Duplication Of Inferior Vena Cava Research Articles

Accessory Right and Left Hepatic Arteries in a 69 year-old White Female Donor with a Duplicated Inferior Vena Cava: Anatomical and Surgical Significance

Hepatic artery variations are relatively common findings in patients with an array of findings that were categorized and quantified in the Michels classification system. Findings of an accessory right and left hepatic artery were found in a 69 year-old white female donor with a duplicated inferior vena cava during routine anatomical dissection (Michels type 7 variation). Research supports that the hepatic artery variations can be due to either failure of regression of ventral anastomosis between the dual aortas or failed regression of fetal hepatic blood flow. Given the concurrent development of the IVC and aortic branches during the fourth to seventh week of gestation, this patient’s duplicated IVC and abnormal CT and SMA anatomy are likely related, both a result of failure of regression of fetal vasculature. There are no known associated comorbidities with this vascular variation however it is clinically significant when undergoing any hepatobiliary surgical procedures and suggests an increased risk for hepatic ischemic events.

Abstract 1072: Two Filter, Or Not Two Filter: Case Report Of Rare Anatomical Variant Of Inferior Vena Cava

This case involves bilateral inferior vena caval filter placement in a 68-year-old male with a history of a recently diagnosed pulmonary embolism (PE) who presented with precipitously dropping hemoglobin and dark tarry stools after starting Eliquis. Endoscopy confirmed ulcerative esophagitis. Interventional radiology was consulted for inferior vena cava (IVC) filter placement as was indicated due to lower extremity thrombosis, PE, and GI bleed. During the procedure, cavography revealed a duplicated inferior vena cava (DIVC), prompting the placement of bilateral Denali filters infrarenally via the right and left common femoral approach. Only 16 similar cases are reported in the literature at the time of this literature review, and this case highlights the efficacy of bilateral infrarenal filter placement in addressing this anatomical variation.

Unusual Cause of Acute Stroke in a Young Woman with Patent Foramen Ovale - Duplicated Inferior Vena Cava and May-Thurner Syndrome.

The etiology of acute ischemic stroke (AIS) may often remain uncertain despite diligent work-up, especially in young people. Although patent foramen ovale (PFO) is a frequent association during such work-up, the actual source of thromboembolism, like deep vein thrombosis (DVT), may not be found. Such associative pathology makes it challenging to prescribe anticoagulation for secondary stroke prevention. We describe a young woman with a known history of PFO who presented with AIS and underwent endovascular reperfusion therapy. Post-thrombectomy, she developed hypoxic respiratory failure due to pulmonary embolism. Initiation of therapeutic anticoagulation was complicated by a retroperitoneal bleed necessitating imaging studies for etiological work-up. Computed tomographic angiography and venogram showed no active contrast extravasation but demonstrated duplication of the inferior vena cava with DVT in the right iliofemoral vein (RIFV). The proximity of the right common iliac artery compressing RIFV against the pelvic inlet is described as May-Thurner syndrome (MTS). Afterward, the patient was successfully treated with anticoagulation and PFO closure. MTS is a rare and underdiagnosed cause of iliofemoral DVT. In patients with known PFO, MTS is a possible cause that needs consideration. Hence, appropriate diagnostic tests are necessary to initiate appropriate management and to prevent AIS recurrence.

Unique Constellation of Vascular Anomalies in a Female Cadaver: IVC, Renal Vein, and Left Colic Artery Variation

Embryological development of the vascular system consists of growth and regression of developing vessels, often resulting in numerous variations. This cadaveric case report describes an individual with a duplicated inferior vena cava accompanied by multiple left accessory renal veins and a superior mesenteric artery-derived left colic artery. These structures may present clinical concerns when physicians are unaware of their presence during even routine surgeries. The 74-year-old female donor was dissected as part of a medical gross anatomy elective course. Anatomy was photographed and measurements were taken. Dissection revealed a duplicated inferior vena cava with a confluence between the right and left inferior venae cavae, known as the preaortic trunk. The left gonadal vein drained directly into the left inferior vena cava, inferior to the vena cava’s junction with the left renal vein. The multiple accessory left renal veins drained into the left inferior vena cava at the level of the primary left renal vein. All three anomalies examined in this donor have the potential to create complications during surgery. Promoting familiarity amongst physicians, particularly radiologists and surgeons, with vascular anomalies can aid in their ability to assess patients and provide better care.

