Placement of Dual Bird's Nest Filters in an Unusual Case of Duplicated Inferior Vena Cava

Soltes, George D.; Fisher, Richard G.; Whigham, Cliff J.

doi:10.1016/s1051-0443(92)72932-7

Cited by 19 publications

(7 citation statements)

References 9 publications

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“…Thus, more than one filter may be required as previously reported. [7][8][9] In our patient, the right IVC was too small to implant the filter. Therefore, we placed one filter in the suprarenal portion, after the confluence of two IVC, to prevent fatal PE.…”

Section: )mentioning

confidence: 84%

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

et al. 2004

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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

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Section: )mentioning

confidence: 84%

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

et al. 2004

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“… 14 , 15 The majority of the literature regarding management of DVT in the presence of aberrant IVC anatomy focuses on decreasing the risk of pulmonary embolism with caval interruption. 8 – 11 In addition, the importance of preoperative cross-sectional imaging in the planning of open abdominal aortic aneurysm repair or retroperitoneal dissections cannot be understated. The presence of retro-aortic renal veins has been cited in the literature to complicate retroperitoneal dissections and aortic aneurysm repairs sometimes leading to significant hemorrhage.…”

Section: Discussionmentioning

confidence: 99%

“…5,6 If venous thrombosis occurs, management strategy involves treatment of the early and late consequences of venous thrombosis, and protection from pulmonary embolism. Strategies to decrease the risk of venous thromboembolism (VTE) in this unique population include anticoagulation alone, 7 anticoagulation with IVC filter placement, [8][9][10][11] and steel coil embolization of duplicated IVC. 8,12 Most recently, pharmacomechanical thrombectomy with thrombolysis has been used to treat thrombosis of a duplicated IVC, but only short-term follow-up is available.…”

Section: Introductionmentioning

confidence: 99%

Angiojet thrombolysis and vena cava filter insertion in a case of a duplicated inferior vena cava

Blackwood

Hsu

2015

SAGE Open Medical Case Reports

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Objectives:Duplication of the inferior vena cava (IVC) complicates interventional procedures. This case report aims to shed light on this unusual anomaly and the preoperative considerations necessary when treatment of venous thromboembolism is undertaken.Methods:An IRB approved case report of a 58 year old woman presented emergently with right lower extremity phlegmasia due to extensive thrombosis of her right iliofemoral and infrarenal portion of her duplicated IVC.Results:The patient underwent IVC filter placement and rheolytic thrombectomy with thrombolysis using the Angiojet device followed by venoplasty and stenting of the iliofemoral system and right IVC. Complete symptomatic and radiographic resolution on duplex imaging was achieved at 1 year follow up.Conclusions:With adequate preoperative awareness of IVC anomalies and treatment options available satisfactory results can be achieved and complications minimized for this unique patient population.

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“…During their ascent from the pelvis, the kidneys drain their blood through a network of anastomotic channels between the paired subcardinal and supracardinal systems. Later, these vessels recede to form a vascular ring around the aorta connecting the left kidney to the IVC, and the retroaortic component usually regresses leaving paired single renal veins (Giordano and Trout, 1986;Larsen, 1997;McClure and Butler, 1925;Shingleton et al, 1994;Soltes et al, 1992).…”

Section: Embryologymentioning

confidence: 99%

“…Inferior vena cavography may delineate the venous anatomy prior to IVC filter placement or interruption in patients with recurrent pulmonary emboli. For the demonstration of detailed anatomy, including accessory conduits for thromboemboli, bilateral injection of contrast has been recommended (Putnam et al, 1999;Reinus and Gutierrez, 1986;Soltes et al, 1992). Inferior vena cava duplication is not a component of any commonly recognized syndromes, although some authors favor screening for associated renal anomalies when diagnosed (Senecail et al, 1987).…”

Section: Clinical Implications Imagingmentioning

confidence: 99%

Approach to the educational opportunities provided by variant anatomy, illustrated by discussion of a duplicated inferior vena cava

2002

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Variant anatomy recognized during routine cadaveric dissection in the first year of medical school offers great learning potential by allowing students to gain enhanced understanding of an array of important subjects. It provides a framework for reviewing common morphology and embryogenesis of the structure in question, and through the help of appropriate faculty, yields insight into the potential medical, radiologic, and surgical implications. The frequency of clinically important anatomic variation is high enough to allow the gross anatomy laboratory to serve as an excellent teaching platform in this regard. Through anatomy, the student is introduced to the concept of patient individuality, and to the individualization of medical and surgical therapies. Recently, one of the variations encountered in our lab was a duplicated inferior vena cava. We describe our approach to such findings through a systematic discussion of the anatomy and embryology, as well as the radiologic and clinical correlates.

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Placement of Dual Bird's Nest Filters in an Unusual Case of Duplicated Inferior Vena Cava

Cited by 19 publications

References 9 publications

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

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

Angiojet thrombolysis and vena cava filter insertion in a case of a duplicated inferior vena cava

Approach to the educational opportunities provided by variant anatomy, illustrated by discussion of a duplicated inferior vena cava

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