/26/2022]
Abstract
Lower-extremity swelling is an uncommon presentation in a pediatric emergency department. Deep venous thrombosis is one of the common differential diagnoses in a patient with an underlying predisposing factor. We report a case of a previously healthy adolescent without any risk factor for thromboembolism presented with deep venous thrombosis. The pertinent literature is reviewed.
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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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