Venous Thrombosis Due to Duplication of the Inferior Vena Cava with Decreased Protein C Activity: A Case Report

Introduction: Duplication of the inferior vena cava (IVC) is a congenital venous malformation that occurs in 0.2%-3% of the population as a result of persistent left and right supracardinal veins. The IVC duplication is prone to deep vein thrombosis due to endothelial dysfunction and associated venous stasis. This is a rare case of recurrent venous thrombosis due to IVC duplication and decreased protein C activity. Case: A 57-year-old male presented with swelling of the left lower limb that gradually developed over a one-week period preceding his visit. He reported a history of superior mesenteric vein thrombosis, approximately three years ago, for which he received anticoagulation therapy for three months. Thoracoabdominal contrast-enhanced computed tomography (CT) revealed thrombi in the locations of the bilateral main pulmonary arteries, IVC duplication, left common iliac vein, left IVC, and left renal vein. Blood work confirmed protein C activity of 21% (baseline 64%-146%), that could have contributed to the recurrent IVC thrombosis and formation of pulmonary artery thrombus. Subsequently, the patient was hospitalized and started on anticoagulation therapy. The swelling in the left lower extremity gradually improved, and the patient was instructed to continue anticoagulation therapy permanently. Conclusion: When investigating venous thrombosis of unknown or recurrent origin, it is necessary to include venous malformations and abnormal activity of blood coagulation factors in differential diagnosis.

Duplicated inferior vena cava in live-related renal transplant donor nephrectomy

Evaluation for prospective donors in live-related renal transplantation poses many challenges. Anatomical anomalies are no longer considered red flags as long as the functionality is maintained. Vascular anomalies increase difficulty during live donor nephrectomy. We herein report a case of live donor nephrectomy in a donor with a duplicated left-sided inferior vena cava (IVC). Adequate length of the left renal vein was got by taking a cuff off the duplicated IVC. The postoperative period was uneventful. Duplicated IVC is not a contraindication for left donor nephrectomy and detailed preoperative imaging helps in delineating and planning such cases.

One filter may be enough for duplicate inferior vena cava filter implantation in patients with deep venous thrombosis: Two cases report

Duplicate inferior vena cava (IVC) is an uncommon congenital malformation, but should be treated carefully under the circumstances of deep venous thrombosis (DVT). However, there is a paucity of clinical guidance on this situation. Duplicate IVC was diagnosed based on the imaging examination that revealed the dual IVC. Deep venous thrombosis was diagnosed by Compression Doppler ultrasonography of both lower extremities with the high-elevated D-dimer. Retrievable IVC filters were implanted to prevent massive and fatal pulmonary embolism. Appropriate anticoagulation therapy was also performed. Two retrievable filters were successfully implanted and retrieved in two patients with deep venous thrombosis and duplicate inferior vena cava, respectively. During further follow-up, no adverse event was reported. Comprehensive imaging examination might contribute to the diagnosis of duplicate IVC, especially when individual conditions were limited. The position above the confluence of bilateral IVCs might be an appropriate suprarenal retrievable filter insertion location. To deal with different types of dual IVC anatomy, different strategies should be taken into consideration.

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.

A Case of Duplication of Inferior Vena Cava and Turner Syndrome

Turner syndrome is one of the most common sex chromosome disorders with many anatomical abnormalities that affect physiological systems of human body. The most common cardiovascular anomalies in Turner syndrome are bicuspid aortic valve and coarctation of aorta. The venous anomalies include partial anomalous pulmonary venous return and persistent left sided Superior vena cava. Duplication of inferior vena cava (IVC) is rare in occurrence. On extensive literature search, no such case of IVC duplication in Turner syndrome is found. We, herein, report an incidental finding of IVC duplication in a known case of Turner syndrome. Any patient with Turner syndrome should be evaluated for additional venous anomalies.

