Supracardinal Vein Research Articles

Prenatal Development of the Caudal Vena Cava in Mammals: Review of the Different Theories with Special Reference to the Dog

Several items of the development of the caudal vena cava in domestic animals are still controversial. In particular, the origin of the lumbar segment of the caudal vena cava is equivocally described. According to different theories it originates from the right-sided supracardinal, caudal cardinal, sacrocardinal, lateral sympathetic or subcardinal veins. In this review, all five theories are compared with each other and discussed in the light of anatomical variations observed in eight dogs. Species-specific diversity, erratic observations because of technical artefacts, and biased interpretation of the original data are three major reasons for the dissimilarity between the five theories, but they cannot explain all differences. Further studies by using modern techniques such as microvascular corrosion casting and non-invasive three-dimensional microtomography are necessary to better understand the normal development and to explain the variations in domestic animal species.

Inferior Vena Cava Duplication and Deep Venous Thrombosis: Case Report and Review of Literature

Duplications of the inferior vena cava (IVC) are seen with an incidence of 0.2% to 3.0%. Duplications causing symptoms are rare, with only six reported cases of IVC duplication associated with a deep venous thrombosis. We present a 78-year-old caucasian woman with an IVC duplication who developed a deep venous thrombosis. The etiologies of IVC duplication include failure of anastomosis between the primitive cardinal veins and failure of regression of the left supracardinal vein. When asymptomatic, treatment includes observation, placing filters in both systems, or coil-embolization of the duplicated segment plus placing a filter in the right IVC. For our patient, we chose to coil-embolize the communication to the duplicated segment as well as place a filter in the main right IVC system.

Unusual fibrous band on the left aspect of the aortic arch

During dissection of a 63-year-old female cadaver, a firm ribbon-like band was found on the left aspect of the aortic arch. Careful dissection showed that the band (6 cm long, 8 mm wide, 2 mm thick) connected the left superior intercostal vein with the accessory hemiazygos vein. Histological examination showed the fibrous structure of the band and showed the presence of a thread-like vascular lumen. The topography and venous connections of the band indicated its origin from persistence of the embryonic anastomosis between the left superior intercostal and accessory hemiazygos veins. This anastomosis derives from the rostral portion of the supracardinal vein that usually regresses on the left side but forms the terminal arch of the azygos vein on the right side. The severe atherosclerosis present in this patient at the level of the aortic arch may have enhanced the effects of arterial pressure on the adjacent venous anastomotic vessel causing reduction of blood flow and progressive fibrosis. The persistence of this venous anastomosis and its possible age-related fibrosis may have clinical relevance in central venous catheter placement.

Images in vascular medicine

A 63-year-old male, with history of hypertension, diabetes mellitus and hypercholesterolemia, underwent an ultrasound scan for prostate hypertrophy, which revealed an abdominal aortic aneurysm (AAA). An abdominal CT scan confirmed the presence of a 5.5 cm diameter AAA and disclosed duplication of the inferior vena cava (IVC) (Panel A; arrows). The right-sided IVC followed the normal IVC anatomy, whereas the left-sided IVC originated in the pelvis from the left common iliac vein, ascended along the posterior-lateral aspect of the abdominal aorta, passed anterior to the AAA neck where it joined the left renal vein and then entered the right-sided IVC. At surgery, the left-sided IVC (Panel B: black arrow left-sided IVC; white arrow left renal vein; bent arrow left spermatic vein) was dissected free of the AAA neck and the AAA was replaced with a 20 mm Dacron tube graft. The postoperative course was uneventful and the patient was discharged on the seventh postoperative day. Duplication of the IVC is estimated to occur in 2 3% of autopsy series. The abnormality is caused by failure of regression of the caudal left supracardinal vein during the first embryologic trimester, which results in persistence of both left and right supracardinal veins. Several variations of double IVC have been described. The left-sided IVC may pass anterior or posterior to the aorta or may ascend along the lateral aspect of the aorta and empty into the left renal vein. The left-sided IVC can also be poorly developed or segmental. The presence of double IVC poses hazards to the surgeon during abdominal aortic surgery. Preoperative diagnosis is desirable and can be made on a CT scan. Ultrasound scan and venography of the vena cava is rarely recommended. It should be noted, however, that CT scans are routinely performed for patients scheduled for AAA repair but not for patients undergoing reconstruction for aortoiliac occlusive disease. Familiarity with the anatomy of the most common types of major venous anomalies is therefore mandatory for all vascular surgeons to reduce the risk of severe venous hemorrhage associated with these anomalies.

