Development Of Inferior Vena Cava Research Articles

Congenital venous anomalies associated with retrocaval ureter: evaluation using computed tomography.

Retrocaval ureter is a rare congenital anomaly resulting from anomalous development of inferior vena cava (IVC) and not from anomalous of the ureter. The anomaly always occurs on the right side due to regression of right supracardinal vein and persistence of right posterior cardinal vein. Retrocaval ureter tends to be associated with various vena cava anomalies because of the embryogenesis. We aimed to identify the prevalence of associated congenital venous anomalies (CVA) resulting from cardinal vein development in adults with retrocaval ureter using computed tomography (CT) images. The study included 22 adults with retrocaval ureter. We evaluated CT findings and determined the incidence of associated CVA using thin slice data sets from CT scanner with 64 or more detectors. We compared the prevalence of CVA in the retrocaval ureter group (mean age: 57 ± 19 years) and in the control group of 6189 adults with normal ureter (mean age: 66 ± 14 years). In the retrocaval ureter group, 4 (18.2%) adults had CVA including double IVC, right double IVC, preisthmic IVC with horseshoe kidney, and preaortic iliac confluence. One of 2 adults with preaortic iliac confluence had right double right IVC. In the control group, 49 (0.79%) adults had CVA including 37 double IVC, 11 left IVC, and 1 IVC interruption azygos continuation. Fifteen horseshow kidneys were found. The prevalence of associated CVA in the retrocaval ureter group was higher than that in the control group (p < 0.001). Retrocaval ureter is frequently associated with CVA. Various CVA with retrocaval ureter could happen because of abnormal development of not only the right posterior or supra cardinal vein but also other cardinal veins.

A descriptive study of experience of laparoscopic repair of retrocaval ureter in a tertiary care institute in Eastern India

Background: Retrocaval ureter (RCU) is a rare congenital anomaly. It occurs due to anomalous development of inferior vena cava (IVC) and not ureter. Here, we describe our experience in surgical techniques and operative results of laparoscopic reconstruction for patients with RCU. Aims and Objectives: The aims of this study were to obtain information regarding clinical presentation, demographic profiles, investigations, indications for intervention, postoperative complications of laparoscopic repair of retrocaval repair, and also to develop laparoscopic surgical skill without causing any untoward effects to the patients. Materials and Methods: Twelve patients with RCU were enrolled in this study. The mean age was 32.4-years-old (23–37 years). All patients were preoperatively evaluated with different relevant imaging modalities. Laparoscopic surgery with transperitoneal approach with insertion of double-j stent was performed to all patients by same surgeon without excision of compressed ureter. Post-operative follow-up was done with ultrasonography every 3 months and repeat DTPA renogram every 6 months for 2.4 years. Results: All operations were completed laparoscopically without conversion to open surgery. There was no obstruction or symptom after the mean follow-up of 2.4 years. Conclusion: Transperitoneal laparoscopic repair is a feasible, safe, and effective modality of The treatment for RCU. Careful dissection along the planes with good respect to tissue and proper hemostasis during each step is the key to success for laparoscopic repair of RCU.

Transperitoneal laparoscopic ureteropyeloplasty of retrocaval ureter: Single surgeon experience and review of literature.

Retrocaval ureter (RCU) is a rare congenital abnormality, secondary to anomalous development of inferior vena cava (IVC) presenting as ipsilateral obstruction needing surgical intervention. The aim of this article is to present surgical techniques and outcome of transperitoneal laparoscopic ureteropyeloplasty in patients with RCU treated by a single surgeon at a tertiary care center and with review of literature. We conducted a retrospective, institutional review board approved chart review of patients who underwent transperitoneal laparoscopic ureteropyeloplasty for RCU at our unit between January 2010 and December 2020. A total of 10 patients were identified. Preoperative evaluation involved a computed tomography-intravenous urography in addition to the conventional evaluation. All the patients underwent dismembered transperitoneal laparoscopic ureteropyeloplasty over a Double J stent. Data analyzed included the demographic profile, operative time difficulty if any, postoperative, intraoperative complications and functional outcome. All cases were completed laparoscopically and no open conversion was required. Average operating time was 96.6minutes± 8.16. Average blood loss was 71 ± 14.49 mL with an analgesia requirement of 115 ± 33.74 mg. One patient developed postoperative urinary leak and responded to percutaneous nephrostomy drainage. Patients were followed up for 3 to 12 months with a serial ultrasound and a follow-up diethylene-triamine-penta-acetic acid renal scan at 3months to rule out any anastomotic site obstruction. Transperitoneal laparoscopic ureteropyeloplasty for RCU was associated with minimal morbidity and good outcomes.

