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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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2
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Igbokwe MC, Maduadi KO, Olatise OO, Aremu A, Revanur V. Congenital bilateral iliac vein anomalies in a Nigerian pediatric kidney transplant recipient: A case report and literature review. Ann Afr Med 2022; 21:98-101. [PMID: 35313413 PMCID: PMC9020631 DOI: 10.4103/aam.aam_39_20] [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] [Indexed: 11/23/2022] Open
Abstract
The finding of bilateral congenital common iliac vein anomalies is indeed uncommon. This article presents the case of an 11-year-old boy with end-stage renal disease who had kidney transplantation (KT). At presentation, he was found to have a large superficial vein running from the left groin over the suprapubic area. The arterial pulsation of both lower limbs was preserved, and there was no pedal edema. Contrast-enhanced computed tomography scan revealed aplasia of the right common iliac vein, stenosis of the left common iliac vein, and marked dilatation of the left external and internal iliac veins. There were also varicosity of numerous pelvic veins and a collateral vein draining the right lower limb. This preoperative diagnosis was key to planning for surgery. On KT surgery, the renal allograft vein was anastomosed in an end-to-side fashion to the inferior vena cava and artery to the common iliac artery. The patient had a smooth postoperative recovery and continues to enjoy a normal renal function.
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Affiliation(s)
| | - Kester O Maduadi
- Zenith Medical and Kidney Center, Radiology Unit, Gudu, Abuja, Nigeria
| | | | - Abayomi Aremu
- Zenith Medical and Kidney Center, Urology and Kidney Transplant Unit, Gudu, Abuja, Nigeria
| | - Vasanth Revanur
- Zenith Medical and Kidney Center, Urology and Kidney Transplant Unit, Gudu, Abuja, Nigeria
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3
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Osborne T, Sheehan F. An unusual case of deep venous thrombosis in a young patient: congenital absence of the infrarenal portion of the inferior vena cava. Oxf Med Case Reports 2019; 2019:omz053. [PMID: 31312459 PMCID: PMC6625006 DOI: 10.1093/omcr/omz053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 04/24/2019] [Accepted: 05/01/2019] [Indexed: 12/02/2022] Open
Abstract
Deep venous thrombosis (DVT) is a commonly encountered diagnosis in clinical practice with a variety of well-established risk factors. Congenital absence of the inferior vena cava (IVC) is an extremely rare but established risk factor for DVT. Patients who develop DVTs are at high risk of long-term complications, including DVT recurrence and post-thrombotic syndrome. Here we report a rare case of a 27-year-old female who presented with an extensive DVT of the right lower extremity secondary to complete absence of the infrarenal portion of the IVC, confirmed on computed tomography. There is little consensus regarding the appropriate management of this patient population, and a brief review of the current evidence follows.
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Affiliation(s)
- Thomas Osborne
- Department of Clinical Radiology, St. Peter's Hospital, Ashford and St. Peter's Hospitals NHS Foundation Trust, Surrey, UK
| | - Frances Sheehan
- Department of Clinical Radiology, St. Peter's Hospital, Ashford and St. Peter's Hospitals NHS Foundation Trust, Surrey, UK
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4
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Lauener S, Bütikofer A, Eigenheer S, Escher R. Thrombophlebitis hiding under a KILT - case report on 40 years long-term follow-up of neonatal renal vein thrombosis. BMC Pediatr 2019; 19:183. [PMID: 31170948 PMCID: PMC6551889 DOI: 10.1186/s12887-019-1567-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/31/2019] [Indexed: 12/15/2022] Open
Abstract
Background Neonatal renal vein thrombosis is a recognised cause of renal and inferior caval vein atresia (IVCA). However, the long-term impact of the condition is underrecognized with a high burden of morbidity for the patient, especially in adulthood. IVCA has been shown to be an independent risk factor for deep venous thrombosis (DVT) with a high risk of recurrence. The acronym KILT for kidney and inferior vena cava anomaly with leg thrombosis summarizes the pathological situation. Case presentation We present the case of a 40-year-old patient with pain in the right lower limb resulting from acute thrombophlebitis. No risk factors could be identified. His history was remarkable with two episodes of deep venous thrombosis first of the left, then the right leg 22 years earlier; at that time also, no risk factor was identified. Because of the idiopathic character of that thrombosis, the patient remained on long-term anticoagulation with phenprocoumon. The present thrombophlebitis occurred while the INR was not therapeutic in the preceding weeks. A CT with contrast showed atresia of the inferior vena cava and of the right kidney, and presence of numerous collaterals. A thorough medical history revealed a renal vein thrombosis as a neonate. Anticoagulation was intensified, and stent placement became necessary after a further 2 years. Discussion and conclusions KILT syndrome is a rare but underrecognized condition. Complications may arise in young adulthood only, and it is of prime importance to instruct parents of the pediatric patient of the possible consequences of renal vein thrombosis and to assure guidance from the treating physicians throughout adulthood. Diagnosis of IVCA is by CT with contrast or by MRI, and lifelong anticoagulation may be necessary. Since the KILT syndrome is widely underdiagnosed, we challenge the clinicians to keep it in mind when confronted with thrombophlebitis or thrombosis of the young, male and with no other identifiable risk factors for deep vein thrombosis.
