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Anomalies of the Inferior Vena Cava in Patients with Iliac Venous Thrombosis

Andrea Obernosterer, MD; Manuela Aschauer, MD; Wolfgang Schnedl, MD; and Rainer W. Lipp, MD
[+] Article and Author Information

From the Karl-Franzens University, Graz, Austria.


Acknowledgment: The authors thank Professor Emeritus Dr. Walther W. Lipp for his advice and critical review of the manuscript.

Requests for Single Reprints: Andrea Obernosterer, MD, Division of Angiology, Department of Internal Medicine, Karl-Franzens University, Auenbruggerplatz 15, 8036 Graz, Austria; e-mail, andrea.obernosterer@kfunigraz.ac.at.

Current Author Addresses: Dr. Obernosterer: Division of Angiology, Department of Internal Medicine, Karl-Franzens University, Auenbruggerplatz 15, 8036 Graz, Austria.

Dr. Aschauer: Magnetic Resonance Institute, Department of Radiology, Karl-Franzens University, Auenbruggerplatz 9, 8036 Graz, Austria.

Dr. Schnedl: Department of Internal Medicine, Karl-Franzens University, Auenbruggerplatz 15, 8036 Graz, Austria.

Dr. Lipp: Division of Nuclear Medicine, Department of Internal Medicine, Karl-Franzens University, Auenbruggerplatz 15, 8036 Graz, Austria.

Author Contributions: Conception and design: A. Obernosterer, R.W. Lipp.

Analysis and interpretation of the data: A. Obernosterer, M. Aschauer, R.W. Lipp.

Drafting of the article: A. Obernosterer.

Critical revision of the article for important intellectual content: A. Obernosterer, W. Schnedl, R.W. Lipp.

Final approval of the article: A. Obernosterer, R.W. Lipp.

Provision of study materials or patients: A. Obernosterer, M. Aschauer.

Statistical expertise: W. Schnedl.

Administrative, technical, or logistic support: A. Obernosterer, M. Aschauer, W. Schnedl, R.W. Lipp.

Collection and assembly of data: A. Obernosterer.


Ann Intern Med. 2002;136(1):37-41. doi:10.7326/0003-4819-136-1-200201010-00009
Text Size: A A A

Background: Cases of deep venous thrombosis in the lower extremities triggered by abnormalities of the vena cava have been reported.

Objective: To describe anomalies of the inferior vena cava in patients with deep venous thrombosis.

Design: Prospective, consecutive case series.

Setting: University Hospital, Graz, Austria.

Patients: 97 patients with deep venous thrombosis.

Intervention: Sonography, venography, or both to diagnose deep venous thrombosis; magnetic resonance angiography to image the inferior vena cava.

Measurements: Anomalies of the inferior vena cava imaged by magnetic resonance angiography.

Results: 31 of 97 patients showed thrombotic occlusion of iliac veins (common and external iliac vein [n = 29] or external iliac vein [n = 2]). Five of 31 patients (3 men, 2 women) had an anomaly of the inferior vena cava. Anomalies were missing inferior vena cava, hypoplastic hepatic segment, and missing renal or postrenal segments. Patients with anomalies were significantly younger than the 92 patients without (mean age±SD, 25±6 years vs. 53±19 years; P = 0.002). In 2 patients with anomalies, the thrombotic occlusion was recurrent.

Conclusions: 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. Patients with both an anomaly and thrombosis may be at higher risk for thrombotic recurrence.

Figures

Grahic Jump Location
Figure.
Single slices of abdominal, gadolinium-enhanced magnetic resonance angiograms demonstrating anomalies of the inferior vena cava (IVC) in patient 1 (top) and patient 2 (bottom).RVCsRHVRAHAVPVCsLRV

In patient 1, the IVC is missing. Tortuous renal venous collaterals ( ) collect the venous blood return from both patent renal veins and drain into the azygous vein (not visible), which is enlarged to compensate for the anomaly. The right hepatic vein ( ) enters directly into the right atrium ( ). In patient 2, the hepatic segment of the IVC is tiny and hypoplastic. The hemiazygous vein ( ), which is enlarged to compensate for the anomaly, collects the venous blood return from markedly dilated paravertebral venous collaterals ( ). The renal segment of the IVC is missing, and the left renal vein ( ) drains to paravertebral venous collaterals. AA = abdominal aorta; PV = portal vein; RRV = right renal vein; SV = splenic vein.

Grahic Jump Location

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Summary for Patients

Blood Clots and Abnormal Vessels of the Inferior Vena Cava

The summary below is from the full report titled “Anomalies of the Inferior Vena Cava in Patients with Iliac Venous Thrombosis.” It is in the 1 January 2002 issue of Annals of Internal Medicine (volume 136, pages 37-41). The authors are A Obernosterer, M Aschauer, W Schnedl, and RW Lipp.

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