We report a case of caval biiliac occlusion in which arterial stent technology in the form of the afx2 unibody stent graft was used to achieve anatomical reconstruction of the ilio caval. Inferior vena cava ivc thrombosis is a lifethreatening condition that is rarely diagnosed in the postpartum period. Intrinsic disruption of superior vena cava flow can also precipitate superior vena cava syndrome. Pulmonary embolism is a fatal consequence of ivc thrombosis, particularly when it is acute and floating. Surgical placement of inferior vena cava filter to prevent. Methods a combined retrospective and prospective study on infants and children with ivc thrombosis treated at aachen and maastricht university hospitals between 1980 and 1999.
In the puerperal setting it is presumably the result of extension of clot from either the iliac or ovarian veins. Thrombosis of the inferior vena cava ivc is an underrecognized entity with a variety of clinical presentations. Neurological complications are uncommon after deep venous thrombosis. Inferior vena caval ivc thrombosis is an essential diagnosis while evaluating any neoplastic lesion, or portal hypertension. It is one of the most uncommon anomaly, with an estimated prevalence of 0. Long term complications of inferior vena cava thrombosis. To prospectively evaluate the efficacy of mr imaging in inferior vena cava ivc thrombosis. It is formed by the joining of the right and the left common iliac veins, usually at the level of the fifth lumbar vertebra. Inferior vena cava ivc filter thrombosis has not been described as a clinical entity. This examination revealed a hyperechoic oval structure. My experience as a surgeon has allowed me to share some information regarding deep vein thrombosis. Our case suggests that outflow obstruction caused by traumatic inferior vena cava thrombosis may be a mechanism of posttraumatic adrenal hemorrhage. Inferior vena cava filters remain the only treatment option for patients with an acute within 24 weeks proximal deep vein thrombosis dvt or pulmonary embolism and an.
Thrombosis of the inferior vena cava by seminoma sciencedirect. Thrombosis of the inferior vena cava and hepatic veins budd. Deep venous thrombosis associated with inferior vena cava. Mar 17, 2020 thrombosis of the inferior vena cava ivc is an underrecognized entity with a variety of clinical presentations. The only vena cava thrombosis though none had complete recanalization of the inferior the. Thirty patients with ivc percutaneous filter thrombosis were assessed by cavography, computed tomographic ct scan andor duplex ultrasonography. A 48yearold man presented to the emergency department with 6 days of constant central abdominal pain. Risk factors for venous thromboembolism included tobacco usage, cur rent or. Results forty patients were enrolled, including four with preceding cardiac catheterisation, 18 with central. Inferior vena cava thrombosis and absence angiologist. The significant number of cases reported in the literature highlights their importance, warranting investigating their existence in younger individuals.
We report the unusual cases of two patients with pulmonary embolism from thrombosis of part of a duplicated ivc. The general concepts of deep venous thrombosis dvt and thrombophlebitis are discussed in detail in deep venous thrombosis. The patient in the case reported here survived for years or more after clinical signs suggesting inferior vena caval obstruction and for more than 4 years after evidence of essentially total hepatic venous obstruction. They can be a risk factor for deep venous thrombosis dvt as a result of inadequate venous drainage of the lower extremities through collateral circulation. Inferior vena caval thrombosis statpearls ncbi bookshelf. Catheter directed thrombolysis for pulmonary embolism in. Thrombosis of the inferior vena cava ivc has similar aetiological factors to lower limb deep venous thrombosis dvt 1. This case report describes an unusual presentation and potential etiology of superior vena cava syndrome. Although dvt most commonly occurs in the lower extremities 4, rarely, thrombus can also form in the inferior vena cava ivc.
Yet, inferior venacavography can fail to localize the cranial extent of the tumor thrombus in the inferior vena cava and may fail to visualize tumor in the right atrium. The presence of aivc in patients with dvt is underestimated because aivc cannot be detected by compression bmode ultrasonography. Clinical suspicion when the lower extremity is swollen far more than can be explained by a thigh clot, think of a higher obstruction. Hypoplasia of the inferior vena cava in a young man. A case report and a descriptive retrospective study of. Welldocumented cases of hepatic vein occlusion of prolonged duration are extremely rare. The diagnosis of ivc thrombosis relies on a combination of three. Congenital absence of the inferior vena cava aivc is a rare vascular defect, commonly reported as a fortuitous finding. Superior vena cava syndrome in a patient with locally. Acute cauda equina syndrome caused by thrombosis of the.
