Anomalies Of Inferior Vena Cava Research Articles

Incidentally Detected Inferior Vena Cava Anomalies: 3 Case Reports

Objective: Inferior vena cava (IVC) anomalies are very rare vascular embryological variations, the incidence rate in the general population is 0.5%. IVC anomalies are usually asymptomatic and detected incidentally. The inferior vena cava is formed between the 6th and 8th weeks of intrauterine embryological development. IVC occurs due to the fusion of the supracardinal, postcardinal, and subcardinal veins during the embryological period. This union results from complex anastomosis of the embryological stage veins. During this time, various IVC anomalies may develop. IVC anomalies increase the risk of deep vein thrombosis in the lower extremity. Because of the increased risk of deep vein thrombosis in these patients, anti-embolism prophylaxis can be performed before the operation. Therefore, the risk of pulmonary embolism increases as well. The use of computed tomography has become more common nowadays. The detection rate of IVC anomalies has increased in examinations performed for other purposes. Case: IVC anomalies are important in terms of surgical interventions and the use of a vena cava filter. Knowing the existence of IVC anomalies can be crucial in preventing complications that may arise during surgical and radiological procedures. The objective of this study is to present three different cases with incidentally detected IVC anomalies.

Features of treatment of venous thromboembolism in patients with abnormalities in the development of the vena cava inferior

Annotation. In the treatment of venous thromboembolism, a special place is occupied by patients with congenital anomalies of the development of the inferior vena cava (IVC). To date, only single cases of treatment of this pathology have been described in the literature. Studying the experience of treating patients with congenital anomalies of the IVC will allow to improve the results of treatment of this category of patients. We analyzed the results of treatment of 1243 patients with venous thromboembolism from 2010 to 2022. For the diagnosis of venous thromboembolism, we used duplex scanning of the veins of the lower extremities, phlebography by spiral computed tomography (SCT), angiopulmonography, and phlebography. 32 (2.5%) patients had bilateral thrombosis of the ileofemoral venous segment. Congenital anomalies of IVC development were diagnosed in 2 (0.16%) patients. One patient had IVC aplasia, the other had IVC hypoplasia. Both patients had bilateral ileofemoral phlebothrombosis. For the treatment of patients with congenital anomalies of IVC and bilateral ileofemoral deep vein thrombosis, we used anticoagulant therapy and elastic compression of the lower extremities. During the study period, venous thromboembolic complications in the form of pulmonary embolism were not recorded, fatal complications were not diagnosed. Massive bleeding was not diagnosed in this category of patients during the study period. Thus, the conducted analysis allows us to state that the use of anticoagulant therapy allows to obtain satisfactory results of treatment of patients with congenital abnormalities of the development of the IVC.

Deep Vein Thrombosis after COVID-19 mRNA Vaccination in a Young Man with Inferior Vena Cava Anomaly Leading to Recurrent Deep Vein Thrombosis

Severe side effects of adenoviral-vectored-DNA COVID-19 vaccines such as thrombosis have been reported. Herein, we report a case of sudden massive deep vein thrombosis (DVT) in a young man with inferior vena cava anomaly 20 hours after the second dose of the mRNA vaccine for COVID-19. There was recurrence of iliofemoral DVT after one year, despite complete resolution and administration of prophylactic anticoagulants. We suggest that the sudden episode was triggered by the vaccine rather than the venous anomaly, which can be associated with recurrence due to inadequate venous return through the small and tortuous infrarenal veins or increased venous pressure and stasis. There are no standard guidelines for the management of DVT following mRNA vaccination. However, we highlight the importance of initial workups, regular follow-ups, and standard treatment options, including the continuous administration of prophylactic anticoagulants which should be considered to prevent recurrence.

