Triple IVC: A combination of periureteral venous ring and left IVC

Variations of the inferior vena cava (IVC) are clinically silent and most often diagnosed incidentally when imaging for other reasons. However, they may have significant clinical implications during retroperitoneal surgery, venous intervention, or differential imaging diagnosis. This article describes a case of triple IVC, discovered on a lumbar CT and MRI scan during an evaluation of back pain. Clin. Anat. 26:1002–1005, 2013. © 2013 Wiley Periodicals, Inc.     

Three cases of amoebic liver abscess causing inferior vena cava obstruction,with a review of the literature

Amoebic liver abscess is a common disease, especially in endemic areas, but it is a rare cause of inferior vena cava (IVC) obstruction, with only a few cases appearing in the literature. We report three cases of amoebic liver abscess complicated with obstruction of the IVC and which responded to conservative treatment or radiological intervention.     

双下腔静脉的MSCT表现及临床意义

目的　探讨双下腔静脉（inferior vena cava,IVC）的多层螺旋CT（multi-slice spiral CT,MSCT）表现及临床意义。 方法　收集经腹部MSCT多期增强扫描发现的18例双IVC患者,采用MPR、MIP和VR等血管成像技术显示IVC解剖,回顾性分析患者临床及影像学资料,结合文献讨论双IVC影像学特征、胚胎学机制及临床意义。 结果　18例双IVC的MSCT表现为3种类型。Ⅰ型83.33%（15例）表现为左侧IVC上行至左肾静脉汇入,再以左肾静脉正常方式经主动脉前方右行,汇入正常的右侧IVC。Ⅱ型11.11%（2例）表现为右侧IVC上行达腰2椎体平面,经腹主动脉后方左行汇入左侧IVC,后者再上行延续为半奇静脉,然后经奇静脉和上腔静脉汇入右心房;右肾静脉主要汇入右侧肾上段IVC,但存在侧支与右侧肾下段IVC相连。Ⅲ型5.56%（1例）表现为右侧IVC全程行径正常,左侧IVC垂直上行接收左肾静脉汇入后,于主动脉后方向右上走行与奇静脉连接。 结论　双IVC有多种复杂的变异类型,对于腹膜后手术及下半身静脉血栓治疗具有重要的临床意义。     

Clinical implications of concomitant variations of the testicular, suprarenal and renal veins: A case report

Multiple venous anomalies have been observed during dissection of the posterior abdominal wall in a 65-year-old, white male cadaver. The left testicular and suprarenal veins united inferior to the superior mesenteric artery, coursed anterior to the abdominal aorta and drained into the inferior vena cava (IVC). Further the left renal vein coursed retroaortically and divided into three branches. The superior branch coursed on the vertebral column and drained into the azygos vein while middle and inferior branches drained into the IVC. The right renal vein was double and both drained into the IVC separately. Due to implications for numerous therapeutical and diagnostic procedures in the retroperitoneal region knowledge of these variations could be useful for clinicians in its recognition and protection.     

Complications in right-sided paraaortic lymphadenectomy: ventral tributaries of the inferior vena cava

The purpose of this study was to describe the distribution and structure of ventral tributaries leading into the inferior vena cava where right-sided paraaortic lymphadenectomy is performed. The study examined 21 retroperitoneal specimens by graphic reconstruction, statistical evaluation, and histological examination of ventral tributaries (VTs). Seventy VTs were identified. The average number per specimen was 3.33. There were 20, 40, and 40% of VTs found in Levels I, II, and III, respectively. During the preparation, we observed an unusual arrangement of the IVC wall, into which VTs were led through a preformed sleeve-like channel and anchored near the lumen. This finding is a key mechanism that explains the ease with which VTs are extracted during surgery. Knowledge of the distribution and histological structure of VTs allows proper orientation of the retroperitoneal area of the front wall of inferior vena cava, which is essential for uncomplicated right-sided paraaortic lymphadenectomy. The histological structure of the VT ostium within the wall of the inferior vena cava explains why injury is easy during the procedure.     

