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Bikdeli B, Sadeghipour P, Lou J, Bejjani A, Khairani CD, Rashedi S, Lookstein R, Lansky A, Vedantham S, Sobieszczyk P, Mena-Hurtado C, Aghayev A, Henke P, Mehdipoor G, Tufano A, Chatterjee S, Middeldorp S, Wasan S, Bashir R, Lang IM, Shishehbor MH, Gerhard-Herman M, Giri J, Menard MT, Parikh SA, Mazzolai L, Moores L, Monreal M, Jimenez D, Goldhaber SZ, Krumholz HM, Piazza G. Developmental or Procedural Vena Cava Interruption and Venous Thromboembolism: A Review. Semin Thromb Hemost 2024. [PMID: 38176425 DOI: 10.1055/s-0043-1777991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.
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Affiliation(s)
- Behnood Bikdeli
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Cardiovascular Research Foundation (CRF), New York, New York
| | - Parham Sadeghipour
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
- Clinical Trial Center, Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Junyang Lou
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Antoine Bejjani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Candrika D Khairani
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sina Rashedi
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Robert Lookstein
- Division of Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Alexandra Lansky
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, Missouri
| | - Piotr Sobieszczyk
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Carlos Mena-Hurtado
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ayaz Aghayev
- Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter Henke
- Section of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, Michigan
| | - Ghazaleh Mehdipoor
- Cardiovascular Research Foundation (CRF), New York, New York
- Center for Evidence-based Imaging, Brigham and Women's Hospital, Boston, Massachusetts
| | - Antonella Tufano
- Department of Clinical Medicine and Surgery, Federico II University Hospital, Naples, Italy
| | - Saurav Chatterjee
- Division of Cardiology, Department of Medicine, Zucker School of Medicine, New York, New York
| | - Saskia Middeldorp
- Department of Internal Medicine, Radboud Institute of Health Sciences (RIHS), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Suman Wasan
- University of North Carolina, Chapel Hill, North Carolina
| | - Riyaz Bashir
- Departement of Cardiovascular Diseases, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Irene M Lang
- Department of Internal Medicine II, Cardiology and Center of Cardiovascular Medicine, Medical University of Vienna, Vienna, Austria
| | - Mehdi H Shishehbor
- University Hospitals Heath System, Harrington Heart and Vascular Institute, Cleveland, Ohio
| | - Marie Gerhard-Herman
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jay Giri
- Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center, Cardiovascular Division, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sahil A Parikh
- Cardiovascular Research Foundation (CRF), New York, New York
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York
| | - Lucia Mazzolai
- Division of Angiology, Heart and Vessel Department, Centre Hospitalier Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland
| | - Lisa Moores
- Department of Medicine, Uniformed Services University of Health Sciences, Bethesda, Maryland
| | | | - David Jimenez
- Respiratory Department, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
- Medicine Department, Universidad de Alcalá (IRYCIS), Madrid, Spain
- CIBER Enfermedades Respiratorias (CIBERES), Madrid, Spain
| | - Samuel Z Goldhaber
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harlan M Krumholz
- YNHH/Yale Center for Outcomes Research and Evaluation (CORE), New Haven, Connecticut
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Gregory Piazza
- Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Thrombosis Research Group, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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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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Brkić F, Želalić S, Vučetić MZ, Schmidt S, Vidjak V, Popić J. Infrarenal inferior vena cava agenesis presenting as acute abdomen and hydronephrosis - case report. Radiol Case Rep 2023; 18:3070-3075. [PMID: 37434616 PMCID: PMC10331014 DOI: 10.1016/j.radcr.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 05/28/2023] [Accepted: 06/01/2023] [Indexed: 07/13/2023] Open
Abstract
The inferior vena cava agenesis (IVCA) is a rare and often asymptomatic malformation due to the abundant development of the collateral circulation. However, it is frequently found in young people and carries a significant risk of deep venous thrombosis (DVT). It is estimated that about 5% of patients under 30 years of age presenting with DVT have this condition. We report a case of a previously healthy 23-year-old patient presenting with signs of acute abdomen and hydronephrosis due to the thrombophlebitis of an unusual iliocaval venous collateral, which developed secondary to IVCA. After treatment, the iliocaval collateral and hydronephrosis completely regressed on a 1-year follow-up. To our knowledge, this is the first such case reported in the literature.