Prevalence of Inferior Vena Cava Anomalies and Their Significance and Impact in Clinical Practice

To evaluate the prevalence of inferior vena cava (IVC) anomalies in an asymptomatic healthy population and symptomatic patients. This was a multicentre retrospective observational study This study was conducted by reviewing the computed tomography (CT) images of 1 000 individuals from South Korea taken for a general medical check up (group A) and 1 000 patients from the USA who visited with various symptoms for which CT was required (group B). A third group of 800 patients with deep vein thrombosis (DVT) and CT from two US centres were used for comparison (group C). Twenty-eight patients with anatomical changes in the IVC due to intervention, extrinsic compression, trauma, other rare conditions, and poor image quality were excluded. The mean age ± standard deviation of each group was 50 ± 6, 54 ± 11, and 54 ± 15 years in groups A, B, and C, respectively. In group A, duplication was the most common anomaly (10 cases, 1.0%), followed by left sided IVC (four cases, 0.4%), hypoplasia (three cases, 0.3%), and megacava (one case, 0.1%). In group B, the most common IVC anomaly was hypoplasia in six cases (0.6%); duplication in three patients, left sided IVC in three patients, aplasia in two patients, web formation in two patients, and megacava in two patients. In group C, hypoplasia was the most common type (32 cases, 4.0%). The prevalence of hypoplasia in patients younger than 50 years of age was significantly higher compared with older patients (12.7% [14/110] vs. 5.3% [10/190]; p = .027). The risk of hypoplasia or aplasia was significantly higher in patients with DVT (odds ratio [OR] 17.032, 95% confidence interval [CI] 5.243 – 55.321), especially in patients with iliofemoral DVT (OR 34.211, 95% CI 10.323 – 113.378). In the normal group, IVC duplication was the most common variation, while hypoplasia was most common in patients with iliofemoral DVT, especially in younger ones.

RARE CASE OF MASSIVE DVT AFTER MRNA COVID-19 VACCINATION IN A PATIENT WITH CONGENITAL IVC ANOMALY

RARE CASE OF MASSIVE DVT AFTER MRNA COVID-19 VACCINATION IN A PATIENT WITH CONGENITAL IVC ANOMALY

Deep Venous Thrombosis and the Unanswered Questions Surrounding Inferior Vena Cava Anomalies

The study by Kim et al. is a multicentre, observational, retrospective study conducted in the United States and South Korea.1 The authors investigated the difference in prevalence of inferior vena cava (IVC) anomalies in patients diagnosed with deep venous thrombosis (DVT) vs. those who had computed tomography (CT) scans for diagnostic purposes, and a control group who had CT scans for health screening purposes. The study concluded that the occurrence of IVC anomalies was 1.8% in the control group and 6.3% in the DVT group.

Prevalence of Inferior Vena Cava Anomalies and Their Significance and Impact in Clinical Practice

To evaluate the prevalence of inferior vena cava (IVC) anomalies in an asymptomatic healthy population and symptomatic patients. This was a multicentre retrospective observational study This study was conducted by reviewing the computed tomography (CT) images of 1 000 individuals from South Korea taken for a general medical check up (group A) and 1 000 patients from the USA who visited with various symptoms for which CT was required (group B). A third group of 800 patients with deep vein thrombosis (DVT) and CT from two US centres were used for comparison (group C). Twenty-eight patients with anatomical changes in the IVC due to intervention, extrinsic compression, trauma, other rare conditions, and poor image quality were excluded. The mean age ± standard deviation of each group was 50 ± 6, 54 ± 11, and 54 ± 15 years in groups A, B, and C, respectively. In group A, duplication was the most common anomaly (10 cases, 1.0%), followed by left sided IVC (four cases, 0.4%), hypoplasia (three cases, 0.3%), and megacava (one case, 0.1%). In group B, the most common IVC anomaly was hypoplasia in six cases (0.6%); duplication in three patients, left sided IVC in three patients, aplasia in two patients, web formation in two patients, and megacava in two patients. In group C, hypoplasia was the most common type (32 cases, 4.0%). The prevalence of hypoplasia in patients younger than 50 years of age was significantly higher compared with older patients (12.7% [14/110] vs. 5.3% [10/190]; p= .027). The risk of hypoplasia or aplasia was significantly higher in patients with DVT (odds ratio [OR] 17.032, 95% confidence interval [CI] 5.243 - 55.321), especially in patients with iliofemoral DVT (OR 34.211, 95% CI 10.323 - 113.378). In the normal group, IVC duplication was the most common variation, while hypoplasia was most common in patients with iliofemoral DVT, especially in younger ones.

Recurrent deep venous thrombosis of lower extremities as a result of compression of large horseshoe kidney cysts in double inferior vena cava - Successfully treatment with sclerotherapy.