Renal cell carcinoma with tumour thrombus extending in duplicated inferior vena cava: A rarity with management conundrum

DIVC may play a role as a confounding factor in imaging diagnostic tests and also may represent a hazard for inadvertent injury and bleeding during surgery. Careful interpretation Radiological investigations help to define such anomalies and avoid significant morbidity during surgical exploration. We present a case of renal cell carcinoma involving Right kidney with tumor thrombus extending into both venae cava. Triphasic Contrast-Enhanced Computerized Tomography (CECT) scan of abdomen with three-dimensional reconstruction showed duplicated left sided IVC, Heterogeneously enhancing intraluminal soft tissue density filling defect was seen along the entire length of right renal vein, also crossing the midline to the left sided duplicated IVC -s/o tumour thrombus. Patient underwent right radical nephrectomy with tumour thrombectomy. Cavotomy was done at the junction of right renal vein and right IVC. Entire thrombus was delivered intact. Histopathological examination showed papillary renal cell carcinoma (type II) stage pT3bN1Mx. IVC thrombus showed clusters of malignant cells of same morphology as tumor entangled in thrombus. The patient is doing well at 3 months of follow-up.

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.

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.

Laparoscopic management of misplaced ureteral double J stent into a left branch of duplicated inferior vena cava

Introduction: Double J Stent is frequently used to preserve urine flow to the kidney in urolithiasis. Migration of double J stent is highly reported in literature. Duplicated inferior Vena Cava is a rare entity that is asymptomatic and usually incidentally diagnosed. Case Presentation: A case of a 46 years old male patient known for multiple episodes of kidney stones presenting for left urolithiasis with hydroureteronephrosis and have underwent a double J stent insertion without fluoroscopic guidance and was discharged home uneventfully, while he returns again for left flank pain. He was diagnosed with Double J stent mispositioning into a duplicated left inferior vena cava. Therefore, a laparoscopic intervention was done to extract the stent and replace it with a new one simultaneously with repair of both the ureter and the vein. Conclusion: Duplicated inferior vena cava is an uncommon finding that has a lot of complications. This is the first reported migration of double J stent into a duplicated inferior vena cava that was Laparoscopically repaired. Keywords: Ureteral stone; Computed tomography scan; Double J stent migration; Duplicated inferior vena cava

Inferior Vena Cava Filter Placement in a Duplicated Inferior Vena Cava: A Case Report.

Inferior vena cava (IVC) duplication is a well-known anatomic variation that is important when relevant procedures are being planned. Duplication of IVC is a relatively rare to detect especially vascular anomaly with a prevalence of 1.5% (range 0.2–3.0%). Knowing this anatomical variation is very important in cases of IVC filter placement. Filter placement in duplicated IVC cases has many options like placing it in both vena cavae, suprarenal filter placement, or coil embolization of the intervenous segment plus placing a filter in the right IVC. We report a case of a patient with newly diagnosed bladder cancer who had a high risk of thrombosis and a recent massive pulmonary embolism. The patient was planned for transurethral resection of the bladder tumor. As a prophylactic measure, an IVC filter placement was requested to prevent further pulmonary emboli that might occur during or after surgery. Cavography showed a duplicated IVC, and the filter placement was performed in the suprarenal portion and was proved to be an adequate and safe procedure. No procedure-related complications were reported. There are few worldwide reported cases of filter placement in a duplicated vena cava, and to our best knowledge, this is the first case reported in Oman.

