“Marsupial cava” and ruptured abdominal aortic aneurysm

Abstract

A patient with a ruptured abdominal aortic aneurysm underwent an emergency operation. A rare anomaly of inferior vena cava, known as "marsupial cava," was found. The iliac vein confluence crossed anteriorly (rather then posteriorly) the right common iliac artery. Even though the patient had undergone a computed tomography scan, this rare anomaly had not been detected and therefore was unexpected by the surgeon. The aim of this report is to describe the technical details required to perform the aortic reconstruction and to stress the importance of routine computed tomography scans and their careful reading in the case of stable patients before retroperitoneal operation. This is, to our knowledge, the first report of an aortic prosthetic grafting for ruptured aortic aneurysm in association with a marsupial cava.

Embryological Aspects and Anatomical Variations of the Inferior Vena Cava – Its Importance in Gynecologic Oncology Surgery

“…However, Rocha concluded that marsupial IVC could not be as rare as previously thought because authors observed four cases of IVC during a period of two years [41]. Case reports associated with vascular surgery have described most cases of this anomaly [38,42,43]. Generally, the anomaly is asymptotic and unrelated to abnormal venous drainage from the lower venous parts of the body [38].…”

The Importance of Venous and Renal Anomalies for Surgical Repair of Abdominal Aortic Aneurysms

“…4A) (Shindo et al, 1999). Because such an anterior position of IVC is typical in most marsupials, as stated by McClure and Huntington in 1929, compared with the posterior position present in placental mammalians, it is used the term "marsupial cava" (Schiavetta et al, 1998).…”

“…With a careful blunt dissection of the right common iliac artery bifurcation, it is possible to gain distal control without mobilizing the caval confluence, which results strictly adherent to aorta. On the contrary, this anomaly is very troublesome if the distal aorta and right common iliac artery are approached retroperitoneally from the patient's right side (Schiavetta et al, 1998). During emergency surgery, the priority of gaining quick control of the aorta and the iliac arteries through the retroperitoneal hematoma may lead to injury to major venous structures, excessive hemorrhage, and subsequent death.…”

Diagnosis, Screening and Treatment of Abdominal, Thoracoabdominal and Thoracic Aortic Aneurysms

“…With a careful blunt dissection of the right common iliac artery bifurcation, it is possible to gain distal control without mobilizing the caval confluence, which results strictly adherent to aorta. On the contrary, this anomaly is very troublesome if the distal aorta and right common iliac artery are approached retroperitoneally from the patient's right side (Schiavetta et al, 1998).…”