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Affiliation(s)
- Filip Brkić
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zajčeva 19, Zagreb, Croatia
| | - Sven Želalić
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zajčeva 19, Zagreb, Croatia
| | - Mirta Zekan Vučetić
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zajčeva 19, Zagreb, Croatia
| | - Saša Schmidt
- Department of Radiology, University Hospital Sveti Duh, Zagreb, Croatia
| | - Vinko Vidjak
- Clinical Department of Diagnostic and Interventional Radiology, Merkur University Hospital, Zajčeva 19, Zagreb, Croatia
- Faculty of Medicine, University of Zagreb, Zagreb, Croatia
| | - Jelena Popić
- Faculty of Medicine, University of Zagreb, Zagreb, Croatia
- Clinical Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia
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Dix C, Clements W, Gibbs H, So J, A Tran H, D McFadyen J. Venous anomalies and thromboembolism. Thromb J 2023; 21:45. [PMID: 37081466 PMCID: PMC10116765 DOI: 10.1186/s12959-023-00484-5] [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: 01/19/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
Patients with venous anomalies are at increased risk of developing venous thromboembolism (VTE) and subsequent complications, but they are often under-recognised. While unprovoked VTE may trigger testing for inherited thrombophilias and malignancy screening, anatomic variants are considered less often. Venous anomalies increase the risk due to venous flow disturbance, resulting in hypertension, reduced flow velocity and turbulence. Recognition is important as endovascular or surgical intervention may be appropriate, these patients have a high rate of VTE recurrence if anticoagulation is ceased, and the anomalies can predispose to extensive VTE and severe post-thrombotic syndrome (PTS). In this case series, we present representative cases and radiological images of May-Thurner syndrome (MTS), inferior vena cava (IVC) variants and venous aneurysms, and review the available literature regarding optimal diagnosis and management in each condition.
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Affiliation(s)
- Caroline Dix
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia.
| | - Warren Clements
- Department of Radiology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Harry Gibbs
- Department of General Medicine, Alfred Health, Melbourne, VIC, 3004, Australia
| | - Joanne So
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
| | - Huyen A Tran
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - James D McFadyen
- Department of Clinical Haematology, The Alfred Hospital, Melbourne, VIC, 3004, Australia
- Australian Centre for Blood Diseases, Central Clinical School, Monash University, Melbourne, Australia
- Atherothrombosis and Vascular Biology Laboratory, Baker Heart and Diabetes Institute, Melbourne, 3004, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
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Barry IP, Tosenovsky P. Endovascular reconstruction of the inferior vena cava in a patient presenting with deep venous thrombosis with concomitant inferior vena cava hypoplasia and aneurysmal dilatation of the iliac veins. Vasc Endovascular Surg 2023:15385744231162937. [PMID: 36888959 DOI: 10.1177/15385744231162937] [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: 03/10/2023]
Abstract
INTRODUCTION Congenital malformations of the inferior vena cava are rare and remain an under recognised cause of spontaneous deep venous thrombosis (DVT). The purpose of this case report is to highlight the rare occurrence of a concomitant iliac vein aneurysm and the feasibility of endovascular reconstruction in the presence of extensive iliocaval thrombus burden, especially in cases where other treatment modalities have been unsuccessful. REPORT This is the report of a 25-year-old male who presented with acute onset left lower limb pain/swelling secondary to extensive iliocaval DVT. This was due to multiple abnormalities of the venous system including hypoplasia of the IVC with aneurysmal dilatation of the iliac veins. He failed an initial management strategy of anticoagulation and thrombolysis but subsequently underwent endovascular reconstruction of the iliocaval system via venoplasty and stenting. Complete symptom resolution and venous patency, including resolution of venous aneurysmal disease, were maintained at twelve-month follow-up. DISCUSSION Reduction of the iliac vein diameter so early after successful reconstruction suggests that the iliac venous aneurysm was secondary to significant venous hypertension, and that if the obstruction causing it is treated, the vein can return to a normal vessel diameter.