Horseshoe kidney is a well-known congenital anomaly and the most common anomaly of the upper urinary tract. This condition is rarely associated with anomalous inferior vena cava (IVC). Polycystic horseshoe kidney is a very rare occurrence and however IVC anomalies common with polycistic disease are an increasingly recognized risk factor for iliofemoral deep venous thrombosis. We present a case of 75-year-old patient with recurrent deep vein thrombosis (DVT) of right leg as a result of compression of large horseshoe kidney cysts in double inferior vena cava. Large renal cyst were successful treated percutaneously punctured for the relief of compression and received injection of acidic solutions of 95% ethanol under ultrasound guidance for prevention against re-accumulation of cyst fluid. Percutaneous aspiration with ultrasound guidance with injection of sclerosing solutions as a relatively simple procedure and can be the method of choice for treatment of renal cysts. Also, any recurrent deep vein thrombosis on lower extremity requires additional evaluation in the form of an ultrasound or multidetector computed tomography examination of the abdomen.

Prevalence of Congenital Anomalies of the Inferior Vena Cava: CT Assessment in Thai Patients

Objective: To determine the prevalence of inferior vena cava (IVC) anomalies in Thai patients who underwent contrast-enhanced computed tomography (CT) of the abdomen. Materials and Methods: Two radiologists retrospectively and independently reviewed the contrast-enhanced abdominal CT examinations in 1,429 Thai patients between August 1, 2018 and January 25, 2019 who met the inclusion criteria. Patients were included, if (a) their CT showed well visualized IVC, renal veins, and right ureter that were not obliterated by tumor, cyst, fluid collection, or intraperitoneal free fluid, (b) they had not undergone previous abdominal surgery that altered anatomical configuration of the IVC, renal veins, and right ureter. The presence of all IVC anomalies were recorded. Results: Among the 1,429 studied patients, 678 were male (47.4%) and 751 were female (52.6%). The prevalence of IVC anomalies was 3.5%. Five types of IVC anomalies were presented. The most common was circumaortic left renal vein in 24 patients or 48.0% of all IVC anomalies and 1.7% of the study population, followed by retroaortic left renal vein in 15 patients or 30.0 % of all IVC anomalies and 1.0% of the study population. Other IVC anomalies included double IVC, left IVC, and retrocaval ureter at 0.5%, 0.2%, and 0.1% of the study population, respectively. Conclusion: The prevalence of IVC anomalies in the present study differed from the previous studies conducted in other countries, which may be attributable to differences in race and ethnicity. Awareness of these anomalies is essential when evaluating routine CT examinations in asymptomatic patients. Their presence should be carefully noted in radiology reports to avoid anomaly-related complications. Keywords: Prevalence; IVC anomalies; Circumaortic left renal vein; Retroaortic left renal vein; Double IVC; Left IVC; Retrocaval ureter

English

Double inferior vena cava is a rare anomaly with incidence rate of 0.2 - 3 %. It occurs due to non-regression of both right and left supracardinal veins during embryonic development. Here, we present a case with double inferior vena cava diagnosed in a patient who underwent routine computed tomography for abdominal pain. In our case, both right and left inferior vena cava are of same caliber and we believe that duplication of IVC in our case was a result of nonregression of anastomosis between left supra subcardinal, posterior subcardinal and intersubcardinal veins resulting in persistence of left subcardinal vein. The knowledge of this anatomical variation is clinically important during retroperitoneal surgeries and vascular and radiological interventional procedures. Inferior vena cava anomalies are rare and incidentally found in asymptomatic patients who undergo radiological imaging for some other diseases. The reported incidence of duplicated inferior vena cava is 0.2 to 3 %. Among all the inferior vena cava anomalies, inferior vena cava duplication and left inferior vena cava are most commonly found. 1,2 Vascular anomalies often get encountered in computed tomography (CT) scans of abdomen and pelvis obtained with contrast injection. Familiarity with these variations is essential for correct interpretation.3 Here, we present a case of duplication of inferior vena cava with left IVC draining into right IVC at upper border of L2 vertebral level.

Atrial Septal Defect Closure via Left Subclavian Vein Approach in a Patient With Absent Inferior Vena Cava.