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Affiliation(s)
- Stefan Lauener
- Department of Medicine, Spital Emmental, Burgdorf, Switzerland
| | - Anne Bütikofer
- Department of Medicine, Spital Emmental, Burgdorf, Switzerland
| | | | - Robert Escher
- Department of Medicine, Spital Emmental, Burgdorf, Switzerland.
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5
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Schiffman MH, Cornman-Homonoff J, Sos TA. Percutaneous Orthotopic IVC Construction in a Pediatric Patient with Symptomatic IVC Agenesis. Cardiovasc Intervent Radiol 2018; 42:308-312. [PMID: 30420997 DOI: 10.1007/s00270-018-2098-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 10/16/2018] [Indexed: 10/27/2022]
Abstract
Inferior vena cava agenesis is an uncommon condition usually attributed to embryologic dysgenesis. When symptomatic, unprovoked deep venous thrombosis and/or lower extremity venous congestion are the most frequent manifestations. Its rarity has precluded consensus regarding appropriate management. Symptomatic chronic venous congestion requires surgical construction of auxiliary venous pathways, which may involve substantial morbidity, prolonged recovery and extensive scarring. We report successful minimally invasive management via percutaneous endovascular orthotopic inferior vena cava construction in a pediatric patient, thereby obviating the need for surgery and its associated morbidity. LEVEL OF EVIDENCE: Level IV, case study.
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Affiliation(s)
- Marc H Schiffman
- Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA.
| | - Joshua Cornman-Homonoff
- Department of Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
| | - Thomas A Sos
- Division of Interventional Radiology, NewYork-Presbyterian Hospital/Weill Cornell Medical Center, 525 East 68th Street, Box 141, New York, NY, 10065, USA
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6
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Menezes T, Haider EA, Al-Douri F, El-Khodary M, Al-Salmi I. Pelvic congestion syndrome due to agenesis of the infrarenal inferior vena cava. Radiol Case Rep 2018; 14:36-40. [PMID: 30305863 PMCID: PMC6174840 DOI: 10.1016/j.radcr.2018.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 04/02/2018] [Indexed: 11/05/2022] Open
Abstract
The inferior vena cava (IVC) is the main conduit of venous return to the right atrium from the lower extremities and abdominal organs. Agenesis of the IVC has an incidence of <1% in the general population [1], although it has been reported in the literature as occurring in up to 8.7% of the population [2]. Patients with absent IVC may present with symptoms of lower extremity venous insufficiency [6], idiopathic deep venous thrombosis [7], or pelvic congestion syndrome. To our knowledge there have only been a few cases reported in the literature of agenesis of the IVC associated with pelvic congestion syndrome [3,10,11]. We present another interesting case of pelvic congestion syndrome due to absent IVC.