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Affiliation(s)
- Ian Patrick Barry
- Department of Vascular Surgery, 6508Royal Perth Hospital, Perth, Western Australia
| | - Patrik Tosenovsky
- Department of Vascular Surgery, 6508Royal Perth Hospital, Perth, Western Australia.,School of Medicine, Curtin University, Perth, Western Australia
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6
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Pulmonary Embolism Risk After Cosmetic Abdominoplasty and Functional Panniculectomy. Ann Plast Surg 2022; 89:664-669. [DOI: 10.1097/sap.0000000000003281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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7
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Di Micco P, Orlando L, Cataldo D, Imbalzano E. Case report: Successful thromboprophylaxis with enoxaparin in a pregnant woman with internal jugular vein agenesis. Front Med (Lausanne) 2022; 9:1011206. [PMID: 36482908 PMCID: PMC9722950 DOI: 10.3389/fmed.2022.1011206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/31/2022] [Indexed: 09/25/2023] Open
Abstract
Internal jugular agenesis is a vascular malformation that is often associated with a history of recurrent headache. Due to the resulting abnormalities in intracranial venous drainage, it may be complicated by neurological dysfunction, such as intracranial hypertension, intracranial micro-thromboses, and neurodegenerative diseases such as multiple sclerosis. The simultaneous presence of jugular vein agenesis and thrombosis is possible in cases of acute illness, hormonal treatment, pregnancy, hypomobility, or venous drainage abnormalities (VDA) (e.g., May-Thurner syndrome). In particular, the literature still lacks data on thromboprophylaxis in pregnant women with jugular vein agenesis. Here, we report a positive experience with prophylaxis using enoxaparin during pregnancy in a patient with internal jugular agenesis.
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Affiliation(s)
- Pierpaolo Di Micco
- Unità Operativa Complessa Medicina, PO Rizzoli, ASL Napoli 2 Nord, Naples, Italy
| | - Luana Orlando
- Department of Clinical and Experimental Medicine, Polyclinic University of Messina, Messina, Italy
| | - Donato Cataldo
- Unità Operativa Complessa Medicina, Frangipane Hospital, Ariano Irpino, Italy
| | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, Polyclinic University of Messina, Messina, Italy
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Boutrous ML, Amankwah KS. Deep Venous Thrombosis and the Unanswered Questions Surrounding Inferior Vena Cava Anomalies. Eur J Vasc Endovasc Surg 2022; 64:395. [PMID: 35820611 DOI: 10.1016/j.ejvs.2022.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Mina L Boutrous
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of Connecticut. Farmington, CT
| | - Kwame S Amankwah
- Department of Surgery, Division of Vascular and Endovascular Surgery, University of Connecticut. Farmington, CT.
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9
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Jenab Y, Ghafouri P, Hosseini K, Shirani S, Shirzad M. Bilateral proximal deep vein thrombosis and
COVID
‐19 in a patient with absence of inferior vena cava: A case report and review of literature. Clin Case Rep 2022; 10:e5972. [PMID: 35734187 PMCID: PMC9194465 DOI: 10.1002/ccr3.5972] [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: 12/05/2021] [Revised: 04/14/2022] [Accepted: 06/03/2022] [Indexed: 12/03/2022] Open
Abstract
Bilateral proximal deep vein thrombosis (DVT) in the lower extremities of young patients should raise suspicion over pro‐thrombotic conditions and venous anatomical abnormalities, even in the presence of other precipitating factors, such as viral infection. The authors present a 33‐year‐old man with bilateral DVT and absence of inferior vena cava (AIVC), who also had concurrent COVID‐19, and discuss the management of this patient.
