Leg Ulceration in Chronic Venous Insufficiency Caused by an Absent Inferior Vena Cava

Abstract

We report here the case of a 55-year-old Japanese man with a one-year history of multiple ulcers on the left crural region. He had had pronounced varicose veins on both legs and the abdominal region for 35 years. Computed tomography images of the thoracic and abdominal regions showed the absence of an inferior vena cava, with pronounced dilatation of paravertebral venous plexus, cutaneous and azygous veins. Conservative topical treatments led to complete healing of the ulcers in one month. An absent inferior vena cava is an uncommon abnormality, often complicated by cardiac and other visceral malformations. It is a rare cause of chronic leg ulcers.

Lower limb ulcers due to an absent inferior vena cava

“… 1 , 2 Patients with chronic obstruction of the IVC usually present with DVT or recurrent nonhealing venous leg ulcers. 2 , 5 , 6 The age at presentation is variable. The cause of ulceration due to chronic obstruction of the IVC is increased venous pressure, leading to the development of collateral circulation in the lower limbs and abdominal wall.…”

“…Although it has been suggested that the absence of the IVC may be a developmental defect, it is difficult to determine what might satisfactorily account for this anomaly. 6 It has also been suggested that the absence of the subrenal IVC may result from intrauterine or perinatal IVC thrombosis and may not be a developmental disorder. 7 Some adolescents with DVT and absent IVC have a history of perinatal IVC thrombosis.…”

“…Conservative treatment may relieve symptoms and prevent recurrent thrombosis. 6 A venous bypass graft from the common iliac vein to the azygos vein can be considered for prevention of DVT, or if conservative treatment fails to heal the ulcers. 6 In our patient, the ulcer disappeared after treatment with topical ointment and compression dressings.…”

Inferior vena cava anomaly: A risk for deep vein thrombosis

“…Venous bypass graft from the common iliac vein to the azygous vein is considered to prevent DVT or if conservative treatments fails to heal the ulcers. [ 7 ]…”

Cauda equina syndrome secondary to an absent inferior vena cava managed with surgical decompression

“…Varicose veins secondary to venous insufficiency in the setting of absent IVC has been described previously. 1,8 Although these findings might represent the natural progression of the patient's chronic venous insufficiency and that they were not present prior to surgery, one possible explanation is a compensatory mechanism in the setting of further diminished venous return after coagulation of the patient's dilated epidural veins.…”