Pivotal role of the sub-supracardinal anastomosis in the development and course of the left renal vein.

A retroaortic left renal vein is encountered frequently in the dissecting room and in radiological investigations. A number of recent reports of this variation led us to review the development of the renal veins and the inferior vena cava to understand its etiology. For further insight, we also examined our collection of serial sections of cat embryos. In human embryos of about 15 mm the "renal collar," a venous ring around the aorta, is formed by anastomoses between subcardinal and supracardinal veins. The ventral part of the "renal collar" is formed from the intersubcardinal anastomosis, the dorsal part from the intersupracardinal anastomosis and the lateral parts from the sub-supracardinal anastomoses. The primitive renal veins drain venous blood from the metanephros into the sub-supracardinal anastomoses. A retroaortic left renal vein would form if the dorsal part of the sub-supracardinal anastomosis and the intersupracardinal anastomosis persist whereas the ventral part of the sub-supracardinal anastomosis and the intersubcardinal anastomosis regress.

Duplication of Inferior Vena Cava with Right Renal Hypoplasia

AbstractCongenital anomalies of the inferior vena cava (IVC) may have clinical implications. The present case study describes a male cadaver with a duplicated IVC and a hypoplastic right kidney. The IVC is derived embryologically from the development and remodeling of the posterior cardinal, subcardinal and supracardinal veins. The definitive kidneys develop from the metanephros. Transforming growth factor‐β (TGF‐β), a positive regulator of angiogenesis and a known inhibitor of tubulogenesis of metanephric tissue in vitro, may provide the link for the concomitant occurrence of the congenital anomalies seen in this case study.

The first report of a patient with interrupted inferior vena cava, multiple post‐renal veins and azygos‐hemiazygos continuation

The first case of a patient with interrupted inferior vena cava, four post-renal veins and an azygoshemiazygos continuation is presented. The complicated anomalies were omphalocele and atrial septal defect. Cine-magnetic resonance imaging and cardiac catheterization showed an anomalous retroaortic left innominate vein, azygos-hemiazygos continuation in the prerenal portion, arch formed renal vein in the renal portion and four embryonic vessels in the post-renal portion. Combination of these anomalies in the major venous system suggested that the inferior vena cava had failed to form and that the bilateral embryonic venous system, postcardinal and supracardinal veins, persisted to be the systemic venous channels.

Anomalous caudal vena cava passing through the vertebral canal in a calf

A 15-day-old female Holstein-Friesian calf with an anomalous caudal vena cava was examined macroscopically, roentgenologically, and histologically. The calf, weighing 43 kg, had severe scoliosis. A common renal vein merged into a single venous trunk formed by the union of the left and right common iliac veins. The trunk entered the vertebral canal through the left intervertebral foramen formed by the last (13th) thoracic and the first lumbar vertebrae. The trunk continued along the ventral side of the narrowing spinal cord inside the canal, and then ran out the left intervertebral foramen formed by the 8th and 9th thoracic vertebrae and emptied via the right azygos vein into the cranial vena cava. In contrast, the hepatic vein passed through the foramen vena cava independently of the trunk and entered the right atrium directly. The pathogenesis of the present anomaly may be explained as follows: The right subcardinal vein, failing to make connection with the liver, shunted directly into the right azygos vein derived from the right supracardinal vein. The body axis began to curve before ossification of the vertebrae occurred. Consequently, the developing right supracardinal vein, located close to the spinal cord, is thought to have become enclosed in the vertebrae with the spinal cord during the early fetal stages.

Persistence of the Supracardinal Veins in Two Calves

Abstract Malformations of the caudal vena cava were found in two male Holstein‐Friesian calves. Cases 1 and 2 were clinically diagnosed as arthritis and intestinal atresia, respectively. Both calves died soon after birth. Case 1: The common trunk, which consisted of the right and left common iliac veins, ran forward just beneath the vertebral column passing through the aortic hiatus, and then entering the coronary sinus by way of the left azygos vein. The other venous trunk originated from the junction of the right and left renal veins and ran normally thereafter. Reduction of the cervical vertebrae, and hypoplasia of the colon, thymus and hypophysis were also observed. Case 2: The common trunk received a renal vein from the horseshoe kidney, passed through the diaphragm on the right side of the aortic hiatus of normal case and emptied into the cranial vena cava by way of the right azygos vein. The hepatic veins passed separately through the foramen venae cavae and entered the right atrium. An abnormal aorta was detached and hung from the vertebral column. Atresia coli, cryptorchidism and wry tail were also observed. The above findings showed that the left supracardinal vein in Case 1 and the right one in Case 2 had existed during their embryological life.