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Affiliation(s)
- Yaser Jenab
- Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Parham Ghafouri
- School of Medicine Tehran University of Medical Sciences Tehran Iran
- Students' Scientific Research Center Tehran University of Medical Sciences Tehran Iran
| | - Kaveh Hosseini
- Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Shapour Shirani
- Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
| | - Mahmood Shirzad
- Tehran Heart Center Tehran University of Medical Sciences Tehran Iran
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10
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Prevalence of inferior vena cava anomalies and their significance and impact in clinical practice. Eur J Vasc Endovasc Surg 2022; 64:388-394. [DOI: 10.1016/j.ejvs.2022.05.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/20/2022] [Accepted: 05/29/2022] [Indexed: 11/18/2022]
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Pasqui E, de Donato G, Camarri S, Molinari R, Cascinelli I, Pelini V, Abate L, Palasciano G. Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis. Front Surg 2022; 9:832336. [PMID: 35392062 PMCID: PMC8980272 DOI: 10.3389/fsurg.2022.832336] [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: 12/09/2021] [Accepted: 02/17/2022] [Indexed: 11/27/2022] Open
Abstract
Introduction Anomalies in inferior vena cava represent an uncommon finding with a prevalence of 0. 3 to 0.5% among healthy patients. Specifically, the condition characterized by the agenesis of the inferior vena cava (IVC; AIVC) has been observed among the 0.0005 to 1% of the general population. AIVC is strongly related to deep vein thrombosis (DVT) of the lower limb and pelvic district, especially in young patients. The rarity of the presented condition could relate to an underestimation of its impact on a particular clinical setting leading to a delayed diagnosis and inaccurate early- and long-term management. Report We presented a case of this anomaly regarding a 31-year-old man presenting with bilateral symptomatic proximal DVT. Duplex vascular ultrasound and subsequent CT-angiography revealed the complete occlusion of the right external and common iliac vein, as well as partial occlusion of the contralateral external iliac vein, in the patient. The exam also revealed the interruption of IVC in its infrarenal part. At the level of renal veins coalescence, IVC appeared again in its usual position. A dilatated portal system, hepatic veins, and azygos and hemiazygos systems were also highlighted. Anticoagulation was promptly started with the administration of Fondaparinux (7.5 mg/die). In addition, compression stocking was initiated within 24 h from diagnosis. After 3 weeks, the anticoagulation regimen was shifted toward the administration of a direct oral anticoagulant (Apixaban; 5 mg two times a day). At 1-month follow-up, a vascular duplex ultrasound revealed a complete resolution of the iliac veins' thrombosis. Conclusion It is important to consider the eventuality of IVC anomalies in a young adult presenting with unexplained, extensive, or bilateral DVT. Accurate diagnostic evaluation is necessary to fully identify this condition that could represent a real challenge.
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Affiliation(s)
- Edoardo Pasqui
- Department of Vascular Surgery, University of Siena, Siena, Italy
- *Correspondence: Edoardo Pasqui ;
| | | | - Silvia Camarri
- Division of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, Italy
| | - Raffaele Molinari
- Division of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, Italy
| | - Irene Cascinelli
- Division of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, Italy
| | - Veronica Pelini
- Division of Radiology, Associated Hospitals in Val di Chiana, Montepulciano, Italy
| | - Luigi Abate
- Division of Internal Medicine, Associated Hospitals in Val di Chiana, Montepulciano, Italy
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12
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Calabrese A, Quintavalla M, Pasin F. Inferior vena cava atresia presenting with bilateral deep-vein thrombosis in a 53-years-old male: it's never too late. Intern Emerg Med 2021; 16:1991-1993. [PMID: 33650083 DOI: 10.1007/s11739-021-02679-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Alberto Calabrese
- Internal Medicine Unit, ASST Cremona Presidio Oglio-Po, Cremona, Italy
| | - Marta Quintavalla
- Radiology Unit, ASST Cremona Presidio Oglio-Po, Viale Concordia 1, Cremona, Italy
| | - Federico Pasin
- Internal Medicine Unit, ASST Cremona Presidio Oglio-Po, Cremona, Italy.
