Inferior Vena Cava Agenesis: An Unusual Cause of Deep Vein Thrombosis and Pulmonary Embolism in Young Adult Patients

Abstract

IntroductionInferior vena cava agenesis (IVCA) is one of the many anomalies of this vessel. It is one of the most uncommon anomalies, with an estimated prevalence of 0.0005–1% in the general population. Around 5% of the patients younger than 30 years with a diagnosis of deep vein thrombosis (DVT) have a total or segmental IVCA.ReportHere two unique cases of young and previously healthy male patients are reported: one with bilateral lower extremity DVT, the second with lower extremity DVT and pulmonary embolism. Both patients were found to have segmental agenesis of the inferior vena cava on computed tomography angiography (CTA). Treatment consisted of ultrasound enhanced thrombolysis (EKOS + alteplase) and venous angioplasty. Both patients were discharged with long-term (up to 24 months) oral anticoagulation and compression stockings. Follow up at 3 and 12 months revealed no new thrombotic episode.DiscussionIVCA can be asymptomatic but the majority of the symptomatic patients present with DVT. IVCA confers a risk factor for DVT. IVCA should be considered and ruled out as a rare but important risk factor and cause of DVT in previously young healthy patients. Once diagnosed, aggressive treatment must be started because of the high risk of post-thrombotic syndrome.

Thrombolysis for deep venous thrombosis associated with inferior vena cava agenesis in a young patient

“…CT and MRI are the best imaging methods to diagnose IVC anomalies 5 6. At the time of diagnosis, treatment should be instituted immediately due to the high risk of PTS 7. In our case, IVC agenesis was diagnosed with CT performed shortly after the patient’s arrival to the hospital.…”

Bilateral proximal deep vein thrombosis and COVID‐19 in a patient with absence of inferior vena cava: A case report and review of literature

“…These methods typically involve the reconstruction of the absent segments with synthetic bypass grafts. The result is venous decompression and symptom relief 28–31 . Since the index DVT happened 1.5 months and it was unlikely that CDT would be of benefit for him, we decided against it.…”

“…The result is venous decompression and symptom relief. 28 , 29 , 30 , 31 Since the index DVT happened 1.5 months and it was unlikely that CDT would be of benefit for him, we decided against it.…”

A Common Manifestation With an Uncommon Diagnosis: Intractable Deep Vein Thrombosis due to IVC Agenesis in a Young Woman

“…The extensive collateral development reduces the risk of pulmonary embolism in these patients but it is still probable. 8 On the other hand, PTS, a syndrome of chronic venous insufficiency due to valvular incompetence associated with an inflammatory response, is characterized with chronic venous reflux and chronic venous hypertension with varicose veins, limb swelling, pain, discoloration, and in severe cases, venous ulcerations is a frequent and disabling complication of DVTs. It is particularly more frequent and severe in patients with proximal iliofemoral, recurrent, and anatomically extensive ipsilateral DVTs, as in cases with IVCA.…”