These various entities may be difficult to differentiate clinically, and the literature offers no clear guidance as to the selection of conservative or surgical treatment. Thrombosis of the inferior vena cava ivc is an underrecognized entity that is associated with significant short and longterm morbidity and mortality. Inferior vena cava ivc thrombosis is a rare complication of acute pancreatitis. Thrombosis of the adjacent inferior vena cava ivct at or near the renal vein orifices may also be present with a prevalence of 4050%. Inferior vena cava an overview sciencedirect topics. Case report innovative treatment for inferior vena cava. A long filling defect is noted within the intrahepatic portion of the inferior vena cava which appears to extend to the left renal vein, highly suspicious for a thrombus. All patients had proximal venous thrombosis when the filter was placed, and the indication for filter placement was a contraindication to anticoagulant therapy. Pulmonary embolism with duplicated inferior vena cava. In this paper, we present 2 siblings with deep venous thrombosis and inferior vena cava abnormalities, with a symptomatic onset at similar age. This condition is mainly seen in pregnant females and the vein gets obstructed as a result of the growing fetus.
An early diagnosis of inferior vena cava thrombosis. An anomaly of the inferior vena cava should be suspected if thrombosis involving the iliac veins is seen in patients 30 years of age or younger. Inferior vena cava agenesis, an unusual cause of deep vein. The mortality rate of ivc thrombosis is twice as high as that of dvt confined to the lower extremities 2. Because the inferior vena cava is located to the right of the midline, drainage of the tributaries is not always symmetrical.
Inferior vena cava agenesis and deep vein thrombosis. Physical examination revealed grossly dilated veins of the abdomen, chest wall and inguinal areas figure 1. By use of computed tomography, we diagnosed four cases of aivc in young patients with idiopathic dvt over a 5 year period. Congenital left inferior vena cava ivc with hemiazygos continuation and drainage into the superior vena cava svc is a rare ivc variant and is asso. This is the reason why, although the diagnosis is challenging, a high index of suspicion is required. Our patient was a 51yearold black woman with locally advanced, stage iiib nonsmall cell. We report on a patient who presented with an acute cauda equina syndrome, which turned out to be caused by thrombosis of the inferior vena cava. Congenital anomalies of the inferior vena cava ivc are common and usually of little clinical significance. A complete guide to deep vein thrombosis in singapore. Anomalies of the inferior vena cava imaged by magnetic resonance angiography.
Reconstruction of the ilio caval confluence remains a challenge for physicians performing interventions in the deep venous system. Vital signs showed an o2 saturation of 90% on room air and a respiratory rate of 24 breathsmin. While duplication of the inferior vena cava was not the cause of the venous thrombosis in our patient, a detailed phlebography test was needed to both identify the anatomical variation and. Inferior vena cava ivc thrombosis is related to the patho logical and clinical spectrum of deep venous thrombosis. Well known complications of deep venous thrombosis are pulmonary embolism and chronic venous insufficiency. If the address matches an existing account you will receive an email with instructions to reset your password. Deep venous thrombosis revealing agenesis of inferior vena cava. Inferior vena cava ivc thrombosis is a disease associated with high morbidity. The inferior vena cava ivc filter is a device that is implanted in the ivc to prevent lowerextremity deep venous thrombosis from causing lifethreatening pulmonary embolism.
Inferior vena cava ivc anomalies are a rare cause of deep venous thrombosis dvt that may be missed if crosssectional imaging is not requested during investigation of the patient. Patient had no significant history or risk factors to predispose him to genitourinary cancers. Imaging evaluation of the inferior vena cava1 the inferior vena cava ivc is an essential but often overlooked structure at abdominal imaging. Congenital inferior vena cava anomalies have a reduced frequency in general population, many times being an asymptomatic finding. Thrombosis of the inferior vena cava and hepatic veins.