Embryological and surgical considerations of absent infra-renal part of inferior venacava and left renal vein

Background: Development of inferior vena cava (IVC) is a complex process that involves the anastomoses between three pairs of embryonic veins. Specific permutations exist in the venous plane of the abdomen and pelvis resulting in variations such as single left IVC, double IVC, and left renal retroaortic vein. Anomalies of the inferior vena cava and renal veins occur infrequently but may contribute to serious morbidity throughout surgical exploration if unidentified. Most anomalies remain asymptomatic until surgical intervention or clinical presentation with thromboembolic complications.&#x0D; Aims and Objective: Our research is aimed to link embryology with developmental disorder and the complications associated with the anomalous vessels in the field of surgery.&#x0D; Materials and Methods: Ten IUD fetuses (ranging from 20 weeks to term fetuses) were collected from the O&amp;G department of the college and injected locally with dilute formalin and placed in containers filled with formalin. Dissection of the fetuses was done to identify congenital anomalies.&#x0D; Results: The external appearance of the 28-week-old fetus showed no gross anomaly. Examination abdominal cavity showed absent infrarenal segment of IVC and left renal vein. The right renal vein was seen running a long course to the left side with tributaries of lumbar veins and was seen continuing as the left femoral vein medial to the femoral artery. Segments of suprarenal and renal IVC were present.&#x0D; Conclusion: Correlating anomalies and variations of IVC and its tributaries to embryology. However, understanding of such anomaly is necessary to avoid significant diagnostic pitfalls and in preoperative surgicaland radiological intervention planning.

Resection of the inferior vena cava in patients with renal cell carcinoma with bulky tumor venous thrombosis

Objective: to develop an effective and safe surgical technique for the treatment of patients with renal cell carcinoma with invasive tumor venous thrombosis of the inferior vena cava (IVC).Materials and methods. The study included 75 patients underwent surgical treatment at the N.N. Blokhin Russian Cancer Research Center between 1995 and 2017. The median age of patients was 57 years (range: 32–72 years). All patients were diagnosed with RCC with invasive tumor venous thrombosis levels II–IV; of them, 55 patients (73.3 %) had complete IVC obstruction and mature venous collaterals. Twenty- seven patients (26.0 %) were diagnosed with regional, 37 (49.3 %) – with distant metastases. Prior nephrectomy was performed in 5 (6.7 %) cases. Surgical treatment included nephrectomy (n = 70; 93.3 %), thrombectomy with IVC resection (n = 75; 100 %), and metastasectomy in solitary distant lesions (n = 11; 14.7 %). Partial IVC resection was demanded in 18 patients (24.0 %): with infrarenal IVC plication – 14 (18.7 %), with reconstruction of IVC with synthetic patch – 4 (5.3 %). Fifty-seven patients (76.0 %) underwent circular IVC resection (with left renal vein (LRV) ligation – 35 (46.7 %)). The IVC was replaced with ePTFE grafts in 4 (5.3 %) patients, IVC reconstruction was not required in 53 (70.7 %) patients. IVC grafting was considered to be justified in patients without mature venous collaterals. Twenty-two patients (29.3 %) received systemic antitumor therapy. Median follow-up was 32.3 months (range: 1–226 months).Results. Median operative time was 237.5 min (range: 135–580 min); median blood loss – 7000 mL (range: 1200–27 000 mL). The post- operative complications rate was 52.1 % (grades III–V – 31.5 %). Hospital mortality was 13.3 % (10 of 75 patients). Thirty-two months overall, cancer-specific, and recurrence-free survival were 42.4 %, 49.5 %, and 61.2 % respectively. At 19 months all prosthesis were patent. None of the patients had glomerular filtration rate &lt;60 ml/min/1.73 m2 after LRV ligation. No patients developed disabling chronic venous insufficiency of the lower limbs after IVC ligation/resection without grafting.Conclusion. Nephrectomy, thrombectomy, and IVC resection is the only effective method of treatment for RCC with invasive tumor venous thrombosis. The development of IVC and LRV venous collaterals allows performing circular IVC resection with LRV ligation without graft replacement.

Transperitoneal laparoscopic repair of retrocaval ureter: Our experience and review of literature.

Context and Aim:Retrocaval ureter (RCU), also known as circumcaval ureter, occurs due to anomalous development of inferior vena cava (IVC) and not ureter. The surgical approach for this entity has shifted from open to laparoscopic and robotic surgery. This is a relatively new line of management with very few case reports. Herein, we describe the etiopathology, our experience with six cases of transperitoneal laparoscopic repair of RCU operated at tertiary care center in India and have reviewed different management options.Methods:From 2013 to 2016, we operated total six cases of transperitoneal laparoscopic repair of RCU. All were male patients with average age of 29.6 years (14–50). Pain was their only complaint with normal renal function and no complications. After diagnosis with CT Urography, they underwent radionuclide scan and were operated on. Postoperative follow-up was done with ultrasonography every 3 months and repeat radionuclide scan at 6 months. The maximum follow-up was for 2.5 years.Results:All cases were completed laparoscopically. Average operating time was 163.2 min. Blood loss varied from 50 to 100 cc. Ureteroureterostomy was done in all patients. None developed urinary leak or recurrent obstruction postoperatively. Maximum time for the requirement of external drainage was for 4 days (2-4 days). Average postoperative time for hospitalization was 3.8 days. Follow-up ultrasound and renal scan showed unobstructed drainage.Conclusions:Transperitoneal or retroperitoneal approach can be considered equivalent as parameters like operative time, results are comparable for these two modalities. We preferred transperitoneal approach as it provides good working space for intracorporeal suturing.