分期递增式球囊扩张技术在布加综合征合并下腔静脉血栓形成腔内治疗中的应用效果及安全性

目的 探讨分期递增式球囊扩张技术在布加综合征(BCS)合并下腔静脉血栓形成腔内治疗中的应用效果及安全性。方法 回顾性分析2016年1月—2018年12月蚌埠医学院第一附属医院血管外科收治的34例BCS合并下腔静脉血栓患者临床资料,其中男18例、女16例,年龄32~53岁。均采用分期递增式球囊扩张技术治疗,即无论新鲜或陈旧性血栓,病变部位导丝开通后行小球囊(8 mm)第1次扩张并予抗凝治疗,1周后采用小球囊(12 mm)第2次扩张,1个月后行大球囊(18~25 mm)扩张治疗。观察手术成功率、围术期并发症、近期通畅率及实验室相关指标。结果 最终手术成功开通33例,成功率97.06%(33/34);其中新鲜血栓14例(14/34)均行经导管溶栓后下腔静脉血栓清除,血流恢复,病变段开通。1例未开通者为下腔静脉长段闭塞,在第1次扩张时反复尝试均无法通过闭塞段,改行下腔静脉-右心房转流手术。33例在1周后行12 mm球囊扩张和1个月后大球囊扩张时导丝均能顺利通过病变段,顺利实施球囊扩张术。33例扩张成功患者在小球囊第1次扩张前碱性磷酸酶、胆红素和血小板水平分别是(111.91±22.38)U/L、(20.76±1.82)U/L和(103.85±21.98)×10⁹/L,在大球囊扩张术前分别是(78.88±10.04)U/L、(19.79±2.03)U/L和(137.27±17.68)×10⁹/L,差异均有统计学意义(t=7.741、2.039、6.802,P值均＜0.05);但红细胞、白细胞及丙氨酸氨基转移酶、天冬氨酸氨基转移酶等指标变化不明显。大球囊开通术后6个月患者门脉高压症状得到明显的改善,腹水消减、肝脾缩小、肝功能好转。住院及随访期间均无患者死亡。围术期未发生致死性肺栓塞、下腔静脉破裂、心包填塞等严重并发症;溶栓期间未发生症状性肺栓塞和致死性肺拴塞。33例患者术后6个月、1年经彩超复查显示下腔静脉通畅率分别是96.97%(32/33)、90.91%(30/33)。结论 分期递增式球囊扩张技术,应用于BCS合并下腔静脉血栓形成腔内治疗过程中安全有效,近期疗效满意。     

Primary Leiomyosarcoma of the Inferior Vena Cava with Budd-Chiari Syndrome

A 44 year old Japanese woman with leiomyosarcoma of the inferior vena cava is reported. She presented with Budd Chiari syndrome and died of hepatic failure about 3 months after the onset of symptoms. The tumor arose from the middle segment of the inferior vena cava, occluded the inferior vena cava and projected into the right atrium. A total of 28 cases of Budd-Chiari syndrome due to primary leiomyosarcoma of the inferior vena cava are reviewed.     

Scimitar syndrome with the left persistent superior vena cava

Scimitar syndrome is a rare, complex congenital anomaly characterized by an anomalous connection of the pulmonary vein with the inferior vena cava (IVC). A persistent left superior vena cava (PLSVC) is another thoracic venous anomaly. We present a rare case with scimitar syndrome associated with the PLSVC. These variations were confirmed by magnetic resonance imaging (MRI) and computed tomography (CT). The typical features and the embryonic development of these variations are described. Radiological evaluations and clinical implications are discussed.     

二维超声测量下腔静脉直径以确定血透患者干体重

目的 用二维超声测量下腔静脉内径,以评估血液透析后病人干体重.方法 采用二维超声测定27例慢性血透病人超滤前后吸气末下腔静脉内径(IVC-I)和正常对照组IVC-I,同时记录当次透析超滤量,透析中血压变化.结果27例超滤前IVC-I较对照组明显升高,超滤量与IVC-I/体表面积(VCD)改变呈显著相关,r=0.42,P<0.01,超滤后24例IVC-I与对照组无明显差异,3例心衰患者较正常组升高.结论 二维超声测定IVC-I可作为血透病人干体重的指标,若病人IVC-I大于正常范围 2s,可认为水负荷过多,若低于正常范围-2s,则认为水负荷不足.     

Anomalous veins of the retroperitoneum: clinical considerations

Abstract: A case of complex anomalies (variations) of the veins of the retroperitoneum in a 57 year old male cadaver is presented. The anomaly involved a double inferior vena cava, with the left suprarenal v. draining into the left vena cava and the right testicular v. drained into the right renal v., There was also no left common iliac v., with the left external iliac v. draining into the left vena cava and the left internal iliac v. into the right common iliac v.. Although duplication of the inferior vena cava has previously been reported the present case is interesting because of the complexity of the associated anomalies.     

A review of venous collaterals in inferior vena cava obstruction

The purpose of this study was to review venous collateralization resulting from inferior vena cava obstruction. The elements responsible for the extent and distribution of venous collaterals in inferior vena cava obstruction and whether or not the obstructive lesion involves tributaries of the inferior vena cava. Common etiologies of inferior vena cava obstruction include extensions of iliofemoral vein thrombi, thrombosis from intraluminal tumors or following trauma, and external compression. The anatomy of the venous collateral systems may be divided into deep and superficial networks, each of which is composed of systems of primary or secondary clinical significance, as defined by the degree of restoration of adequate venous return and the extent of visceral venous decompression. The most common obstructions of the inferior vena cava involve the lower third of the vessel. The azygos-hemiazygos and vertebral venous plexus systems play the most significant roles, while the superficial systems are less prominently involved. In upper level inferior vena cava obstruction, reestablishment of venous circulation is less developed, which usually leads to a poorer clinical outcome. © 1992 Wiley-Liss, Inc.     