Double inferior vena cava with multiple interconnections – a rare case report

Duplication of the inferior vena cava (IVC) has been estimated to occur in 0.2% to 3% of the population. Although rare, the presence of double inferior vena cava is important to recognize as it has important implications. Diagnostic confusion in interpreting imaging results can arise when a venous anomaly is mistaken for a pathologic process like lymphadenopathy. If such patient were to need an IVC filter placement, separate filters would be required, one for the right and one for the left IVCs. A vascular surgeon would need to be aware of these anomalies to perform safe surgery of the retroperitoneal organs. We present a case of duplicated IVC, which was observed during routine dissection of a 58-year-old male cadaver. Left IVC was communicating with left renal vein superiorly. The left renal vein was running obliquely behind the abdominal aorta. Also, the left IVC was connected to right IVC by one transverse anastomosing vessel. The two-retroaortic communication between right and left IVC make this case report unique.

Duplication of infrarenal IVC-a rare developmental anomaly detected on MDCT angiography-Case report

Duplication of infra-renal inferior vena cava(IVC) is a rare entity with most of them being detected incidentally. Information about the presence of infra-renal IVC has great surgical significance while performing transplant surgeries and operating on retro peritoneum. Here we present a case of a prospective renal donor who was incidentally detected with this anatomical variant.

Discovery of a duplicated inferior vena cava during surgical resection for retroperitoneal sarcoma

Discovery of a duplicated inferior vena cava during surgical resection for retroperitoneal sarcoma

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.

Transplantation of a Kidney With Duplicated Ureter Harvested From a Donor With Vascular Anomaly in the Form of Double Inferior Vena Cava: A Case Report

During the organ procurement procedure, a surgeon encounters anatomic anomalies not very often but also not uncommonly. These changes may put the success of the transplant into question. Despite the thorough diagnosis of the potential donor, these anomalies are often diagnosed during organ donation. In our paper we present a case of kidney transplantation with duplicated ureter. The organ was collected from a donor with duplicated inferior vena cava. After transplantation, the kidney functioned immediately. Taking into consideration the well-being of the recipient, organs with anatomic abnormalities should be carefully considered for transplantation. This is especially important when there is a constant shortage of organs for transplantation.

Vena Caval Abnormalities Discovered During Dissection in the Anatomy Lab: Two Cadaveric Case Reports

IntroCongenital abnormalities of the inferior vena cava (IVC) are rare in the general population with the incidence of IVC duplication being between 0.2 – 3%. Persistent left superior vena cava (SVC) has an incidence of 0.3 – 0.7%. It is important to identify such variations through imaging prior to various thoracic and abdominal surgeries to minimize peri‐operative complications.MethodsTwo cadavers with vena caval abnormalities were identified in a medical school cadaveric anatomy lab. The donor’s age, sex and cause of death were identified through bequeathal services. The pathway of the aberrant structures was identified through dissection and any tributaries along their courses were isolated. Surrounding structures were examined to identify any other concurrent abnormalities.ResultsWe identified two cadavers with vena caval abnormalities. The first case was a 75‐year old female whose cause of death was a bowel obstruction with comorbid dementia. On this cadaver we identified a persistent left SVC that originated from the brachiocephalic vein on the left side that measured 19 mm in diameter. The aberrant structure drained into the right atrium via the coronary sinus, which was noticeably enlarged. The second case was a 76‐year old female whose cause of death was multiorgan failure with comorbid end stage liver failure, pulmonary edema and hypothyroidism. We identified a duplicated IVC with a diameter of 12 mm originating at the left iliac vein and draining into the left renal vein. Along the duplicated IVC were multiple branches originating from the posterior abdominal cavity.ConclusionWe present here two cases with rare vena caval abnormalities found in cadavers in our anatomy lab. The embryological origin of a duplicated IVC stems from the persistence of both left and right supracardinal veins during development. A persistent left SVC occurs when the left superior cardinal vein fails to regress inferior to the brachiocephalic vein. Although rare, recognizing these anatomical variations bears clinical relevance, especially in a surgical setting. These abnormalities are important to identify pre‐operatively to avoid unexpected peri‐operative complications.