Although the condition is considered rare, case reports have shown that ivc thromboses may be underdiagnosed. In absence of a congenital anomaly, the most common cause of ivc thrombosis is the presence of an unretrieved ivc filter. Its walls are rigid and it has valves so the blood does not flow down via gravity. Endovascular management of chronic upper extremity deep vein thrombosis and superior vena cava syndrome. An inferior vena cava filter is a type of vascular filter, a medical device that is implanted by vascular surgeons or interventional radiologists into the inferior vena cava to prevent lifethreatening pulmonary emboli pes. On the left, they drain into the renal vein which in turn drains into the inferior. For example, most commonly, pulmonary emboli are thought to arise from a lower extremity deep venous thrombosis. Congenital malformations of the inferior vena cava ivc are rare and underreported. The inferior vena cava or ivc is a large vein that carries the deoxygenated blood from the lower and middle body into the right atrium of the heart.
Patients caring such anomalies are at risk to develop deep vein thrombosis. It is a rare risk factor for deep venous thrombosis dvt, found in approximately 5% of cases of unprovoked lower extremity le dvt in patients inferior vena cava which appears to extend to the left renal vein, highly suspicious for a thrombus. Deep vein thrombosis can strike anybody, sometimes without noticeable symptoms. Inferior vena cava thrombosis as a complication of femoral vein catheterisation. However, the implications and complexity of ivc thrombosis ivct merit specific attention. Inferior vena cava thrombosis due to acute pyelonephritis. Inferior vena cava ivc thrombosis is an underrecognized entity that is associated with significant morbidity and mortality. To determine, during heparin therapy, the embolic risk associated with acute inferior vena cava thrombosis compared with noncaval thrombosis. Inferior vena caval thrombosis clinical presentation.
May 26, 2011 inferior vena cava thrombosis diagnosis. Inferior vena cava ivc thrombosis remains underrecognised as it is often not pursued as a primary diagnosis. Thrombosis of the inferior vena cava ivc is an underrecognized with a variable clinical presentation. Pdf inferior vena cava ivc thrombosis remains underrecognised as it is often not pursued as a primary diagnosis. Inferior vena cava syndrome is a pathological condition which is characterized by obstruction or blockage of the inferior vena cava vein which transports blood from the lower extremities to the heart.
Due to the substantial increase in the number of ivc filters placed in the united states and the very low filter. Abdominal varicosities secondary to inferior vena cava. Pdf inferior vena cava thrombosis as a complication of. Aim to evaluate the long term outcome after paediatric inferior vena cava ivc thrombosis. Inferior vena cava thrombosis in behcet disease radiology. March 19 1996 accepted after revision june 30 1996 this study has been presented at the xvth congress of the international society on thrombosis and haemostasis, jerusalem, israel, june 1116, 1995.
Interruption of the inferior vena cava ivc for the prevention of pe was first performed in 1893 using surgical ligation. It is associated with a wide variety of congenital and pathologic processes and can be a source of vital information for. In contrast, we present a case in which inferior vena cava thrombus was detected in the suprarenal inferior vena cava before an adrenal hemorrhage. Around 5% of patients below 30 years of age with deep vein thrombosis dvt have a total or segmental inferior vena cava agenesis. A 47yearold previously healthy man presented with acute moderate flank pain. In their report, m ruggeri and colleagues feb 10, p 4411 point out the clinical relevance of the congenital absence of the inferior vena cava ivc in young patients thrombosis dvt. Inferior vena cava agenesis ivca constitutes one of many inferior vena cava congenital anomalies. They are placed in patients with lower extremity venous thrombosis in whom systemic anticoagulation is contraindicated or unsuccessful in preventing pulmonary embolism. The typical presentation spectrum of deep vein thrombosis. Both caval anomalies were easily identified with ultrasound, and the patients were successfully treated with anticoagulants. Also, the authors found more frequently bilateral dvt and ab. It is also important to differentiate bland thrombus from tumor thrombus. Inferior vena cava atresia ivca is a rare but well described vascular anomaly.
Symptomatic proximal deep venous thrombosis extending to. Ivc thrombosis with associated portal vein thrombosis. The management of ivc thrombosis can be divided into medical and surgical. To describe the indication for a vena cava filter vcf, the most common and important complications, and the practical management of patients who have a vcf placed. Inferior vena cava ivc aneurysms are extremely rare. The rate of ivc anomalies has been found to be higher in patients with acute dvt than the background rate in the general population. Inferior vena cava filters duffett 2017 journal of. A 43yearold man with a medical history of multiple deep vein thrombosis and right inferior vena cava ivc filter placement, was evaluated for shortness of breath and venous claudication.