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Affiliation(s)
- Terence Menezes
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada
| | - Ehsan A Haider
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada.,Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Faten Al-Douri
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada.,Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Mohamed El-Khodary
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada.,Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | - Ishaq Al-Salmi
- Department of Radiology, St. Joseph's Healthcare Hamilton, Hamilton, Canada
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7
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Williams JG, Phan H, Winston HR, Fugit RV, Graney B, Jamroz B, English B, Chan ED. A 27-Year-Old Man With Acute Severe Low Back Pain and Bilateral Leg Swelling That Prompted Renting a Wheelchair for Mobility. Chest 2017; 151:e35-e39. [PMID: 28183502 DOI: 10.1016/j.chest.2016.08.1459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/30/2016] [Accepted: 08/16/2016] [Indexed: 11/29/2022] Open
Abstract
A 27-year-old man with OSA, posttraumatic stress disorder, and chronic mechanical back pain presented with a 3-day history of acute atraumatic worsening of his low back pain as well as right groin numbness that was exacerbated by walking. He also complained of bilateral leg "heaviness," pain, and swelling, all becoming so severe that he rented a wheelchair for mobility.
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Affiliation(s)
- John G Williams
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Huy Phan
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Helena R Winston
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Randolph V Fugit
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Pharmacy, Denver Veterans Affairs Medical Center, Denver, CO
| | - Bridget Graney
- Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO
| | - Brant Jamroz
- Department of Radiology, Denver Veterans Affairs Medical Center, Denver, CO
| | - Benjamin English
- Department of Radiology, Denver Veterans Affairs Medical Center, Denver, CO
| | - Edward D Chan
- Department of Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Division of Pulmonary Sciences and Critical Care Medicine, University of Colorado Denver Anschutz Medical Campus, Aurora, CO; Department of Medicine, Denver Veterans Affairs Medical Center, Denver, CO; Department of Medicine and Academic Affairs, National Jewish Health, Denver, CO.
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8
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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 PMCID: PMC5427403 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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9
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Deep Vein Thrombosis Provoked by Inferior Vena Cava Agenesis. Case Rep Vasc Med 2016; 2015:651436. [PMID: 26788400 PMCID: PMC4695640 DOI: 10.1155/2015/651436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 11/21/2015] [Accepted: 12/08/2015] [Indexed: 11/17/2022] Open
Abstract
Inferior vena cava agenesis (IVCA) is a rare congenital anomaly that can be asymptomatic or present with vague, nonspecific symptoms, such as abdominal or lower back pain, or deep vein thrombosis (DVT). Here, we present a 55-year-old male who came with painless swelling and redness of his left lower limb. On examination, swelling and redness were noted extending from the left foot to the upper thigh; it was also warm compared to his right lower limb. Venous Doppler ultrasound was done which showed DVT extending up to the common femoral vein. Subsequently, computed-tomography (CT) of the chest and abdomen was done to exclude malignancy or venous flow obstruction; it revealed congenital absence (agenesis) of the infrarenal inferior vena cava (IVC).
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10
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Paddock M, Robson N. The curious case of the disappearing IVC: a case report and review of the aetiology of inferior vena cava agenesis. J Radiol Case Rep 2014; 8:38-47. [PMID: 24967034 DOI: 10.3941/jrcr.v8i4.1572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
We report the case of a previously well 18-year-old male who presented to the Emergency Department with lower limb pain. An ultrasound demonstrated extensive left sided deep vein thrombosis and computed tomography demonstrated inferior vena cava agenesis, leading to the diagnosis of inferior vena cava agenesis associated deep vein thrombosis. The aetiology of inferior vena cava agenesis is explored in depth.
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Affiliation(s)
- Michael Paddock
- Academic Unit of Radiology, University of Sheffield, Royal Hallamshire Hospital, Sheffield, United Kingdom
| | - Nicola Robson
- Department of Radiology, Poole Hospital NHS Foundation Trust, Poole, Dorset, United Kingdom
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11
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McAree BJ, O'Donnell ME, Fitzmaurice GJ, Reid JA, Spence RAJ, Lee B. Inferior vena cava thrombosis: a review of current practice. Vasc Med 2013; 18:32-43. [PMID: 23439778 DOI: 10.1177/1358863x12471967] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Inferior vena cava (IVC) thrombosis remains under-recognised as it is often not pursued as a primary diagnosis. The aetiology of IVC thrombosis can be divided into congenital versus acquired, with all aetiological factors found among Virchow's triad of stasis, injury and hypercoagulability. Signs and symptoms are related to aetiology and range from no symptoms to cardiovascular collapse. Painful lower limb swelling combined with lower back pain, pyrexia, dilatation of cutaneous abdominal wall veins and a concurrent rise in inflammatory markers are suggestive of IVC thrombosis. Following initial lower limb venous duplex, magnetic resonance imaging (MRI) is the optimal non-invasive imaging tool. Aetiology directs treatment, which ranges from anticoagulation and lower limb compression to open surgery, with endovascular therapies increasingly favoured. The objective of this review is to assess current literature on the aetiology, presentation, investigation, treatment, prognosis and other factors pertaining to IVC thrombosis.
