Bilateral Inferior Vena Cava With Azygos Continuation but Without Congenital Heart Disease Complicates Routine Venous Cannulation for Cardiopulmonary Bypass in an Adult

Abstract

Attempted venous cannulation with a dual-stage cannula for cardiopulmonary bypass in routine coronary revascularization led to the discovery of an abnormal inferior vena cava in a 65-year-old patient. The operative and postoperative course of the patient were not affected by the inferior caval anomaly. The detailed infradiaphragmatic venous anatomy was elucidated later by MRI and showed bilateral inferior caval veins with azygos continuation. Although this malformation of the inferior cava is rare in adults, the occurrence should be known. Quick recognition and handling should be achieved if detected during cannulation for cardiopulmonary bypass.

Re: Duplicated IVC with Normal-Appearing Right IVC and Azygos Continuation of the Left IVC

“…Instead it receives the left renal vein and, more superiorly, crosses the midline dorsal to the aorta, continuing on to join the azygos vein. Although duplication of the IVC with azygos continuation of the IVC [5], and with the azygos and hemiazygos continuation has been reported [3,6], we could not find a description in the radiologic literature of the combination of such with an uninterrupted right IVC. Recognition and reporting of developmental alterations in IVC anatomy are important for pulmonary angiography, IVC filter placement, potential kidney donors, cardiac catheterization, and some surgical procedures, especially aortic aneurysm repair.…”

Uncommon Celiac Trunk Variations in Association with Other Vascular Anomalies-Two Case Reports

“…The presence of this variation can complicates the procedure for cardiopulmonary bypass, since the lack of a solid IVC trunk can make difficult to establishing cannula [11]. Ectatic azygos-hemiazygos system may be misdiagnosed as mediastinal, retrocrural and retroperitoneal adenopathies [12].…”

Infrahepatic caudal/inferior vena cava interruption with azygos/hemiazygos continuation. Vascular anomaly in swine

“…The absence of CVC/IVC may lead to procedural difficulties during femoral vein catheter advancement9, IVC filter placement18, temporary pacing through the transfemoral route1, electrophysiology studies19,20, and cardiopulmonary bypass surgery 21. Awareness of the existence of these anomalies before femoral vein catheter advancement or other procedure through femoral vein would avoid unnecessary injury or undue delay.…”