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13
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Hung ML, Kwon D, Sudheendra D. Endovascular IVC Reconstruction in an 18 Year Old Patient with Subtotal IVC Atresia. EJVES Vasc Forum 2021; 52:5-10. [PMID: 34258606 PMCID: PMC8260863 DOI: 10.1016/j.ejvsvf.2021.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 04/23/2021] [Accepted: 06/01/2021] [Indexed: 10/25/2022] Open
Abstract
Introduction Inferior vena cava (IVC) atresia is an uncommon venous anomaly that is an under recognised cause of unprovoked acute deep venous thrombosis (DVT) in young adults. The purpose of this case report is to highlight endovascular IVC reconstruction as a feasible treatment option, particularly in challenging cases when other therapeutic modalities have failed. Report This is the report of an 18 year old patient with near complete IVC atresia and a longstanding history of exertional nausea of unknown aetiology, who presented with extensive acute DVT. He was treated successfully by endovascular IVC reconstruction after failing initial anticoagulation and thrombolysis. Symptom resolution and venous patency were maintained at 2.5 year follow up. Discussion IVC atresia is an important aetiology to consider in a young patient presenting with unprovoked DVT. Endovascular stenting can restore venous patency and is feasible even when there is near complete IVC atresia. This case was uniquely challenging in the length of atretic IVC that was reconstructed and also highlights an atypical clinical presentation of IVC atresia.
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Affiliation(s)
- Matthew L Hung
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Dennis Kwon
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Deepak Sudheendra
- Division of Interventional Radiology, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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14
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Menning M, Yousef M. Congenital Inferior Vena Cava Agenesis with Ulceration and Deep Vein Thrombosis. Eur J Case Rep Intern Med 2021; 8:002312. [PMID: 33869091 DOI: 10.12890/2021_002312] [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: 01/20/2021] [Accepted: 01/26/2021] [Indexed: 11/05/2022] Open
Abstract
Objectives This is one of the few case reports of congenital inferior vena cava atresia (IVCA) with extensive bilateral lower extremity ulcers. Background IVCA is a congenital anomaly characterized by poor venous return in the lower extremities with increased risk of deep vein thrombi (DVTs) and, rarely, non-healing ulcers. Results A 45-year-old woman with history significant for DVTs presented with extensive bilateral lower extremity ulcers, and a CT scan revealed congenital IVCA. Oedema management, DVT prevention, routine wound care and skin grafts resolved the ulcers. Conclusion Congenital venous abnormalities should be included in the differential diagnosis of multiple unprovoked DVTs and non-healing ulcers. LEARNING POINTS There are very few reports in the English literature describing inferior vena cava atresia with extensive bilateral lower extremity ulcers.We present our findings as well as new insights into the congenital causes of bilateral lower extremity ulcers and deep vein thrombi (DVTs).Especially for young adults with a history of multiple DVTs and non-healing ulcers, venous abnormalities should be included in the differential diagnosis and advanced imaging should be utilized.
