Anomalies of the inferior vena cava and renal veins and implications for renal surgery

Abstract

Abnormalities of the inferior vena cava (IVC) and renal veins are extremely rare. However, with the increasing use of computed tomography (CT), these anomalies are more frequently diagnosed. The majority of venous anomalies are asymptomatic and they include left sided IVC, duplicated IVC, absent IVC as well as retro-aortic and circumaortic renal veins. The embryological development of the IVC is complex and involves the development and regression of three sets of paired veins. During renal surgery, undiagnosed venous anomalies may lead to major complications. There may be significant hemorrhage or damage to vascular structures. In addition, aberrant vessels may be mistaken for lymphadenopathy and may be biopsied. In this review we discuss the embryology of the IVC and the possible anomalies of IVC and its tributaries paying particular attention to diagnosis and implications for renal surgery.

A newborn infant with intrathoracic mass: Answers

“…In most cases, the adrenal gland remains at its normal location in the abdomen. CIKs are usually asymptomatic and functionally normal [7,8,11]. The size and structure of the thoracic right kidney of our patient were also normal.…”

“…Although isolated absence of IVC is asymptomatic, in rare cases it may manifest itself symptomatically through chronic venous obstruction, with heaviness, cramps, edema or associated dermal changes, such as leg ulceration [10,11]. Followup of our patient as an outpatient continues, and no need for any medical or surgical approach has arisen up to the last visit.…”

Congenital Vitelline Band Causing Intestinal Obstruction in an Adult with a Double Inferior Vena Cava

“…It is also important to inform the referring surgeon regarding this anomaly to avoid catastrophic complications during surgery [10]. Although double IVC is known to be associated with a range of genitourinary abnormalities including horseshoe kidney, crossed fused ectopia, cloacal exstrophy, and retroaortic renal vein, none of these anomalies were seen in our patient [11].…”

Double inferior vena cava with three shunts: a rare anomaly with important implications for surgeons

“…The potential for misdiagnosis on imaging may occur, leading to unnecessary treatment [2]. The surgeons should be aware of such variation of the IVC when performing surgical procedures in retroperitoneal region such as laparoscopic nephrectomy or donor nephrectomy [6,20]. When attempting cava filtration, DIVC patient may require placement of a caval filter into each vessel in order to avoid the embolism [5].…”

“…DIVC is also a risk factor for formation of thrombosis back pain and anomalous circulation of blood to the heart as a consequence of changes in blood flow [21]. In addition, the DIVC can increase a risk of vascular injury during retroperitoneal procedures leading to life-threatening [6,9]. Therefore, this asymptomatic anomaly has to be known prior to precede any abdominal surgery and sufficient preoperative planning is required to avoid an unexpected iatrogenic complication during the operation.…”