A Ruptured Abdominal Aortic Aneurysm with a Left-sided Inferior Vena Cava

Abstract

An 81 year-old man had persistent lumbar pain, abdominal pain, and abdominal distension for a week was acutely admitted to our hospital. An enhanced computed tomography scan showed a ruptured infrarenal abdominal aortic aneurysm and a left-sided inferior vena cava. We successfully performed emergency abdominal aortic reconstruction, though we needed temporary abdominal closure with a vinyl sheet for 3 days for fear of abdominal compartment syndrome. He recovered uneventfully and was discharged 27 days after surgery. Left sided inferior vena cava is a rare anomaly of the inferior vena cava and we review the relevant literature here.

Circumaortic left renal vein (circumaortic renal collar) associated with the presence of vascular anomalies: a case series and review of literature

“…Lee et al [13] described a case of double left renal veins in the form of a venous collar in a 15-year-old girl who presented with intermittent haematuria. Nishibe et al [18] described the combination of abdominal aortic aneurysms and congenital anomalies of the IVC and its tributaries such as double IVC, left-sided IVC, circumaortic renal collar and retroaortic renal vein. In our case no.…”

Cattell-Braasch Maneuver: A Gadget to Manipulate Abdominal Aortic Aneurysm in a Patient with a Left-Sided Inferior Vena Cava

“…Conversely, if we approach the AAA neck from the left of the Treitz ligament, as is often performed in cases of normal anatomy, the root of the mesentery and the crossing point of the LIVC would become obstacles to dissecting the AAA neck. We searched the literature for studies pertaining to AAA with LIVC, which described (or the author directly answered) the approach to the aneurysm; there was no restriction with regard to the date of publication (Table 1) [4][5][6][7][8][9][10][11][12]. We reviewed 9 case reports describing 10 open surgeries.…”

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

“…Holt et al (2007) suggested that IVC malformations may be part of a spectrum of retroperitoneal developmental anomalies that includes testicular descent and germ cell dysplasia. Although nine case reports identified an association between a left-sided IVC and AAA (Tsukamoto et al, 2000;Rispoli et al, 2001;Nishimoto et al, 2002;Papavassiliou et al, 2003;Giglia and Thompson, 2004;Nishibe et al, 2004;Evers et al, 2007;De Franciscis et al, 2008;Radermecker et al, 2008;Marin-Manzano et al, 2009), this probably reflects both publication bias and the fact that patients with an AAA routinely undergo abdominal CT imaging, thereby facilitating the discovery of any IVC anomaly. While the prevalence of left-sided IVC appears to be increased in some series of AAA patients (Hingorani and Ascher, 2003), the anomaly does not feature in other large series (Kaplan et al, 1999), suggesting that the two conditions are not genuinely linked.…”

“…Technical difficulties during abdominal surgery, particularly retroperitoneal surgery. The abnormal position of the IVC and/or its association with supernumerary renal veins and anomalous tributaries (Ito et al, 2007;Byler et al, 2009) complicate dissection and increase the risk of hemorrhage (Aljabri et al, 2001;Nishibe et al, 2004;Kumar et al, 2008). A transperitoneal rather than a retroperitoneal approach to the abdominal aorta and kidneys has been recommended in patients with a duplicate IVC to enable better visualization and control of aberrant vessels (Radermecker et al, 2008).…”

“…Although these anomalies are rare and frequently asymptomatic, they are clinically significant as they may be misinterpreted as lymphadenopathy on imaging (Evans et al, 2001;Castillo et al, 2008), cause bleeding during abdominal surgery (Nishibe et al, 2004), and predispose to venous thrombosis (Moubarak et al, 2009). This review describes the anatomy, demographics, associated conditions, imaging, and clinical implications of two major infe-rior vena caval anomalies, isolated left-sided and duplicate IVC.…”