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Affiliation(s)
- Melanie Menning
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mira Yousef
- College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Klein-Weigel PF, Elitok S, Ruttloff A, Reinhold S, Nielitz J, Steindl J, Lutfi P, Rehmenklau-Bremer L, Hillner B, Fuchs H, Wrase C, Herold T, Beyer L. Inferior vena cava-syndrome. VASA 2021; 50:250-264. [PMID: 33459041 DOI: 10.1024/0301-1526/a000919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Inferior vena cava syndrome (IVCS) is caused by agenesis, compression, invasion, or thrombosis of the IVC, or may be associated with Budd-Chiari syndrome. Its incidence and prevalence are unknown. Benign IVCS is separated from malignant IVCS. Both cover a wide clinical spectrum reaching from asymptomatic to highly symptomatic cases correlated to the underlying cause, the acuity, the extent of the venous obstruction, and the recruitment and development of venous collateral circuits. Imaging is necessary to determine the underlying cause of IVCS and to guide clinical decisions. Interventional therapy has changed the therapeutic approach in symptomatic patients. This article provides an overview over IVCS and focuses on interventional therapeutic methods and results.
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Affiliation(s)
- Peter Franz Klein-Weigel
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Saban Elitok
- Nephrology, Endokrinology/Diabetology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Andreas Ruttloff
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Sabine Reinhold
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Jessica Nielitz
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Julia Steindl
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Philippe Lutfi
- Angiology - Interdisciplinary Center of Vascular Diseases, Ernst von Bergmann Klinikum Potsdam, Germany
| | | | - Birgit Hillner
- Institute of Radiodiagnostic, Helios Klinikum Buch, Berlin, Germany
| | - Heiko Fuchs
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Christian Wrase
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
| | - Thomas Herold
- Institute of Radiodiagnostic, Helios Klinikum Buch, Berlin, Germany
| | - Lukas Beyer
- Diagnostic and Interventionel Radiology, Ernst von Bergmann Klinikum Potsdam, Germany
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Oblitas CM, García-García A, Galeano-Valle F, Palacios-Bermejo A, Ojeda-García R, Echenagusía-Boyra M, Álvarez-Luque A, Del-Toro-Cervera J, Demelo-Rodríguez P. Long-term anticoagulant treatment in patients with inferior vena cava agenesis and deep vein thrombosis. Thromb Res 2020; 196:305-307. [PMID: 32977127 DOI: 10.1016/j.thromres.2020.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Inferior vena cava agenesis (IVCA) is a rare and underdiagnosed congenital anomaly that predisposes to deep vein thrombosis (DVT). Optimal duration of anticoagulant treatment in these patients is not well established. METHOD Observational retrospective study that included all consecutive patients older than 18 diagnosed with IVCA and DVT. Data including demographics, initial clinical presentation, modality of diagnosis, treatment and outcomes were obtained. RESULTS In patients with IVCA and DVT (n = 9), mean age was 42 and 66% were males. Five (55,5%) patients had bilateral DVT and the most frequent location was ilio-femoral. Only one patient had concomitant pulmonary embolism (PE). During follow-up (mean of 77.8 months), anticoagulation was withdrawn in 2 patients and both developed recurrence of DVT (22.2%, CI 95% 2.8-60.0). One minor bleeding (11.1%, CI 95% 0.3-48.3), five post-thrombotic syndrome (55.6%, CI 95% 21.2-86.3) and no deaths were registered. CONCLUSION In patients with DVT and IVCA, post-thrombotic syndrome was developed in approximately half of the patients. No major bleeding events were recorded during long-term anticoagulant therapy and recurrences occurred only in patients who had anticoagulation withdrawn. These data suggest that extended anticoagulant therapy might be considered in these patients.
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Affiliation(s)
- Crhistian Mario Oblitas
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Alejandra García-García
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Francisco Galeano-Valle
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain; Instituto de investigación sanitaria Gregorio Marañón, Madrid, Spain.
| | | | - Raquel Ojeda-García
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain
| | - Mikel Echenagusía-Boyra
- Department of Vascular Interventional Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Arturo Álvarez-Luque
- Department of Vascular Interventional Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Jorge Del-Toro-Cervera
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain; Instituto de investigación sanitaria Gregorio Marañón, Madrid, Spain
| | - Pablo Demelo-Rodríguez
- Venous Thromboembolism Unit, Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Spain; Instituto de investigación sanitaria Gregorio Marañón, Madrid, Spain
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