Vena Cava Anomalies Research Articles

Inferior Vena Cava Anomalies during Laparoscopic Retroperitoneal Lymph Node Dissection

To report our experience with congenital inferior vena cava (IVC) anomalies found during laparoscopic retroperitoneal lymph node dissection (LRPLND). Two men with a mean age of 31.5 years (range 26-37 years) underwent LRPLND because of nonseminomatous germ-cell tumors (NSGCT) between December 2003 and July 2004. A four-port technique was used. A left IVC anomaly was found in both patients. The two operations were performed with no serious immediate complications and minimal blood loss. Congenital IVC anomalies were identified intraoperatively. A left-sided template modified because of anatomic variation was used. Mean operative time was 95 minutes (range 60-130 min). Both patients remain without tumor recurrence at a median of 24.5 months of follow-up (range 15-34 months). Although uncommon, IVC anomalies must be considered when performing LRPLND because of potential complications. Preoperative studies are essential in surgical planning.

Pelvic venous variations in patients with congenital inferior vena cava anomalies: classification with computed tomography

Pelvic venous variations of congenital inferior vena cava (IVC) anomalies that have the potential to cause problems during related surgery and interventional radiology are not fully appreciated. To classify pelvic venous variations of congenital IVC anomalies using computed tomography (CT). CT images for 36 patients with congenital IVC anomalies were retrospectively reviewed. Pelvic venous variations were classified with regard to the relationship with the iliac veins and the presence of interiliac communication. Pelvic venous variations were classified into eight types. One azygous continuation displayed normal connection with the bilateral common iliac veins (CIV) (type 1). Of 28 double IVCs, 11 (39.3%) displayed no interiliac communication (type 2a), five (17.9%) displayed interiliac communication from the left CIV (type 2b), one (3.6%) had communication from the right CIV (type 2c), six (21.4%) had communication from the left internal iliac vein (IIV) (type 2d), and five (17.9%) had communication from the right IIV (type 2e). Six left IVCs displayed symmetrical-to-normal connection with the bilateral CIV (type 3). One absence of infrarenal IVC displayed no connection with the CIV (type 4). Eight types of pelvic venous variations of congenital IVC anomalies were classified using CT.

Venous variants and anomalies on routine abdominal multi-detector row CT

Objective This study aims to determine the types and prevalence rates of anatomic variations of the hepatic veins, portal vein, inferior vena cava and renal veins, and to establish statistical correlations between various anomalies and frequency differences between male and female using multi-detector row computed tomography (CT). Materials and methods One thousand one hundred and twenty patients (588 men, 532 women) were evaluated with routine abdominal CT. Frequencies of different variants were noted and compared, and correlations between three categories of variation were tested. Results In total, 1261 abdominal vein variants and anomalies were identified in 756 (67.5%) of 1120 patients. Six hundred and forty-two hepatic vein variants were detected in 468 (41.8%) patients. One or more inferior right hepatic veins were identified in 356 (31.8%) individuals, and tributary hepatic veins were detected in 147 (13.1%) patients. Portal vein variations and anomalies were observed in 307 (27.4%) cases. The most frequent of these was trifurcation (139 patients, 12.4%). A total of 311 inferior vena cava and renal vein variants were identified in 258 (23%) cases. Six patients (0.5%) exhibited inferior vena cava anomalies, 62 (5.5%) had circumaortic renal veins, 53 (4.7%) had retroaortic renal veins, and 210 (18.8%) had multiple renal veins. Conclusion The prevalence of abdominal vein variations is high, and routine abdominal CT demonstrates these abnormalities very well. The data suggest that hepatic vein variants and multiple right renal veins are more frequent in women than in men, and that hepatic vein variation is correlated with portal vein variation.

Congenital anomalies of the inferior vena cava revealed on CT in patients with deep vein thrombosis.

We describe a possible relationship between inferior vena cava anomalies and extensive thrombosis of the inferior vena cava and the iliac and femoral veins. An anomaly of the inferior vena cava should be considered in young patients who present with deep vein thrombosis of the femoral and iliac veins. Coagulation abnormalities, frequently found in these patients, may be a contributory factor.

Intestinal malrotation as an incidental finding on CT in adults.

Intestinal malrotation in adults is usually an incidental finding on computed tomography (CT). We present the CT findings of 18 adult patients with malrotation and discuss the clinical implications. Abdominal scans of 18 patients (12 women, six men; age range = 15-79 years) with intestinal malrotation were reviewed. Special attention was directed to the location of the superior mesenteric vessels, the location of the small and large bowels, the size of the uncinate process, the situs definition, and additional anomalies. The malrotation was an incidental finding in all but one patient. The malrotation was type Ia in 17 patients and IIc in the one symptomatic patient. The superior mesenteric vessels were vertically oriented in 10, inverted in two, normally positioned in four, and mirror imaged in two cases with situs ambiguus. All patients had aplasia of the pancreatic uncinate process, five had a short pancreas, and two had a preduodenal portal vein. Fourteen patients had a normal situs and four had heterotaxia. Seven patients had polysplenia, six of which with associated inferior vena cava anomalies. Intestinal malrotation can be diagnosed on CT by the anatomic location of a right-sided small bowel, left-sided colon, an abnormal relationship of the superior mesenteric vessels, and aplasia of the uncinate process. Awareness of these abnormalities is necessary to diagnose this anomaly. It should be sought in patients with a situs problem, inferior vena cava anomalies, polysplenia, or preduodenal portal vein. Although usually an incidental finding, it is important to diagnose such a malrotation because it may cause abdominal symptoms. Also, knowledge of associated vascular anomalies is important when abdominal surgery is planned.

Inferior vena cava anomalies associated with giant omphalocele—A proposed classification: A. Gorenstein, Sh. Meyer, and M. Schiller. Z. Kinderchir 38:380–382, (December), 1983

Inferior vena cava anomalies associated with giant omphalocele—A proposed classification: A. Gorenstein, Sh. Meyer, and M. Schiller. Z. Kinderchir 38:380–382, (December), 1983

Inferior vena cava anomalies associated with giant omphalocele--a proposed classification.

Thirteen patients with hepatomphaloceles were investigated pre-operatively by an inferior venocavogram as to the shape of the eviscerated liver and the course of the inferior vena cava. Roentgenographic findings correlated with operative findings and three distinct patterns of anomaly were seen. Type 2 and particularly Type 3 are likely to be associated with severe post-operative complications if the peculiar anatomy is not recognized beforehand. We feel that a pre-operative inferior venocavogram and determination of type of anomaly is mandatory in planning the treatment of these patients.

Diagnosis of inferior vena cava anomalies by computerized tomography

Knowledge of normal and variant vascular anatomy has become essential with increasing use of computerized tomography and ultrasound. We present three cases of IVC anomalies diagnosed by computerized tomography, including azygos continuation of the IVC and the first case of left IVC demonstrated on CT scan. The embryology of the normal and variant IVC is presented. The practical significance of these findings is discussed.