Portal and mesenteric vein and inferior vena cava thrombosis associated with antiphospholipid syndrome

We report a 48-year-old man with thrombosis of the portal and superior mesenteric vein and inferior vena cava associated with primary antiphospholipid syndrome (APS). Primary APS was diagnosed by a positive reaction with anticardiolipin antibody (aCL) and the absence of any evidence suggesting the presence of other disease states known to be associated with aCL. A coeliac angiography showed obstruction of the portal and superior mesenteric vein with prominent collaterals and cavernous transformation. Femoral vein angiography showed total obstruction of the external iliac vein and inferior vena cava, and dilation of the pelvic veins, with contrast medium in the lumbar vein. This case is noteworthy as a report of primary APS accompanied by extensive abdominal and pelvic venous thrombosis.     

Trauma-induced thrombosis of the inferior vena cava

A 25 year old foreign patient, in his native country had a blunt polytrauma of the abdomen and of the thigh. The consequence was a complete thrombosis of the vena cava inferior in a distal position to the junction with the liver veins. The diagnosis was realized with phlebography, angiography and computertomography. The diaphragmatic part of the vena cava inferior and the liver veins were not affected by the thrombosis. The increasing edemas of the shank and a stasis ulcer which were the reason for the patients admission to the hospital could be treated successfully by Furosemid and Phenprocoumon within a period of 4 weeks.     

Urokinase and AT-III concentrate treatment in inferior vena cava thrombosis associated with nephrotic syndrome

A patient with an inferior vena cava thrombosis in nephrotic syndrome was treated with heparin, AT-III concentrates and urokinase. After a few days on treatment he showed a complete resolution of the thrombosis. We suggest that this therapeutic combination may be a good approach to the treatment of thrombosis in nephrotic syndrome.     

Ultrasonic diagnosis of thrombosis of the inferior vena cava

Ultrasonic scanning was used in 115 patients with suspected occlusion of vena cava inferior. Details of ultrasonic diagnosis of non-occlusive and occlusive thrombosis of vena cava inferior and vena cava compression from the outside, monitoring of the thrombosed vena cava and the antiembolic cava filter are discussed.     

Superficial venous thrombosis associated with congenital absence of the inferior vena cava and previous episode of deep venous thrombosis

Congenital malformations of the inferior vena cava (IVC) are uncommon and may be associated with an increased risk of venous thrombosis. We report the case of a man with congenital absence of the IVC and remote history of deep venous thrombosis who now presents with severe abdominal wall superficial thrombophlebitis. To our knowledge, this is the first report of a patient with IVC absence who has developed both deep and superficial venous thromboses.     

Renal vein thrombosis and inferior vena cava thrombosis in systemic lupus erythematosus

Phlebography of the inferior vena cava with selective study of the renal veins was performed in 43 patients with systemic lupus erythematosus (SLE). Inferior vena cava thrombosis (IVCT) or renal vein thrombosis (RVT) was found in 3 of 11 patients (27%) with nephrotic syndrome, in 8 of 13 (61.5%) with previous thrombophlebitis, and in 3 of 4 (75%) with suggestive acute clinical picture. In contrast, none of the 20 control patients with SLE had IVCT or RVT. These results show that SLE patients with thrombophlebitis have a very high risk of developing IVCT or RVT; patients with nephrotic syndrome have a smaller risk. Neither IVCT nor RVT was found in SLE patients without antecedent thrombophlebitis or nephrotic syndrome.     

Combined pharmacomechanical thrombectomy for acute inferior vena cava filter thrombosis

Inferior vena cava (IVC) filter thrombosis has been reported to occur in up to 30% of cases and is associated with significant morbidity. The optimal treatment of IVC thrombosis has not been established to date. We report a case of IVC filter thrombosis with associated vena caval obstruction successfully treated with catheter-directed thrombolysis and adjunctive mechanical thrombectomy.     

Pelvic venous thrombosis and abnormality of the post-renal inferior vena cava

After angiography, a 17 year-old male patient presented a pseudo appendicular syndrome. After two poorly contributive surgical explorations, CT and MR Imaging showed atresia of the infra-renal vena cava, with pelvic thrombophlebitis extending to the gonadal and lumbar collateral circulation.     

Anomalies of the inferior vena cava in patients with iliac venous thrombosis

BACKGROUND: Cases of deep venous thrombosis in the lower extremities triggered by abnormalities of the vena cava have been reported. OBJECTIVE: To describe anomalies of the inferior vena cava in patients with deep venous thrombosis. DESIGN: Prospective, consecutive case series. SETTING: University Hospital, Graz, Austria. PATIENTS: 97 patients with deep venous thrombosis. INTERVENTION: Sonography, venography, or both to diagnose deep venous thrombosis; magnetic resonance angiography to image the inferior vena cava. MEASUREMENTS: Anomalies of the inferior vena cava imaged by magnetic resonance angiography. RESULTS: 31 of 97 patients showed thrombotic occlusion of iliac veins (common and external iliac vein [ n = 29] or external iliac vein [ n = 2]). Five of 31 patients (3 men, 2 women) had an anomaly of the inferior vena cava. Anomalies were missing inferior vena cava, hypoplastic hepatic segment, and missing renal or postrenal segments. Patients with anomalies were significantly younger than the 92 patients without (mean age+/-SD, 25+/-6 years vs. 53+/-19 years; P = 0.002). In 2 patients with anomalies, the thrombotic occlusion was recurrent. CONCLUSIONS: An anomaly of the inferior vena cava should be suspected if thrombosis involving the iliac veins is seen in patients 30 years of age or younger. Patients with both an anomaly and thrombosis may be at higher risk for thrombotic recurrence.     

