Agenesia de segmento infra-hepático de veia cava inferior associada a trombose venosa profunda de repetição: relato de caso

Abstract

Resumo A agenesia de veia cava inferior é descrita em menos de 1% da população, de ocorrência rara e devido a alterações embrionárias. Sua correlação com a trombose venosa profunda certamente é subestimada, visto que tal alteração é de difícil detecção pela ultrassonografia. O objetivo deste artigo foi relatar o caso de uma paciente de 41 anos com dor e edema até a raiz de coxa direita após cirurgia plástica. Foi realizado dúplex venoso de membros inferiores e evidenciada trombose venosa profunda ilíaco-femoro-poplíteo e distal bilateralmente. Solicitado angiotomografia venosa devido a não visualização de veia cava inferior no ultrassom, evidenciando trombose de plexo lombar direito e segmento ilíaco-femoral bilateral, além de agenesia de segmento infra-hepático de veia cava inferior, com ectasia e tortuosidade compensatória de veias paravertebrais, sistema ázigos e hemiázigos, com varizes pélvicas bilateralmente. Foi realizada anticoagulação sistêmica e oral, com boa evolução clínica.

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

“…The latter is divided based on location into intrahepatic, suprarenal, renal, and infrarenal segment agenesis. Only 6% of all cases are renal or infrarenal variants [1] , [2] , [3] , 5 , 7] . Some authors suggest that agenesis of the infrarenal IVC segment develops because of intrauterine thrombosis rather than a congenital malformation, but there is still no clear evidence for either theory [2] , [3] , [4] , 8 , 9] .…”

“…There should be a high degree of suspicion, and one should examine the abdominal and pelvic venous pool anatomy in young patients presenting with bilateral DVT (50% of all cases), pelvic DVT, recurrent episodes, or idiopathic thrombosis without known risk factors, especially in males (82% of all cases) [7] , [8] , [9] , 13 , 14] .…”

“…It is necessary to think about and search for IVCA and other venous malformations in young people, especially males, presenting with bilateral lower extremity or pelvic DVT and without any known risk factors. Unrecognized preoperatively, such anomalies can lead to profuse and potentially fatal bleeding during surgeries [7] . Adequate medications could reduce the risk of potential recurrent thromboembolic incidents [8 , 9 , 14] , but further research is necessary to determine the best therapeutic strategy, the optimal duration of treatment, and the long-term outcome of such patients.…”

Features of treatment of venous thromboembolism in patients with abnormalities in the development of the vena cava inferior

“…Деякі літературні джерела говорять про двосторонній розвиток тромботичного процесу у венах нижніх кінцівок у пацієнтів з аномаліями розвитку НПВ (так звані білатеральні венозні тромбози) [4,10].…”

Inferior Vena Cava Agenesia Associated with Deep Venous Thrombosis: Case Report

“…DVT is a multifactorial disease, characterized by the acute formation of thrombi in deep veins, associated with factors that promote hypercoagulability, blood stasis and endothelial injury [5]. There is evidence demonstrating that patients with agenesis of the inferior vena cava are more likely to develop DVT in the lower limbs earlier, possibly due to the tendency towards venous stasis in the lower limbs [2,6], in which venous return depends on a system formed by collateral.…”