Duplicate inferior vena cava complicating the evaluation of primary aldosteronism

Abstract

A 64-year-old man with a known duplicate inferior vena cava (D-IVC) and resistant hypertension presented to our emergency department in a hypertensive crisis. He had a longstanding history of hypertension and unexplained hypokalemia treated with oral potassium supplementation. The patient was diagnosed with primary aldosteronism and MRI of the abdomen revealed a left-sided adrenal adenoma. Adrenal venous sampling (AVS) lateralised aldosterone hypersecretion to the left adrenal gland. The patient subsequently underwent an uncomplicated laparoscopic left adrenalectomy. The patient’s postoperative course was uneventful, and he was discharged on a single antihypertensive medication on postoperative day 1. D-IVC is one of several rare IVC anatomical variants that have been well described in the literature. Knowledge of this patient’s unique abdominal venous anatomy enabled successful AVS and appropriate surgical management. It is necessary to identify potential anatomical variants of abdominal venous anatomy that may complicate these invasive procedures.

Double inferior vena cava‐an important anatomical variant in retroperitoneal surgery

“…Iliac venous inflows into the duplicated system may be isolated to each respective side or may join at the inferior origin of the duplicated IVC. 2,3 On the one hand, according to Chen et al, our case is a type two duplication that represents the 20.2% of double inferior vena cava. 4 On the other hand, Natsis et al describe our case as a type two in terms of thickness in both duplicated infrarenal vena cava.…”

“…When a duplicated IVC is present, the left moiety drains into left renal vein, which in turn usually joins with the right IVC, leading to the normal suprarenal anatomy. Iliac venous inflows into the duplicated system may be isolated to each respective side or may join at the inferior origin of the duplicated IVC 2,3 . On the one hand, according to Chen et al ., our case is a type two duplication that represents the 20.2% of double inferior vena cava 4 .…”