A Case of Deep Venous Thrombosis With a Double Inferior Vena Cava Effectively Treated by Suprarenal Filter Implantation

Abstract

SUMMARYEmbryogenesis of the inferior vena cava (IVC) is a complex process involving the formation and regression of several anastomoses, thus, various anomalies may occur. We report a case of deep venous thrombosis (DVT) accompanied by a double inferior vena cava (DIVC). A 76-year-old-man was admitted because of right leg edema and pain. Venography revealed two IVC and massive venous thrombus. To avoid massive pulmonary embolism (PE), it was necessary to block both the right and the left IVC. However, the right IVC was too small to implant the filter, so we placed a temporary IVC filter (Antheor filter) in the suprarenal portion of the IVC, after the confluence of the two IVC, and started thrombolytic and anticoagulant therapy. Venography, performed 6 days after filter implantation, showed a considerable amount of remaining thrombus. We replaced the Antheor filter with a Günther retrievable filter because the former has a catheter and is not suited for long-term use, whereas the latter can be used permanently. Two weeks after filter exchange, thrombus had decreased but remained. We therefore did not remove the Günther filter. The patient's symptoms gradually improved in response to anticoagulant therapy, and he was discharged with no complications. The present case illustrates the importance of a correct understanding of anatomy and demonstrates the effectiveness of using a suprarenal IVC filter in DVT. (Jpn Heart J 2004; 45: 1063-1069 Key words: Double inferior vena cava, Deep venous thrombosis, Inferior vena cava filter A double inferior vena cava (DIVC) is a congenital anomaly that commonly results from persistence of the embryonal venous system and occurs in 2% to 3% of the population.1-3) We encountered a case of DIVC accompanied by deep venous thrombosis (DVT), which sometimes brings about fatal pulmonary embolism (PE). A DIVC is rarely associated with DVT. However, the position of the From the

Filter Placement for Duplicated Cava

“…The placement of bilateral IVC filters has been described in several patients. [4][5][6][8][9][10]16,[19][20][21][22][23][24][25] The advantage of this approach is that it protects renal veins and prevents recurrent PE. Currently, new retrievable devices are commercially available making feasible temporary placement of dual filters.…”

Deep venous thrombosis caused by congenital absence of the inferior vena cava: Report of a case

“…5 These anomalies, such as absence of the IVC, hypoplasia of the IVC, double IVC, and left IVC may predispose to venous thrombosis because of resultant venous stasis. [2][3][4][6][7][8][9][10][11][13][14][15][16][17][18][19][20][21][22][23][24][25] However, if there is a deep venous collateral system that drains the blood from the lower extremities to the heart via the azygous and hemiazygous veins, patients without visceral and heart anomalies are usually asymptomatic. In adults, most IVC anomalies are detected incidentally during routine radiologic screening or abdominal surgery.…”

Left‐sided and duplicate inferior vena cava: A case series and review

“…Each IVC usually receives its corresponding suprarenal (Itoh et al, 2001;Sürücü et al, 2001), renal (Fronek et al, 2006), and lumbar veins (Givens, 1912) although the left-sided IVC may drain into the left renal vein rather than directly into the right-sided IVC. One or more cross-communicating veins may be seen between the left and right-sided IVCs (Marrocco-Trischitta et al, 2001;Mano et al, 2004;Murata et al, 2009), but this is not invariable (Siddiqui and Hans, 2008). In the less common variety of duplicate IVC, both vessels are ipsilateral and most often on the right side (Nagashima et al, 2006).…”

“…Gender ratio Japan 14 cases (Takai et al, 2001;Taniguchi et al, 2001;Mano et al, 2004;Nakatani et al, 2004;Nagashima et al, 2006;Ito et al, 2007;Murata et al, 2009) 7M:7F USA 11 cases (Sugimoto et al, 2000;Hama, 2007;Snow et al, 2007;Milani et al, 2008;Nanda et al, 2008;Siddiqui and Hans, 2008;Kennealey et al, 2009;Cheng and Zangan, 2010;Hayden and Klotz, 2011;Kayhan et al, 2011) 7M:4F UK Five cases (Evans et al, 2001;Shaw et al, 2003;Wu et al, 2005;Fronek et al, 2006;Chaturvedi et al, 2007) 4M:1F Turkey Four cases (Tatar et al, 2005;Gocmen et al, 2007;Nevruz et al, 2007;Vurucu et al, 2009) ing is only a brief summary. During the sixth to eighth week of gestation, three symmetrical pairs of veins, the postcardinal, subcardinal, and supracardinal, develop sequentially in the body wall of the lower half of the embryo (Schoenwolf et al, 2009).…”