Duplication of the inferior vena cava associated with other variations

Multiple vascular variations, including duplication of the inferior vena cava, double renal arteries and anomalies of the testicular blood vessels, were observed during dissection of the retroperitoneal region of a cadaver of an 87-year-old Japanese man. The right inferior vena cava arose from the union of right common iliac veins and a thinner interiliac vein. This interiliac vein ascended obliquely from right to left and joined the left common iliac veins to form the left inferior vena cava. The right and left inferior venae cavae were of approximately equal width. The right testicular vein consisted of medial and lateral venous trunks. The two venous trunks coalesced to form a single vein, which drained into the confluence of the right inferior vena cava and right renal vein. The left testicular vein was composed of the medial and lateral testicular veins, which drained into the left renal vein. Double renal arteries were seen bilaterally, which originated from the lateral aspects of the abdominal aorta. The right testicular artery arose from the right inferior renal artery and accompanied the lateral trunk of the right testicular vein running downwards. The left testicular artery arose from the ipsilateral inferior renal artery and ran downwards accompanied by the left lateral testicular vein. In addition, the bilateral kidneys showed multicystic changes.     

The hepatic veins: Anatomy and classification on single slice spiral CT in North Indian population

AimsTo find out the normal pattern of hepatic veins in the North Indian population and to categorize them.MethodsThe present study was conducted on 100 patients whose spiral CT abdomen was performed for various medical conditions in the department of radiodiagnosis.ResultsFour categories were recognized. Category-1, when right hepatic vein drains independently into the inferior vena cava whereas middle and left hepatic veins join together to form a common trunk before draining into the inferior vena cava. It was observed in 74% patients. Category-2 was observed in 2% patients, where right & middle hepatic veins join to form a common trunk and left hepatic vein drain independently into the inferior vena cava. Category-3 was observed in 21% patients, where all the three major hepatic veins drain independently into the inferior vena cava. Category-4 was observed in 3% patients, where all the three major hepatic veins join together to form a common trunk before draining into the inferior vena cava.ConclusionsCategory-1 is the most common pattern of major hepatic vein drainage found in the North Indian population. The present study also concluded that single right, middle and left hepatic vein is the most common pattern of hepatic veins present in the North Indian population. Caudate lobe is drained by more than one vein in majority of North Indians. Also superomedial vein, right accessory vein and inferior right hepatic vein are the most common accessory veins present in the North Indian population.     

置管溶栓联合球囊扩张治疗布加氏综合征合并下腔静脉血栓

目的:探讨置管溶栓联合分期球囊扩张治疗布加氏综合征合并下腔静脉血栓的临床应用.方法:全组15例,均经彩色多普勒超声证实为布加综合征合并下腔静脉血栓,同时行CT检查7例,造影检查8例.先经股静脉入路置入溶栓导管于下腔静脉内,抗凝和溶栓治疗7～10 d,然后行病变段开通和分期球囊扩张治疗.结果:15例血栓基本消失或明显缩小,其中2例一期球囊扩张成功,13例行分期球囊扩张治疗.术后15例随访6～24个月,平均13.1个月.13例症状和体征完全消失,2例明显改善,无肺栓塞、血管撕裂、心包填塞等并发症发生.结论:置管溶栓联合分期球囊扩张治疗布加氏综合征合并下腔静脉血栓安全有效,具有临床可行性.     

The inferior supernumerary renal arteries: A classification into three types

Among cases that had multiple renal arteries on one side, an inferior supernumerary renal artery was found in 24/270 cases (ca. 9%) on the right and in 19/270 cases (ca. 7%) on the left, together with the usual renal artery. We have noticed that there are correlations between their levels of origin from the aorta and their positional relation to the ureter and the inferior vena cava (IVC). An inferior supernumerary renal artery (InfRA) of lower origin passes in front of the IVC and behind the ureter. An InfRA of middle origin passes in front of both the IVC and the ureter. An InfRA of upper origin passes behind the IVC and in front of the ureter or renal pelvis. In addition there was a tendency for the lower origin type to have an ureteric branch, while the middle and upper origin types had a gonadal branch. These findings suggest that different derivations lead to the inferior supernumerary renal arteries.     