Total inferior vena cava thrombosis following coronary artery bypass surgery

A 44-yr-old male presented with abdominal and back pain following coronary bypass surgery (CABG). Total inferior vena cava (IVC) thrombosis was then documented by computed tomography as well as IVC contrast cineangiography. Furthermore, the patient developed multiple pulmonary emboli. This presentation with severe abdominal and back pain with lack of early peripheral edema without apparent hepatic or renal dysfunction and with extreme elevation of erythrocyte sedimentation rate seems rather unusual. To our knowledge, such massive IVC thrombosis has not been reported following CABG. Thrombolytic and anticoagulant therapy was utilized with good recovery.     

Leydig cell tumor, gynecomastia, and inferior vena cava thrombosis

Leydig cell tumor is a testicular tumor with a low incidence characterized by a high estrogens secretion from the tumoral cells. Its more frequent clinical presentation is a testicular nodule with or without other endocrine manifestations due to estrogenic hypersecretion. We're reporting a case of a Leydig cell tumor with high plasmatic levels of estradiol, gynecomastia and inferior cava vein thrombosis, which hasn't been described among its clinical features up to now. Vascular thrombotic phenomenons have already been reported in other clinical situations with hiperestrogesism and they could also be associated with these tumors. Patients with Leydig cell tumors could be at a higher risk of developing thromboembolic phenomenons because of tumoral hyperestrogenism and could present thrombotic complications among the clinical findings.     

Surgery of inferior vena cava associated malignant tumor lesions

BACKGROUND: Tumor lesions of the inferior vena cava (IVC) can originate from the vein or can develop by malignant tumor infiltration from the surrounding tissue. In this context, particular attention should be paid to tumor lesions with pegs into or within the IVC. The aim of this series of a single surgical center was to analyze the perioperative management, the individual-specific and -adapted surgical technique, as well as the outcome including prognostic considerations in IVC-associated malignant tumor lesions. PATIENTS AND METHODS: Over a 6-year time period, all consecutive patients with IVC-associated malignant tumor lesions and their patient- and finding-specific characteristics were registered, data and parameters of the diagnostic and therapeutic management were documented, and both the short- and long-term outcomes (complication rate, perioperative morbidity/mortality, tumor recurrence rate, survival) were assessed with periodic follow-up investigations. RESULTS: Overall, 12 patients were enrolled in the study from 1/1/2001-31/12/2006:6 primary IVC-tumors (leiomyosarcomas, 50%) and 6 secondary IVC-tumors (2 retroperitoneal tumor lesions, 16.7%, 3 renal cell carcinomas 25% and 1 carcinoma of the adrenal gland, 8.3%). 4 of the secondary tumors had pegs into the IVC. The RO resection rate was 83%. The perioperative morbidity was 33%; whereas, the hospital mortality was 8.3% (n = 1). Surgical reconstruction of IVC was achieved in each case (100%). There was a mean postoperative observation period of 20 months (range, 1-58 months). Complete follow-up documentation was obtained for all of the patients (100%). Three patients experienced recurrent tumor growth (27.5% out of n = 11). While the overall mortality through the follow up observation period was 27.5%, the tumor-specific mortality was 16%. CONCLUSIONS: The primary surgical aim is RO resection to provide a long-term outcome with no tumor recurrence including the reconstruction of the IVC based on a reasonable risk-to-benefit ratio. The favorable outcome of this case series demonstrates that IVC-associated tumor lesions can be approached if there is an appropriate expertise of the surgical team, a sufficient perioperative management and an adequate financial background with a reasonable survival rate. The variable prognosis of the various tumor lesions depends on tumor entity, stage, resection status and individual risk factors.     

Thrombolytic therapy for inferior vena cava thrombosis in paroxysmal nocturnal hemoglobinuria

Two patients with paroxysmal nocturnal hemoglobinuria had increasing abdominal girth and ascites. The Budd-Chiari syndrome or inferior vena cava thrombosis was shown by angiography. After thrombolytic therapy, both patients improved, and thrombolysis was shown by radiography. Neither patient had induction of hemolysis secondary to these agents. These studies suggest that both streptokinase and urokinase are safe and effective in the treatment of intra-abdominal venous thromboses associated with paroxysmal nocturnal hemoglobinuria.     

Acute inferior vena cava thrombosis. Early results of heparin therapy

STUDY OBJECTIVE: To determine, during heparin therapy, the embolic risk associated with acute inferior vena cava thrombosis compared with noncaval thrombosis. DESIGN: Prospective controlled study. SETTING: University-affiliated general hospital. PATIENTS: Of 68 consecutive patients considered, 18 with cavographically proved inferior vena cava thrombosis and 45 with phlebography-proved noncaval proximal thrombosis met all other eligibility criteria and completed the study. INTERVENTIONS: All patients received adjusted continuous IV heparin therapy for ten days. MEASUREMENTS AND RESULTS: All 63 patients underwent systematic baseline and "day 10" perfusion lung scanning and phlebocavography. None suffered pulmonary embolism within the ten days, but 11/63 patients showed thrombus extension on day 10 phlebocavograms. Retrospectively, no significant difference could be found between the groups with and without extension. CONCLUSIONS: (a) The early embolic risk associated with heparin-treated venous thromboses appears low and does not seem to depend on the location (caval or more peripheral) of venous clots. (b) Thrombus extension may occur in spite of apparently "adequate" anticoagulation with heparin.