Ligation of inferior vena cava for septic thrombophlebitis

A case is presented wherein an old retropelvic infection became active with the organism aerobacter cloacae and continued to cause a septic iliofemoral thrombophlebitis of the right side. This was temporarily controlled by streptomycin but the organism rapidly developed a resistance to the drug. The septic thrombophlebitis suddenly spread to the left iliofemoral system and the inferior vena cava was ligated in an attempt to control the septicemia. On the sixth postoperative day the patient developed a suppurative meningitis with the same organism and died two days later.Following ligation of the inferior vena cava there was moderate edema of both thighs, particularly the left and of the back up to the shoulder blades which reached its maximum degree on the third day and subsided to practically normal by the eighth day.Streptomycin when first administered was effective in inhibiting the growth of aerobacter cloacae but rapidly lost its value. In vitro tests showed: first day, 0.5 micrograms of streptomycin per cc. of agar inhibited growth; eleventh day, 3.0 micrograms per cc. agar inhibited growth; twenty-fifth day, 40.0 micrograms per cc. agar inhibited growth, and thirty-third day, 500.0 micrograms per cc. agar inhibited growth.     

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.     

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.     

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.     

Injuries of the inferior vena cava

The treatment of 77 patients with wounds of the inferior vena cava admitted to Grady Hospital, Atlanta, Georgia, from January 1972 through December 1983, was reviewed. All injuries were identified by laporotomy and/or thoracotomy. Trauma resulted from gunshot wounds in 79 per cent of patients, stab wounds in 18 per cent, and blunt trauma in 3 per cent, with an overall mortality of 30 per cent. The chief determinates of survival were preoperative hypotension, location of the injury and the presence of other major vascular injuries. Of the 49 patients admitted in shock, 22 (45%) died, all of complications related to organ ischemia. Only one patient not hypotensive on admission succumbed. Of the 29 patients with at least one additional injury to a major vascular structure, 45 per cent died. The mortality of infrarenal and suprarenal injuries was relatively low (22% and 33% respectively), compared with retrohepatic and supradiaphragmatic injuries, both of which were fatal in 67 per cent of the cases. Despite advances in the care of the trauma patient, significant improvement in survival has not occurred, and the patient mortality has remained at 30 per cent.     

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.