Without the femoral venous approach, transcatheter closure of an atrial septal defect is challenging. We performed percutaneous closure via the left subclavian vein in a patient with absence of the inferior vena cava with azygos continuation. Considering that inferior vena cava anomalies are not extremely rare among those with congenital heart disease, the left subclavian vein approach can be an alternative to the femoral approach.

Inferior vena cava anomalies: review and surgical considerations

Angiología es una revista científica bimensual editada desde 1949. Está dedicada al estudio de las enfermedades vasculares, incluyendo todos los aspectos de la medicina vascular, el diagnóstico no invasivo, el tratamiento quirúrgico tradicional arterial y venoso, así como el mínimamente invasivo y/o endovascular.

Clinical and procedural implications of congenital vena cava anomalies in adults: A systematic review

BackgroundAlthough congenital vena cava (CVC) anomalies in adults have implications for surgical and radiological interventions, the literature is scare and disparate. The aim of this systematic review was to assess cardiovascular clinical and procedural implications of CVC anomalies in adults without congenital heart disease. Methods and resultsWe searched PubMed and EMBASE from database conception through October 2018 for English-language studies describing the epidemiology of CVC anomalies or their clinical or procedural implications in humans. Two independent reviewers screened 7093 records and identified 16 relevant studies. We found two major implications of CVC anomalies: 1) congenital inferior vena cava (CIVC) anomalies are associated with a 50–100-fold higher risk of deep venous thrombosis, particularly among younger patients, and 2) persistent left superior vena cava (PLSVC) is associated with a 2–3-fold higher risk of supraventricular arrhythmias. PLSVC also poses technical challenges to cardiovascular electronic device implantation, requiring alterations in surgical approach and lengthening procedure and X-ray exposure times. Due to the large disparity in reported prevalence rates of CIVC anomalies, we performed a meta-analysis of CIVC anomaly prevalence including 8 studies, which showed a weighted prevalence of 6.8% (95% CI, 4.5–9.2%). ConclusionThese findings challenge the notion that CVC anomalies are rare and asymptomatic in adults. Rather, the literature indicates that CVC anomalies are not uncommon and have important clinical and procedural implications. To further understand the prevalence and implications of CVC anomalies, a robust US population-based study and nationwide registry is warranted in the current era of venous interventions.

SUCCESSFUL PERFORMANCE OF CARDIAC ELECTROPHYSIOLOGICAL PROCEDURES VIA A CONGENITAL INFERIOR VENA CAVA ANOMALY- REPORT OF 2 CASES

Background: Femoral vein access is the preferred approach for advancing multiple catheters via the inferior vena cava (IVC) to the heart during routine cardiac electrophysiology study and catheter ablation. Compared to acquired venous abnormalities, congenital inferior vena cava anomalies are encountered rather infrequently in adult electrophysiology procedures and their presence may pose technical procedural challenges. Presentation: We describe 2 cases in which we were able to successfully perform cardiac electrophysiological procedures in the presence of a complex congenital venous anomaly, the left sided IVC. First case was 30 year old gentleman presented with history of recurrent episodes of supraventricular tachycardia terminated with AV nodal blocking agents. Second case was 21 year old boy with WPW syndrome and recurrent supra-ventricular tachycardia. Diagnosis and Management: We managed to pass the EP catheters in both cases with a bit difficulty and angulation, while given I/V heparin to reduce the risk of thrombosis and confirmed the position of catheters via subclavian venous placement of a guidewire. In first case, typical AV node reentry tachycardia was induced which was mapped and ablated in the slow pathway region. In second case, right posterior accessory pathway was ablated at 6 0’clock. CT angiography of the abdominal veins was performed which confirmed the finding of left sided IVC. Follow-up and Outcomes: Abnormalities of the IVC are relatively uncommon. But it is an important condition that may be encountered by electrophysiologist. Catheter ablation of the slow AV nodal pathway and right posterior accessory pathway was safely and successfully performed with this unusual venous anomaly. Keywords: SVT, LEFT IVC, RFA

Giant Adrenal Pseudocyst in Patient With Duplicated Inferior Vena Cava: A Case Report

Adrenal pseudocysts are rare entities in clinical practice and many are picked up incidentally.1 The incidence of congenital anomaly of inferior vena cava is estimated to range from 0.2% to 3.0% in the general population.2 We report an exceptional case of a giant right-sided adrenal pseudocyst with inferior vena cava duplication to illustrate the clinical and histopathological features of this entity.

