Abdominal aortic replacement with a left-sided inferior vena cava: transperitoneal and left retroperitoneal approaches

An unsuspected left-sided inferior vena cava (IVC) can present a formidable challenge for the surgeon attempting aortic reconstructive surgery. A 73-year-old man with aorto-iliac occlusive disease and a 64-year-old man with a seven centimeter (cm) abdominal aortic aneurysm (AAA) each underwent an aorto-femoral bypass graft in the setting of a left-sided cava. In the former case the conventional transperitoneal approach was utilized and in the latter case the extended left retroperitoneal incision was employed. The technical details required in performing these procedures and the developmental anatomy of this and other major venous anomalies are discussed.