Concurrent duplication and azygos continuation of the inferior vena cava

Duplication of the inferior vena cava and azygos continuation of the inferior vena cava arise from separate embryologic anlage. The former arises from persistence of both supracardinal veins and the latter from arrested development of the right subcardinal vein. Individually these entities are uncommon, but their occurrence together in one patient is exceedingly rare. A patient with both these anomalies of the venous system concurrently is described. This combination has been reported only once before in the radiologic literature.

Ovarian, oviductal, and adrenal vascular connections in female lizards (genus Anolis).

The urogenital blood vessels of Anolis equestris and A. carolinensis were studied using dissection, injection of silicone rubber, and histology. A new blood-vascular connection between small veins in the pampiniform plexus at the base of the ovary and an ostial extension of the secondary oviductal vein is described. Chemical messengers could thus be carried in the blood from the ovarian venous drainage to the oviduct. Furthermore, close apposition of the secondary oviductal vein and artery provides an anatomical basis for countercurrent exchange of these messengers. A circular venous arcade, involving the supracardinal vein and branches of the oviductal veins, also is described; this arcade could serve to deliver adrenal hormones to each oviduct.

Double inferior vena cava or iliac vein occlusion? A diagnostic problem in radionuclide venograms

Radionuclide venography in two patients with suspected deep venous disease revealed double channel drainage with cross-pelvic collateral circulation. Contrast inferior venacavograms revealed that one patient had persistent right and left supracardinal veins (double inferior vena cava) and the other had iliac vein occlusion with ascending lumbar collateral circulation. The similarity of radionuclide venographic findings in these two patients emphasizes the importance of contrast venacavography in patients with this appearance on radionuclide venography.

Absence of the inferior vena cava.

Recently, while investigating possible candidates for cardiac surgery, the author encountered 5 cases of an unusual pattern of systemic venous drainage. These patients appeared to have no inferior vena cava. Instead, blood from the lower extremities and kidneys drained into a large posterior azygos vein which eventually ascended into the thorax and emptied into the superior vena cava (Fig. 1). This anomaly has traditionally been called “absence of the inferior vena cava” and is also known as “persistence of the supracardinal vein.” It is more correctly termed “infrahepatic interruption of the vena cava with azygos continuation” (2). The malformation has been mentioned only rarely in the literature of American radiology (1, 6). Several references, however, appear in the pediatric literature, the most comprehensive being the recent review by Anderson et al. (2). This condition per se is harmless. Until the advent of cardiac catheterization and angiocardiography, the few reported examples were almost all discovered at autopsy. Now, cases associated with severe cardiac and extracardiac anomalies, often producing cyanosis, are being discovered antemortem. The pertinent features in our 5 cases are presented in tabular form rather than as individual case reports (Table I). Roentgenologic findings are discussed separately. Embryology In the embryo, the supracardinal vein runs in the dorsal aspect of the body. It empties cranially into the common cardinal vein, the anlage of the superior vena cava (Fig. 2). The three segments of the supracardinal vein have separate fates. The lowermost portion becomes the postrenal segment of the inferior vena cava. The uppermost portion becomes the azygos vein. The midsegment is obliterated. The upper end of the inferior vena cava is formed by other embryonic veins (the efferent veins of the liver). If these fail to develop properly, blood from the lower extremities and abdomen is forced to continue through the entire length of the supracardinal vein. Thus, the middle segment of the supracardinal vein does not regress, and the anomaly described herein results (5). Roentgen Findings If no associated anomalies are present, the findings on plain roentgenograms may well be normal. It is logical to expect azygos enlargement because of the large volume of blood carried by this vessel. This finding has been reported but rarely, however (2, 6). Most of the roentgenographic changes are related to the associated anomalies. All our cases showed cardiac enlargement and increase in the pulmonary vascularity, reflecting increased pulmonary blood flow, and all were admixture type lesions with either a single ventricle or a large ventricular septal defect. The angiographic findings are striking.

INFRAHEPATIC INTERRUPTION OF THE INFERIOR VENA CAVA WITH AZYGOS CONTINUATION (PERSISTENT RIGHT CARDINAL VEIN).