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Affiliation(s)
- B J McAree
- Department of Vascular and Endovascular Surgery, Royal Victoria Hospital, Belfast, Northern Ireland
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12
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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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13
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Garg K, Cayne N, Jacobowitz G. Mechanical and pharmacologic catheter-directed thrombolysis treatment of severe, symptomatic, bilateral deep vein thrombosis with congenital absence of the inferior vena cava. J Vasc Surg 2011; 53:1707-10. [PMID: 21609802 DOI: 10.1016/j.jvs.2011.02.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 02/03/2011] [Accepted: 02/06/2011] [Indexed: 11/28/2022]
Abstract
We report the use of mechanical and pharmacologic catheter-directed thrombolysis in treating deep vein thrombosis with congenital absence of the inferior vena cava The patient presented with disabling bilateral lower extremity swelling and pain and was found to have extensive bilateral iliofemoral deep vein thromboses. Genetic testing revealed a factor V Leiden mutation. The patient underwent thrombolysis using a Possis (MEDRAD Inc, Warrendale, Pa) catheter and overnight infusion of tissue plasminogen activator. The patient tolerated the procedure well, with prompt return to daily activities. He remains free of symptoms at 3 years on oral anticoagulation, with a patent venous architecture.
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Affiliation(s)
- Karan Garg
- Department of Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
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14
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Abstract
Absence of an infrarenal inferior vena cava is an infrequent finding on computed tomography scans and is usually an unexpected, incidental finding. This report concerns a young patient with an absent infrarenal inferior vena cava who presented with abdominal and back pain.
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Scali ST, Beck AW, DeMartino RD, Duxbury A, Walsh DB. Endovascular management of congenital atresia of the infrarenal IVC. Vasc Endovascular Surg 2010; 44:234-6. [PMID: 20308176 DOI: 10.1177/1538574410361790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This case illustrates the feasibility of endovascular treatment for chronic venous insufficiency attributable to congenital atresia of the infrarenal inferior vena cava (IVC). Three-dimensional computed tomography (CT) venography can elucidate alternate sites of drainage and identify other venous pathology, such as dominant stenoses that may be amenable to venoplasty and/or stent placement.
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Arash Mohammadi Tofigh, Coscas R, Koskas F, Kieffer E. Surgical Management of Deep Venous Insufficiency Caused by Congenital Absence of the Infrarenal Inferior Vena Cava. Vasc Endovascular Surg 2008; 42:58-61. [DOI: 10.1177/1538574407306791] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Congenital absence of the inferior vena cava (CAIVC) is a rare vascular defect, commonly reported as a fortuitous finding because patients are typically asymptomatic of the condition itself but are symptomatic of associated conditions such as congenital heart disease, polysplenia, asplenia, and inversion of bowel viscera. The presence of CAIVC is probably underestimated because CAIVC may not be detected by compression B-mode ultrasonography. By use of computed tomography, we diagnosed a case of CAIVC in a young athletic patient with disabling venous stasis symptoms of the lower limbs. Venous prosthetic reconstruction of the infrarenal vena cava provided with early subsiding of edema and healing of stasis ulcers. An intracaval web was found as potentially responsible for the condition. We present and propose our surgical method for this rare disabling condition.
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Affiliation(s)
| | - Raphaël Coscas
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
| | - Fabien Koskas
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
| | - Edouard Kieffer
- Service de Chirurgie Vasculaire, CHU Pitie-Salpêtrière, Paris, France
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