Relationship of the lumbar lordosis angle to the abdominal aortic bifurcation and inferior vena cava confluence levels

The objective of this study is to determine the relationship of the variations of the lumbar lordosis angle (LLA) to the aortic bifurcation level and inferior vena cava (IVC) confluence level using CT angiography. A retrospective study was conducted using the data available on abdominopelvic CT angiography scans. The LLA, the level and angle of bifurcation of the aorta, the level and angle of confluence of the IVC were identified using multiplanar and 3D reconstruction. Linear regression models were fitted to the data. We interpreted 181 scans for 181 individuals having a mean age of 55 years (18-89). The most common site of aortic bifurcation was at L4-L5 disc space (34.8%) and that of vena confluence was at the upper of L5 (29.3%). The mean LLA was 34.65° (13°-77°). The mean aortic bifurcation angle was 47.43° (17°-100°) and the mean IVC confluence angle was 71.86° (30°-120°). The positions of the aortic bifurcation and venous confluence levels showed a proximal shift with an increasing LLA P < 0.001. This study showed that the level of bifurcation of the aorta and the level of confluence of the IVC may vary with the variations of the LLA.     

Interruption of the inferior vena cava with azygos termination associated with congenital absence of portal vein

The authors report an exceptional and well-documented case of interruption of the retrohepatic segment of the inferior vena cava with an “azygos continuation”, combined with absence of the portal vein. The only known combination of congenital anomalies of the inferior vena cava and the portal vein was that of an “azygos continuation” and a preduodenal portal vein. The double interruption, portal and inferior caval, may be associated with a disturbance of preferential flows induced by the left umbilical thrust. According to hemodynamic theory, the left umbilical flow is the determining factor in organogenesis of the portal vein and the retrohepatic segment of the inferior vena cava.     

Ieiomyosarcoma of the superior vena cava producing superior vena cava syndrome and heart tamponade

An autopsy case of primary leiomyosarcoma arising in the superior vena cava is presented. A 44 year old Japanese man presented with superior vena cava syndrome and eventually died due to heart tamponade and acute renal failure. Autopsy revealed that the superior vena cava was occluded with a tumor that had invaded the pericardium and right thoracic cavity. Primary caval venous leiomyosarcoma is a rare but lethal disease and most cases arise from the inferior vena cava. This case represents a very rare case of leiomyosarcoma with the rare clinical findings of superior vena cava syndrome and heart tamponade.     

13～15岁内蒙青少年胸段椎旁大血管与胸椎的位置关系

目的 探讨正常13～15岁青少年主动脉,上、下腔静脉与椎体之间的解剖空间关系,为其前路或后路手术方式提供依据。 方法 收集内蒙古地区63例13～15岁青少年正常胸腰CT资料,其中13岁15例,14岁21例,15岁27例。将连续扫描的胸腰椎断层影像原始数据以DICOM格式导入Mimics 16.0软件分析与测量,以左侧横突末端与棘突末端焦点确定为原心O点,测量主动脉距原点O的距离（AO）、主动脉-椎体角（α）、上腔静脉距原点O的距离（V₁O）、上腔静脉-椎体角（β）、下腔静脉距原点O的距离（V₂O）、下腔静脉 椎体角（θ）。 结果 AO, α：13岁（52.16±3.21）mm,（1.89±0.47）°;14岁（52.63±2.28）mm,（-1.91±0.97）°;15岁（57.57±3.52）mm,（-2.47±0.66）°;Ⅴ₁O,β：13岁（66.71±5.82）mm,（-5.14±1.42）°;14岁（77.01±2.89）mm,（-11.18±2.64）°;15岁（78.54±0.70）mm,（-20.61±2.05）°;Ⅴ₂O,θ：13岁（62.69±5.66）mm,（-23.85±1.92）°;14岁（65.71±5.39）mm,（-18.46±2.77）°;15岁（75.98±8.49）mm,（-18.58±2.09）°, 不同椎体之间大血管与椎体间距和角度差异有统计学意义（P＜0.05）。结论 掌握不同椎体之间大血管与椎体之间距离和角度,有助于降低脊柱置钉过程中血管损伤的发生率。     

恶性肿瘤引起下腔静脉梗阻血管内支架治疗的临床应用

目的探讨恶性肿瘤引起下腔静脉梗阻血管内支架治疗的临床效果。方法16例下腔静脉梗阻患者中．原发性肝癌7例,肝转移癌6例,胃癌2例,胰腺癌腹膜后淋巴结转移1例（其中男性9例,女性7例,年龄40～70岁）。均造成下腔静脉的完全或部分梗阻,采用经皮股静脉穿刺行血管内支架治疗。结果16例患者均一次成功植入血管支架。下腔静脉梗阻症状明显改善。全部病例均无严重并发症。结论血管支架植入术可迅速缓解下腔静脉恶性梗阻的临床症状．是治疗恶性下腔静脉梗阻有效的姑息性治疗方法。