An anomalous inferior vena cava with azygos continuation is a distinct entity now being diagnosed more frequently in patients with congenital heart defects. As a congenital abnormality, it may become apparent at any age, but is certainly more often noticed in children undergoing cardiac catheterization. The incidence of this anomaly in patients with congenital heart defects has been stated to be 0.6 per cent, and in most clinically diagnosed cases, cyanosis is produced by the cardiac defects. Abnormal positions of the heart, such as mirror image dextrocardia, dextroversion, situs inversus with levocardia or levoversion, and partial inversion of the abdominal viscera (heterotaxia) are common, as well as additional anomalies of the superior vena cava. Most of the reported cases have been described from observations in the dissecting laboratory (2, 3) and usually designated “absence of the vena cava,” although, as Hollinshead states (4), neither the infrarenal portion nor the suprahepatic portion is apparently ever absent. The infrarenal portion, in fact, may be normally situated, but the inferior vena cava does not have its usual course. What should be the upper end of the inferior vena cava, as it pierces the diaphragm and enters the heart, is formed entirely by the hepatic veins and thus represents the venous return from the liver only. The anomalous vena cava, after receiving the renal veins, passes into the thorax through the aortic hiatus and becomes continuous with either the azygos or the hemiazygos vein. Usually, such cases are interpreted as being due to a failure of development of the anastomosis between the right subcardinal vein and the hepatic veins, with a persistence of the upper end of one or both supracardinal veins which in earlier stages drained upward to the superior caval system. Of special interest to the radiologist in this condition is the distinct configuration often seen in the dilated azygos vein, which sometimes presents as a mediastinal tumor. This tumefaction may produce a protuberance at the junction of the enlarged azygos vein with the superior vena cava. The largest single series clinically described to date is that of Anderson et al. (1). They encountered a total of 15 cases of absent inferior vena cava in approximately 2,500 new patients with congenital heart defects observed over a six-year period at the University of Minnesota Hospital and reviewed 26 cases previously published. These authors described a typical “candy cane” appearance of the anomalous venous pathway. When angiocardiography was performed from the leg vein, the most common pattern encountered was azygos continuation with normal position of heart and abdominal viscera. Other authors (5, 6) have also described isolated cases in which the dilated azygos vein simulated a mediastinal tumor. Occasionally, surgical intervention was undertaken.

Charles Freeman Williams McClure

Charles Freeman Williams McClure

Aortic homograft substitution for the postrenal inferior vena cava.

Although anomalies of the venous system are fairly frequent, those of the inferior vena cava are comparatively uncommon. The human inferior vena cava is of complex origin (Fig. 1). It is derived from elements of nearly all the trunk veins of the embryo.¹During the sixth, seventh, and eighth weeks of development, rapid changes take place in the mesonephros and the blood vessels associated with it. The postcardinal veins are the dorsal vessels of the mesonephros. They and the subcardinal veins, which lie ventromesially, are the dominant trunk vessels in the sixth week of development. The supracardinal veins which lie dorsomesial to the postcardinals develop rapidly during the seventh week. The posterior portion of the right supracardinal vein eventually becomes the postrenal vena cava of the adult. The left supracardinal vein largely disappears. By the end of the eighth week of intrauterine growth, the adult pattern has been established.

The development of the veins in the domestic cat (Felis domestica) with especial reference, 1) to the share taken by the supracardinal veins in the development of the postcava and azygos veins and 2) to the interpretation of the variant conditions of the postcava and its tributaries, as found in the adult

The development of the veins in the domestic cat (Felis domestica) with especial reference, 1) to the share taken by the supracardinal veins in the development of the postcava and azygos veins and 2) to the interpretation of the variant conditions of the postcava and its tributaries, as found in the adult

A case of persistent left supracardinal vein with two left spermatic veins

The Anatomical RecordVolume 20, Issue 1 p. 94-96 Article A case of persistent left supracardinal vein with two left spermatic veins Ivan E. Wallin, Ivan E. Wallin Department of Anatomy and the Henry S. Dennison Research Laboratories, University of ColoradoSearch for more papers by this author Ivan E. Wallin, Ivan E. Wallin Department of Anatomy and the Henry S. Dennison Research Laboratories, University of ColoradoSearch for more papers by this author First published: December 1920 https://doi.org/10.1002/ar.1090200106Citations: 1AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume20, Issue1December 1920Pages 94-96 RelatedInformation