Renal transplant in children with previous inferior vena cava thrombosis

Our experience with renal transplantation in children with inferior vena cava thrombosis is presented in this study. Of the 238 children who have received renal transplants at our institution, four had IVC thrombosis (discovered during pretransplant evaluation: three patients; found at surgery: one patient). The pretransplant US evaluation diagnosis of IVC thrombosis in three patients was confirmed by transjugular retrograde cavography. There were no signs of hypercoagulability or IVC thrombosis symptoms prior to diagnosis in any patient. The graft was implanted in a left orthotopic position in three patients. Venous drainage was attained to the infrahepatic vena cava or native renal vein after ipsilateral nephrectomy. The renal artery of the graft was anastomosed to the aorta. In one patient, the graft was placed in the left iliac fossa. Patient and graft survival are 100%. Three grafts are functioning normally after a mean follow-up of 3.7 yr. The graft placed in the iliac fossa has moderate dysfunction due to high pressure venous outflow. Children with IVC thrombosis can be successfully transplanted orthotopically. Candidates with any suspicious-looking occlusion on ultrasound should be studied by retrograde venography to confirm diagnosis prior to transplantation.     

Deep venous thrombosis in a child associated with an abnormal inferior vena cava

Congenital anomalies of the inferior vena cava (IVC), such as absence or atresia, although well documented, are uncommon and result from aberrant development during embryogenesis. Absence or atresia of the IVC is usually discovered accidentally. Patients are typically asymptomatic of the condition itself. Many concurrent cardiovascular-associated abnormalities have been described. We report a 10-y-old boy admitted to the emergency room with painful swelling of his right lower limb without previous trauma or surgery. After 3 d, swelling also involved the left lower limb. A Doppler ultrasound of the lower limbs revealed bilateral thrombosis of the vena iliaca communis, vena iliaca externa, femoral vein communis and superficial extending to the IVC. Magnetic resonance imaging (MRI) of the abdomen was performed. On MRI, we demonstrated a hypoplastic IVC. The results of blood coagulation studies, including levels of antiphospholipid antibodies, proteins C and S, and antithrombin III, were normal. The patient was treated with intravenous heparin for 8 d and discharged with oral warfarin therapy, which has been recommended for life.
Conclusion: Therapy against deep venous thrombosis must be focused on its prevention in the future. An abnormal inferior vena cava should be considered in young patients with deep venous thrombosis without apparent cause.     

Congenital calcified thrombosis of inferior vena cava,bilateral renal veins and left spermatic vein

An infant with severe congenital calcified thrombosis in the inferior vena cava, bilateral renal veins and left spermatic vein is presented. Five previously published cases and pertinent points concerning this rare occurence are discussed. The etiology of this calcified thrombosis remained unknown.The institution from which the work originated     

Neonatal inferior vena cava and renal venous thrombosis treated by thrombectomy and nephrectomy.

Neonatal inferior vena cava and renal venous thrombosis with obstruction was diagnosed clinically and confirmed by ultrasonography. Successful thrombectomy and nephrectomy were performed at 40 hours of age. Thrombus with obstruction occluding the inferior vena cava favours immediate surgery.     

Bilateral adrenal hemorrhage associated with bilateral renal vein and vena cava thrombosis

Idiopathic bilateral adrenal hemorrhage with thrombosis of both renal veins and inferior vena cava are presented using US and CT in a newborn. To our knowledge such bilateral involvement of the adrenal glands and the renal veins have not been reported previously.     

Renal vein thrombosis in the newborn infant.]

In a child born with traumatism to a diabetic mother, an acute thrombosis of the left renal vein occurred. An arteriography performed at the acute stage, established the diagnosis. The newborn received urokinase and heparin administered through an arterial catheterism. An arteriography, repeated at the 3rd day, showed an improvement in the vascularization of the kidney, which returned to normal functions. The radiological symptons of renal vein thrombosis are reviewed including the arteriography which is never used for the diagnosis in newborns. The interest of the use of urokinase and its efficiency in this disorder are discussed. This therapy harmless and efficient seems of interest. Such a therapy has to be tried because of the failure of isolated heparin-therapy and of the sequellae which may be observed after spontaneous recovery or after anticoagulant treatment.     

Calcified thrombus in the inferior vena cava in infants and children

Calcified thrombi in the prerenal (suprarenal) segment of the inferior vena have a characteristic radiographic appearance that permits accurate plain film diagnosis. Most have been fortuitously discovered in infants and young children. None of the affected individuals has had clinical evidence of venous obstruction. Vena caval obstruction is usually incomplete.Uncalcified clot caudal to the calcified thrombus caused complete obstruction of the inferior vena cava and renal veins in one of our patients, a healthy infant; since collateral flow was adequate surgery was not advised. We believe that aggressive diagnostic and therapeutic measures are unnecessary in the management of infants and children with calcified thrombi in the inferior vena cava.     

Successful adult‐to‐child renal transplantation utilizing the ovarian vein in children with inferior vena cava/iliac vein thrombosis

Tao R, Shapiro R. Successful adult‐to‐child renal transplantation utilizing the ovarian vein in children with inferior vena cava/iliac vein thrombosis.
Pediatr Transplantation 2010: 14:E70–E74. © 2009 John Wiley & Sons A/S. Abstract: IVC/iliac vein thrombosis has previously been considered to be a contraindication to renal transplantation because of the technical difficulties and the increased risk of graft thrombosis. We report two successful cases of adult‐to‐child kidney transplantation in which we anastomosed the graft renal vein to the recipient ovarian vein in the presence of IVC and/or iliac vein thrombosis, with no short or long term vascular complications. Our experience, which adds to the successful reports from several other centers, suggests that the inability to use the iliocaval axis should no longer be considered a contraindication to pediatric renal transplantation.     

Transiliac catheterization of the inferior vena cava for long-term venous access in children

In infants and children requiring prolonged, multiple central venous (CV) catheterizations, the superior (SVC) and inferior vena cava may become thrombosed or stenotic, making CV access a difficult problem. Use of the iliac vein may be an acceptable alternative. We report a patient with thrombosis of the SVC in whom the external iliac vein was accessed through a retroperitoneal approach for placement of an implantable port. This technique is easy to perform, and there are no special materials or patient positioning required. Accepted: 6 January 1998