Results forty patients were enrolled, including four with preceding cardiac catheterisation, 18 with central venous saphenous. Regarding this condition, we present the case of a 63yearold man who had repeatedly visited the emergency room suffering from abdominal and back pain and painful lower limb edema. Robust response to nivolumab in patient with renal cell. Anomalies of the inferior vena cava in patients with deep. Ivc aneurysms can present with significant clinical complications such as thrombosis, pulmonary embolism, and bleeding. A case of superior vena cava syndrome caused by colon cancer treated with bevacizumab combination chemotherapy. Of 68 consecutive patients considered, 18 with cavographically proved inferior vena cava thrombosis and 45 with phlebographyproved noncaval. Vena cava thrombosis occurred within a followup rangeof9to818days,withamediantimetothrombosisof 30. Inferior vena cava thrombosis is an underrecognized entity associated with significant morbidity and mortality. Hypercoagulability related to haematological or neoplastic abnormalities, venous stasis secondary to extraluminal pressure from tumours or inflammatory processes and vessel injury due to trauma have all been implicated as primary mechanisms in the.
Inferior vena caval thrombosis radiology reference article. Pdf mr imaging in inferior vena cava thrombosis esther. In the case of known or suspected pulmonary embolism, a cabin altitude restriction should be considered to mitigate the. An oscillating thrombus inside the inferior vena cava the. In absence of a congenital anomaly, the most common cause of ivc thrombosis is the presence of an unretrieved ivc. Reconstruction of the iliocaval venous confluence using. Thrombosis of the inferior vena cava and hepatic veins buddchiari syndrome. Evaluation revealed left renal cell carcinoma, with inferior vena cava tumour thrombus invasion. Jun 18, 2019 if the address matches an existing account you will receive an email with instructions to reset your password. If you suddenly feel pain on your leg when walking, or if you notice a reddishbruiselike spot on your calf, then you should be careful because that could be the symptoms of deep vein thrombosis. Neonatal renal and inferior vena cava thrombosis associated with. Inferior vena cava filters are implanted scaffolds, usually selfexpanding nitinol, designed to entrap migratory venous thromboemboli. Anomalies of the inferior vena cava in patients with iliac. Inferior vena cava thrombosis abstract thrombosis of the inferior vena cava ivc is an underrecognized entity that is associated with signi.
Presentation and management of inferior vena cava thrombosis. We performed a focused bedside emergency department ultrasound scan figure 1 to exclude an abdominal aortic aneurysm. Congenital absence of inferior vena cava the lancet. Etiology and treatment of acute inferior vena cava thrombosis. Patients with both an anomaly and thrombosis may be at higher risk for thrombotic recurrence. Jan 01, 2002 sonography, venography, or both to diagnose deep venous thrombosis. On the right, the gonadal veins and suprarenal veins drain into the inferior vena cava directly. Dvt deep vein thrombosis ivc inferior vena cava pe pulmonary embolism vcf vena cava filter vte venous thromboembolism mechanism of action.
Renal malakoplakia, which is a chronic inflammatory process, generally confined to the urinary tract collecting system, is a rare cause of rvt 4. Facial swelling and shortness of breath are not always an. The prevention of deep venous thrombosis inferior vena cava filter cpg id. Nagashima m, otani t, kojima k, obitsu y, suda y, ishii k. Inferior vena cava filters remain the only treatment option for patients with an acute within 24 weeks proximal deep vein thrombosis dvt or pulmonary embolism and an absolute contraindication to anticoagulation. Inferior vena cava ivc thrombosis is related to the pathological and clinical spectrum of deep venous thrombosis dvt. Caval penetration by inferior vena cava filters circulation. Inferior vena cava ivc filters have been available for over 20 yrs. Anomalies of the inferior vena cava in patients with iliac venous thrombosis. Symptomatic proximal deep venous thrombosis extending to the inferior vena cava after arthroscopic meniscectomy. Their effectiveness and safety profile is well established. Aneurysm of the inferior vena cava with thrombosis inoue. Although the condition is considered rare, case reports have.
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