Case Report: Inferior Vena Cava Agenesia in a Young Male Patient Presenting With Bilateral Iliac Veins Thrombosis

Abstract

IntroductionAnomalies in inferior vena cava represent an uncommon finding with a prevalence of 0. 3 to 0.5% among healthy patients. Specifically, the condition characterized by the agenesis of the inferior vena cava (IVC; AIVC) has been observed among the 0.0005 to 1% of the general population. AIVC is strongly related to deep vein thrombosis (DVT) of the lower limb and pelvic district, especially in young patients. The rarity of the presented condition could relate to an underestimation of its impact on a particular clinical setting leading to a delayed diagnosis and inaccurate early- and long-term management.ReportWe presented a case of this anomaly regarding a 31-year-old man presenting with bilateral symptomatic proximal DVT. Duplex vascular ultrasound and subsequent CT-angiography revealed the complete occlusion of the right external and common iliac vein, as well as partial occlusion of the contralateral external iliac vein, in the patient. The exam also revealed the interruption of IVC in its infrarenal part. At the level of renal veins coalescence, IVC appeared again in its usual position. A dilatated portal system, hepatic veins, and azygos and hemiazygos systems were also highlighted. Anticoagulation was promptly started with the administration of Fondaparinux (7.5 mg/die). In addition, compression stocking was initiated within 24 h from diagnosis. After 3 weeks, the anticoagulation regimen was shifted toward the administration of a direct oral anticoagulant (Apixaban; 5 mg two times a day). At 1-month follow-up, a vascular duplex ultrasound revealed a complete resolution of the iliac veins' thrombosis.ConclusionIt is important to consider the eventuality of IVC anomalies in a young adult presenting with unexplained, extensive, or bilateral DVT. Accurate diagnostic evaluation is necessary to fully identify this condition that could represent a real challenge.

Agenesis of the Intrahepatic Inferior Vena Cava: A Case Report and Literature Review

“…While catheter-directed thrombolysis has been associated with rapid relief of symptoms and reduction of thrombus burden, this approach may be challenging due to the difficult vascular anatomy [ 19 ]. Furthermore, performing thrombolytic therapy in this chronically obstructed vascular condition may increase the risk of DVT recurrence [ 20 ]. Open surgical reconstruction may be considered a possible therapeutic approach in patients with chronic venous insufficiency [ 21 ].…”

Infrarenal inferior vena cava agenesis presenting as acute abdomen and hydronephrosis – case report

“…As mentioned above, the pelvic and lower extremity DVT risk is elevated (10-fold increase) due to often insufficiently developed collateral pathways, leading to inadequate venous return, venous hypertension, and venous stasis [6 , 15 , 18] . About 5% of people under 30 with DVT have this condition [5 , 8 , 9 , 14 , 19] . Symptoms may develop after rigorous physical activity, typically as lower back or abdominal pain due to lumbar vein thrombosis or lower extremity pain, swelling, and erythema due to DVT [4 , 8 , 14 , 20] .…”

“…Unfortunately, it is often challenging to visualize VCI due to overlaying structures and bowel gas. Therefore, CT or MRI angiography is done because these modalities have much higher sensitivity and can easily show the exact anatomy of the collateral network [3 , 8 , 9 , 13 , 19 , 21] . In addition, genetic testing for thrombophilia and searching for other causes of hypercoagulability, such as prolonged immobilization, recent trauma, surgery, or vascular catheterization, are highly recommended [8] .…”