Background Atresia of the inferior vena cava (IVC) is a congenital anomaly associated with partial or total absence and increases the risk of deep vein thrombosis (DVT) by op to 10 times due to venous stasis.1 Although it occurs in 5% of cases of DVT without risk factors favoring2, a prevalence of 1% of general population is estimated.3 Material and methods We present the cause of a 30-year-old patient, smoker, professional truck driver, who addresses the ED for pain, edema and functional impotence in the lower left limb. One month ago, the patient suffered a trauma to the limb, with a closed tibial fracture that required a plaster cast and then orthosis. After two weeks, he has edema in his lower limb, reason why he started antivitamin K (acenocoumarol) therapy. The paraclinical examinations performed revealed an overdose of oral anticoagulants with INR over the therapeutic limit, biological inflammatory syndrome, and vascular ultrasound revealed a deep venous thrombosis in the left ilio-femoral vessel. The investigations also revealed partial atresia of the IVC with collateral circulation and multiple supra- and infra-diaphragmatic shunts, and the iliac veins were drained by collaterals from the azygos / hemiazygos system. Results and conclusions Most patients with IVC atresia remain asymptomatic until the onset of a trigger factor (ex. immobilization of the lower limb) or until the third decade of life. The evolution of symptoms under treatment with parenteral anticoagulants (fondaparinux 7.5 mg) and then oral (apixaban 2×5 mg) was favorable with significant remission of edema.
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