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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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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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Morosetti D, Picchi E, Calcagni A, Lamacchia F, Cavallo AU, Bozzi A, Lacchè A, Sergiacomi G. Anomalous development of the inferior vena cava: Case reports of agenesis and hypoplasia. Radiol Case Rep 2018; 13:895-903. [PMID: 29997719 PMCID: PMC6037009 DOI: 10.1016/j.radcr.2018.04.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 11/15/2022] Open
Abstract
We reported the cases of two adult male patients who were admitted to our emergency room with abdominal pain and dyspnea caused by gallstones and pulmonary embolism respectively. During the radiological investigations, as collateral findings, we found two anomalous development of the inferior vena cava. These conditions affect about 4% of population and, although asymptomatic or mildly symptomatic, are associated with thrombotic manifestations as deep vein thrombosis and pulmonary embolism. The prompt recognition of these anomalies is necessary in order to prevent the complications associated with these conditions and to set the best therapy for patients.
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Affiliation(s)
- Daniele Morosetti
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Eliseo Picchi
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Antonello Calcagni
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Feliciana Lamacchia
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Armando Ugo Cavallo
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Alessio Bozzi
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Adriano Lacchè
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
| | - Gianluigi Sergiacomi
- Department of Diagnostic and Molecular Imaging, Interventional Radiology and Radiotherapy, University Hospital of Rome "Tor Vergata", Viale Oxford 81, 00133 Rome, Italy
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Ahmed AK, Finocchi V, Al-Agib S. Inferior vena cava calcification, a possible link with recurrent deep venous thrombosis and pulmonary embolism: a case study and review of literature. BJR Case Rep 2018; 4:20180018. [PMID: 31489221 PMCID: PMC6711275 DOI: 10.1259/bjrcr.20180018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/18/2018] [Accepted: 03/30/2018] [Indexed: 01/23/2023] Open
Abstract
Inferior vena cava (IVC) anomalies have been reported to have an association with deep venous thrombosis of the lower limbs. It is, therefore, necessary to study the IVC in recurrent cases of unprovoked deep venous thrombosis (DVT) and/or pulmonary embolism (PE), where all other causes have been excluded. We report a case of a 65-year-old male, who had recurrent episodes of DVT in the past 5 years; some of which associated with PE of unknown cause. CT thorax abdomen and pelvis did not find an obvious cause for the DVT and/or PE, however, it did highlight a diffuse calcification of the IVC. Only a few cases of calcification of the IVC have been reported in literature, and a number of them have been associated with clot formation and PE. We speculate that, as in other anomalies of the IVC, calcification of the IVC might slow the blood flow, and thus predispose to DVT and/or PE. Our opinion is that in all cases of unexplained DVT and/or PE, a careful examination of the IVC should be performed. Furthermore, when this condition is present, other risk factors for hypercoagulability should be avoided and anticoagulant therapy should be considered.
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Affiliation(s)
- Ahmed Ka Ahmed
- Department of Radiology, Nobles Hospital, Douglas, Isle of Man
| | - Vanina Finocchi
- Department of Radiology, Nobles Hospital, Douglas, Isle of Man
| | - Salah Al-Agib
- Department of Radiology, Nobles Hospital, Douglas, Isle of Man
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Azdaki N, Mohammadifard M, Ghasemian MR, Saburi A. Successful intravenous streptokinase therapy in refractory extensive deep vein thrombosis associated with inferior vena cava agenesis: A novel treatment for a rare case. Ann Card Anaesth 2017; 20:268-269. [PMID: 28393797 PMCID: PMC5408542 DOI: 10.4103/aca.aca_211_16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Nahid Azdaki
- Atherosclerosis Research Center, Birjand University of Medical Sciences, Birjand, Iran
| | - Mahyar Mohammadifard
- Atherosclerosis Research Center, Birjand University of Medical Sciences; Department of Radiology, Birjand University of Medical Sciences, Birjand, Iran
| | | | - Amin Saburi
- Chemical Injuries Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
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Sitwala PS, Ladia VM, Brahmbhatt PB, Jain V, Bajaj K. Inferior vena cava anomaly: a risk for deep vein thrombosis. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2014; 6:601-3. [PMID: 25535612 PMCID: PMC4264299 DOI: 10.4103/1947-2714.145486] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context: Inferior vena cava (IVC) anomalies have a 0.5% incidence rate and could be associated with other congenital abnormalities. In later stage of the disease, trophic ulcers with or without deep vein thrombosis (DVT) is consistent finding. Case Report: A 29-year-old male patient presented with recurrent lower extremity ulcers. Further workup revealed an absent infrahepatic inferior vena cava, prominently dilated azygos and hemiazygos veins with enlarged retroperitoneal collaterals without DVT. Conclusion: IVC anomaly should be suspected in a young patient presenting with unexplained venous thrombosis and recurrent ulcers of a lower extremity. IVC anomaly would inherently lead to blood flow stasis and endothelial injury. Thus per Virchow's triad, other risk factors for hypercoagulability such as physical inactivity, smoking tobacco, oral contraceptive pills should be avoided and when hereditary thrombophilias or other irreversible risk factors are present, lifelong anticoagulation should be considered.
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Affiliation(s)
- Puja S Sitwala
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Vatsal M Ladia
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Parag B Brahmbhatt
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
| | - Vinay Jain
- Department of Radiology, Veterans Affairs Medical Center, Johnson City, Tennessee, USA
| | - Kailash Bajaj
- Department of Internal Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, USA
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