Double inferior vena cava

Venous anomalies involving the inferior vena cava are very rare. The case of a 74-year-old man with coronary artery disease is presented. Interestingly, a double inferior vena cava was incidentally discovered during coronary artery bypass grafting. Persistence of the left hepatic segment vein appeared as a left inferior vena cava-a very rare condition.     

Anomalies of the inferior vena cava

The inferior vena cava is formed by a complex process of embryogenesis during the sixth to tenth week of gestation. Improper completion of the process may result in four anatomic anomalies: duplication of the inferior vena cava, transposition or left-sided inferior vena cava, retroaortic left renal vein, and circumaortic left renal vein. The first two anomalies can be diagnosed by sonography and all four anomalies can be seen on CT scan of the abdomen. Duplication and transposition of the inferior vena cava should be further delineated by preoperative phlebography. Preoperative diagnosis of the anomalies should reduce the complication rate of abdominal aortic operations.     

Aneurysms of the inferior vena cava

Aneurysms of the inferior vena cava are very rare. We describe a case of a saccular aneurysm of the inferior vena cava that thrombosed after vigorous exercise. This presented as deep venous thrombosis associated with a retroperitoneal mass. Laparotomy with biopsy confirmed the benign nature of this lesion, and symptoms gradually resolved. It is hypothesized that the increased intraabdominal pressure during exercise led to the thrombosis of what is presumed to be a congenital aneurysm of the inferior vena cava.     

Injuries of the inferior vena cava.

Injuries of the IVC, whether caused by blunt or penetrating mechanisms, are usually fatal. Patients who arrive in shock and fail to respond to initial resuscitative measures, those who are still actively bleeding at the time of laparotomy, and those with wounds of the retrohepatic vena cava have a low probability of survival. Death most commonly is caused by intraoperative exsanguination. Knowledge of the anatomy and exposure techniques for the five different segments of the intra-abdominal vena cava is very important to trauma surgeons. Although some wounds of the vena cava, especially those of the retrohepatic vena cava, are best left unexplored, most injuries inferior to this level can be exposed and repaired by lateral suture technique. Preservation of a lumen of at least 25% of normal is probably important in the suprarenal vena cava but is of no provable value inferior to the renal veins. No evidence supports the need to expose and repair vena caval wounds that have spontaneously stopped bleeding. Such wounds, especially in the retrohepatic area, may be managed expectantly provided that there is no strong suspicion of an associated injury to a major artery or hollow viscus.     

Traumatic thrombosis of the inferior vena cava

Traumatic thrombosis of vena cava is rare. Thrombosis of the inferior vena cava diagnosed by uroscanner after blunt abdominal trauma involving the kidney is reported. The Doppler exam confirmed the floating character of the clot. Three days after the initiation of anticoagulant therapy, the thrombus disappeared without any clinical or radiological signs of pulmonary embolism. Fifteen cases of traumatic thrombosis of the inferior vena cava have been described in the literature. Mechanisms, clinical pictures and the management are discussed.     

Complications of inferior vena cava filters

With the introduction of retrievable inferior vena cava filters, the number being placed for protection from pulmonary embolism is steadily increasing. Despite this increased usage, the true incidence of complications associated with inferior vena cava filters is unknown. This article reviews the known complications associated with these filters and suggests recommendations and techniques for inferior vena cava filter removal.     

下腔静脉内平滑肌瘤病诊治分析

目的 总结下腔静脉内平滑肌瘤病的诊治经验.方法 回顾性分析1998年3月至2007年4月收治的8例下腔静脉内平滑肌瘤病患者的临床资料,并随访观察其疗效.结果 8例患者中4例术前经下腔静脉造影同时取活检术前诊断为下腔静脉内平滑肌瘤病.8例患者中有1例拒绝手术治疗,14个月后猝死.接受手术治疗的7例患者术后病理示IVL,其中除1例死于术中大出血,1例术后2年复发外,其余5例无严重并发症,术后随访7～65个月,平均随访29个月,已恢复正常生活.结论 下腔静脉内平滑肌瘤病多源于子宫平滑肌瘤,是一种雌激素依赖性肿瘤.下腔静脉造影的同时取活组织检查是术前诊断下腔静脉内平滑肌瘤病的有效方法.手术切除肿瘤是惟一有效的治疗方法,同时应进行抗雌激素治疗,近期疗效满意.     

Ligation of the inferior vena cava

A case record of recurring pulmonary embolization treated by ligation of the inferior vena cava, ganglonectomy and perivenous sympathectomy is reported.     

Congenital anomalies of the inferior vena cava

Congenital anomalies of the inferior vena cava are a relatively rare pathology, usually with an asymptomatic iter. They are usually diagnosed by chance during surgery on the aorta or retroperitoneal structures. From bioptic material their incidence is estimated to be 2-3% and the percentage of intraoperative findings varies in different series between 0.2 and 0.6%. Of the various kinds of anomaly, caval duplication and a left-positioned vena cava are those most commonly found. The recent report of a case of a malpositioned vena cava and iliac veins prompted us to re-examine the literature and revise our series of cases.     