Retrocaval ureter: a rare cause of urinary tract obstruction

Retrocaval ureter is an uncommon cause of ureteric obstruction due to a rare congenital anomaly of inferior vena cava. We report a case of 23 year old male who presented with right flank pain and was diagnosed with ultrasound and intravenous urography. He underwent open retroperitoneal ureteroureterostomy.

Diagnosis and prognosis of fetal inferior vena cava malformation by fetal echocardiography

Objective To summarize the characteristics of two-dimensional(2D) ultrasound, spatiotemporal imaging correlation(STIC) and vascular casting of fetal inferior vena cava(IVC) malformations, analyze the clinical characteristics and the prognosis of fetal IVC malformations, and explore the early diagnostic value of fetal echocardiography for fetal IVC malformations. Methods Sixty-one cases of fetal IVC malformation diagnosed by fetal echocardiography in Beijing Anzhen Hospital Maternal Fetal Medical Consultation Center were retrospectively analyzed. The clinical data, echocardiographic features, genetic testing information and prognosis were summarized. Results ①In the 61 cases of IVC malformation, there were 51 cases of absence of IVC, 46 cases of absence of liver segment, 5 cases of absence of left IVC hepatic segment, 9 cases of left IVC (including 5 cases of left IVC and absence of IVC hepatic segment), 5 cases of double IVC, and 1 case of right hepatic vein reflux. ②Ten fetuses of the 61 fetuses were simple IVC deformity without any other malformations. Other venous malformations included 7 cases of absence of right superior vena cava and persistent left superior venacava, 2 cases of absence of venous catheters, and 3 cases of persistent right umbilical vein, 2 cases were merged alone; 49 cases were merged with intracardiac structural malformations and arrhythmia. ③Thirty-eight pregnant women underwent Down′s screening or non-invasive DNA, all of which were at low risk.Four cases underwent amniocentesis, and no obviously abnormality was found. Sixteen cases underwent autopsy and genome sequencing after induced labor, one was single gene abnormalities (ZFPM2 classical mutation). ④STIC images were collected in 20 cases, and 19 cases were clearly visualized. ⑤Vascular cast was made to show the shape of blood vessel more clearly and stereoscopically in 4 cases of absent hepatic segment of IVC. ⑥Eleven fetuses were born and confirmed from the results of postnatal ultrasound, who were healthy in follow-up; 16 fetuses were induced labor; 33 fetuses were losed during follow-up; 1 fetus died after birth (arrhythmia). Conclusions Fetal echocardiography combined with STIC technology can clearly diagnose the anomalies of IVC. Vascular casting can provide stereoscopic and visual manifestations of the anomalies of IVC. The prognosis of simple anomalies of IVC is good. Key words: Echocardiography, Fetal; Inferior vena cava malformation; Spatiotemporal imaging correlation; Vascular cast

Massive Inferior Vena Cava Thrombosis Associated With Retroperitoneal Venolymphatic Malformation: Use of Intravascular Ultrasound for Diagnosis and Management

Inferior vena cava (IVC) anomalies are uncommonly described. Many are associated with a higher rate of thromboembolic complications. Here we report a case of IVC thrombosis in a 20-year-old woman with a large isolated retroperitoneal venolymphatic malformation (VLM) with IVC envelopment in which a

Unusual Pattern of Left Inferior Vena Cava: A Case Report

: A left inferior vena cava (IVC) is an IVC anomaly with a prevalence of 0.2% - 0.5%. Typically, the left IVC joins the left renal vein, crosses anterior to the aorta, and unites with the right renal vein to form a normal right IVC. We report a case of an unusual left IVC with retrohepatic crossing over and intrahepatic venocaval shunts. In addition, situs ambiguous and polysplenia accompanied the anomaly. Though most IVC anomalies are discovered incidentally on imaging without relevant symptoms, knowledge about its variants is important to avoid misinterpretation on diagnostic imaging and to plan for surgical and interventional procedures.

Inferior vena cava calcification, a possible link with recurrent deep venous thrombosis and pulmonary embolism: a case study and review of literature.

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.