Agenesis of Inferior Vena Cava with Cavernous Transformation and Hypoplastic Infrarenal Part of IVC, Rare Congenital Vascular Anomalies: A Case Series

Congenital vascular anomalies are although rare but may cause serious complications. Vascular pathologies are best demonstrated by contrast enhanced computed tomography, with the advent of multidetector computed tomography and applying multiplanar reformation techniques. However, ultrasound color Doppler and catheter angiography are accessory imaging modalities utilized to rule out vascular anomalies. We present here a case series of 2 patients aged 19 years and 54 years, diagnosed with congenital vascular anomalies (agenesis of inferior vena cava and hypo plastic infra renal segment of inferior vena cava). The development of inferior vena cava (IVC) includes early embryogenesis stages including formation, confluence and involution of three primary longitudinal venous systems. Agenesis of inferior vena cava or hypoplasia of segment of inferior vena cava leads to formation of collaterals to maintain the venous flow. Contrast enhanced computed tomography with multiplanar reformation provides ulterior spatial and contrast resolution in cases of recognized vascular abnormalities. Inferior vena cava obstruction due to thrombosis or congenital vascular anomaly leads to extensive collateralization accompanied by varicose veins. In our case series, we found contrast enhanced computed tomography as an ulterior modality in setting ultimate diagnosis with accuracy and maximum detail.

A Rare Case of Right Retrocaval Ureter with Duplication of Infrarenal IVC.

Retrocaval ureter, also known as circumcaval ureter, is a rare congenital anomaly which commonly presents with loin pain in middle age group. Here, ureter passes between the inferior vena cava (IVC) and psoas muscle and gets compressed. Duplication of IVC is another rare congenital anomaly in the development of IVC. We present a case of a 49-year-old male who presented with loin pain and upon thorough investigation was found to have retrocaval ureter along with duplication of the infrarenal IVC. We bring forward this rare type of combination of two congenital malformations.

Endovascular Management of Venous Ulcer in a Patient With Occluded Duplicated Inferior Vena Cava and Review of Inferior Vena Cava Development

Duplication of inferior vena cava (IVC) is the most common IVC anomaly. We report a successful iliac vein and collateral stenting for venous decompression in a patient with an occluded right femorocaval graft with a duplicated IVC. We also review the literature of embryological development of IVC.

Retrocaval ureter - a case report

AbstractRetrocaval ureter is a rare congenital anomaly which has a incidence of occurence of one in 1500 live births. It is known to occur 2.8 times more commonly in males than females. While carrying out a study on congenital anomalies in urinary system in a collection of still born fetuses, a case of retrocaval ureter was noticed in a still born male foetus. In Retrocaval ureter, ureter is S shaped on the right side and a part of inferior vena cava is anterior to the proximal part of the ureter. Here the development of ureter is normal. Whereas the development of inferior vena cava is abnormal.

Anatomical Variation in Inferior Vena Cava- A Case Report and Review

We highlight the case of a double Inferior Vena Cava (IVC) encountered in a routine dissection of a 46 year old male cadaver. We outline gross anatomical details, summarize the embryological development of IVC and present the case as a reminder of this rare anatomical variation, as in such cases, pre-operative abdominal cross sectional imaging kis usually not available; hence the operating surgeon needs to rely on vigilance and awareness of other potential anatomical variations that are associated with the condition.

Congenital retroperitoneal vascular anomalies: impact on pelvic surgery

Congenital anomalies of the inferior vena cava (IVC) are not commonly recognized since they generally do not cause symptoms. Preoperative cross-sectional imaging can identify anomalies of vascular structures that are highly relevant to the pelvic surgeon. The clinical impact of congenital vascular variations of IVC, especially on paraaortic lymphadenectomy, is investigated. In case the surgeon is unaware of these anomalies, impending differential diagnostic confusion (paraaortic adenopathy), intraoperative blood loss and the need for transfusion may occur. The development of IVC is a complex process concerning the formation of several anastomoses between three paired embryonic veins (posterior cardinal, subcardinal, supracardinal veins). In double IVC, the left IVC typically ends at the level of the left renal vein, in an anastomosis which crosses anterior to the aorta to join the normal right IVC. Anomalies of IVC are present in 0.4-3.5% of women. As different aberrations of IVC have important clinical implications, awareness of retroperitoneal abnormal vessels is crucial to avoid diagnostic pitfalls and intraoperative complications.