Leiomyosarcoma of the inferior vena cava]

Leiomyosarcomas of the inferior vena cava are rare and the clinical symptoms unspecific. We report a case of leiomyosarcoma of the inferior vena cava in an 82-year-old woman presenting with weight loss and abdominal pain. Following elaborate preoperative examinations, surgical resection was performed and the inferior vena cava was reconstructed. Clinical signs, diagnosis, therapy, and prognosis are discussed.     

Perinatal inferior vena cava thrombosis and absence of the infrarenal inferior vena cava

We report a case of infrarenal absence of the inferior vena cava (IVC) presenting as a major iliofemoral deep venous thrombosis in an adolescent. This is the first report of infrarenal IVC absence in which IVC thrombosis has been demonstrated in the perinatal period. We propose an association between perinatal IVC thrombosis and subsequent infrarenal IVC absence. In addition, the case demonstrates the importance of assessment for anatomical anomalies in patients presenting with apparently idiopathic deep venous thrombosis.     

Left kidney cancer grossly extending into left-sided inferior vena cava of duplicated inferior vena cava

The left radical nephrectomy with tumor thrombectomy in the presence of a duplicated inferior vena cava is of high surgical risk because the venous tumor thrombus renders the anomalous venous structures dilated and tortuous, making injury more likely. We present a case of a left kidney cancer grossly extending into the left side of a duplicated inferior vena cava. What is more important is to bring such an aberrant vascular anatomy with tumor thrombus to the attention of urologists with high-resolution pictorial illustrations.     

Leiomyosarcoma of inferior vena cava

A case of leiomyosarcoma of the inferior vena cava is presented and pertinent clinical features of 57 reported cases in the English literature are reviewed.     

Developmental anomaly of the inferior vena cava

Despite the many possible modes of presentation, congenital anomalies of the inferior vena cava are increasingly being found in asymptomatic patients. Although plain chest radiography may reveal enough suggestive signs, the diagnosis is usually confirmed by ultrasound, computed tomography and magnetic resonance imaging. The authors present a case of infrarenal absence of the inferior vena cava that presented as a retroperitoneal mass and discuss the embryology and clinical implications of this unusual entity.     

Leiomyosarcoma of the inferior vena cava

Leiomyosarcoma of the inferior vena cava is a rare tumor of mesenchymal origin most commonly found in women. Clinical signs are non-specific. Imagery with ultrasound, CT, or MRI may strongly suggest the diagnosis, but it can only be confirmed by histologic examination of tissue obtained pre or intra-operatively. The tumor is slow growing but nonetheless carries a bad prognosis; it may grow to a large size before directly invading adjacent structures. Systemic spread is a late occurrence. Radical surgical resection is the only treatment which offers any hope for prolonged survival. Standard vascular surgical techniques are usually sufficient. Progress in the techniques of hepatectomy and liver transplantation have allowed the experienced surgeon to undertake the removal of retrohepatic lesions once considered unresectable. High-lying lesions adjacent to the hepatic veins or with thrombus extending into the proximal vena cava may require extracorporeal circulation with or without profound hypothermic circulatory arrest. The efficacy of chemotherapy, whether pre-operative for inaccessible tumors or post-operative for incompletely resected or recurrent tumor, is poorly defined and very limited.     

Dual inferior vena cava: two inferior vena cava filters

The formation of the venous drainage system of the human body is a complex process involving structures forming and regressing in a predefined order. Interruption of any one of these steps results in the formation of a congenital anomaly. Knowledge of these anomalies can prevent us from potential serious and sometimes fatal complications. Variations from the normal anatomy of the inferior vena cava (IVC) occur in 3% of the population. The complex embryology of the IVC stems from three pairs of fetal veins: (1) posterior cardinal veins, (2) subcardinal veins, and (3) supracardinal veins. The cardinal veins constitute the main venous drainage system of the embryo. Although venous anomalies are rare, their knowledge is crucial in diagnosis and treatment. These variations should not be mistaken for pathologic finding, but should be viewed as normal findings of abnormal embryogenesis. We present a case here identifying a dual IVC, subsequently leading us to place two IVC filters.     

Neuroendocrine tumour of the inferior vena cava

Malignant tumours of the inferior vena cava (IVC) are rare. Secondary involvement of the IVC by adjacent retroperitoneal tumours is more common than the occurrence of leiomyosarcomas of the IVC. The authors present a case of a secondary neuroendocrine tumour of the infrarenal vena cava that presented with pulmonary emboli. To their knowledge this presentation has not been reported previously. The tumour was technically resectable and reconstruction of the IVC was not required. No primary tumour was identified. As palliative treatment, an aggressive surgical approach is recommended when the primary tumour is controlled or is not readily identified.     

Obstruction of the inferior vena cava and varicocele

The role of the left spermatic vein as a replacement in cases of obstruction of the inferior vena cava is discussed in connection with a case of varicocele revealing a thrombosis of the inferior vena cava.     

Thrombosis of the inferior vena cava by seminoma

We report a case of metastatic seminoma that caused thrombosis and obstruction of the inferior vena cava. The pathogenesis of this rare clinical entity is discussed. The diagnostic studies for detection of vena caval thrombosis and clinical management strategies are reviewed.