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Anwar H, Pardi A, Patel M, Raquib AR, Andrews K, Broniak C, Sperling EE. Duplicated Inferior Vena Cava: A Case Study With Clinical Implications. Cureus 2025; 17:e81652. [PMID: 40322393 PMCID: PMC12049088 DOI: 10.7759/cureus.81652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2025] [Indexed: 05/08/2025] Open
Abstract
The inferior vena cava (IVC) is a large, retroperitoneal vein that ascends anterolaterally along the right side of the vertebral column, draining venous blood from both lower extremities, the pelvis, and the abdomen to the right atrium of the heart. The IVC undergoes complex embryological development during the fourth to eighth weeks of gestation, which can result in many anatomical variations, including duplication of the IVC. This study presents the case of duplicated IVCs in a 79-year-old male donor patient. While the second IVC on the left side of the body generally terminates by draining into the left renal vein, the individual described here demonstrated an extension superior to the renal veins, with the renal and gonadal veins draining into the ipsilateral IVCs. The two IVCs joined at T9 and passed as one into the right atrium at T8. The IVC's role as the largest vein in the body is important to consider when assessing any vascular abnormality present in the IVC and its potential implications, which may include a higher risk of venous thromboembolism or pulmonary embolism.
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Affiliation(s)
- Hamsat Anwar
- Medicine, Western University of Health Sciences COMP-NW (College of Osteopathic Medicine of the Pacific - Northwest), Portland, USA
| | - Andrew Pardi
- College of Medicine, Western University of Health Sciences, Lebanon, USA
| | - Mira Patel
- College of Medicine, Western University of Health Sciences, Lebanon, USA
| | | | - Katherine Andrews
- College of Medicine, Western University of Health Sciences, Lebanon, USA
| | - Christine Broniak
- College of Medicine, Western University of Health Sciences, Lebanon, USA
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Jiang Z, Chen Y, Shi Y, Amuti S, Luo B, Ruze A. A rare combined variation of left renal vasculature in a human cadaver: embryological basis and clinical significance. Anat Sci Int 2025; 100:247-250. [PMID: 39249639 DOI: 10.1007/s12565-024-00798-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 08/27/2024] [Indexed: 09/10/2024]
Abstract
Classically, a single renal artery supplies, and a single renal vein drains each kidney. The morphology and variations in the renal vascular structures are of great importance when performing any type of renal surgery. The present case describes a rare combination of renal vasculature variation in a formalin-fixed, Chinese male cadaver. In this case, the left kidney is drained by a main renal vein (MRV) and an inferior renal vein (IRV), the latter might be the remnant of the left dorsal renal vein during the embryonic period. Two sets of renal arteries are present in this case, possibly due to persistent mesonephric arteries during embryonic development. Describing such anatomical variations is not only of academic interest but also important to help radiologists with the correct interpretation of image examinations and for surgeons to be prepared in advance.
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Affiliation(s)
- Zhuoying Jiang
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, 2001 Longxiang Boulevard, Longgang District, Shenzhen, China
| | - Yujun Chen
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, 2001 Longxiang Boulevard, Longgang District, Shenzhen, China
| | - Yuting Shi
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, 2001 Longxiang Boulevard, Longgang District, Shenzhen, China
| | - Siyiti Amuti
- Department of Human Anatomy, School of Basic Medical Science, Xinjiang Medical University, No.567, Shangde North Road, Shuimoogou District, Xinjiang Uyghur Autonomous Region, Urumqi, China
| | - Baohua Luo
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, 2001 Longxiang Boulevard, Longgang District, Shenzhen, China.
| | - Abudureyimujiang Ruze
- School of Medicine, The Chinese University of Hong Kong, Shenzhen, 2001 Longxiang Boulevard, Longgang District, Shenzhen, China.
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Damen NS, Jianu AM, Lazăr M, Rusu MC, Piţigoi G, Petrescu S. The Incidence and Variants of the Reno-Hemiazygos Connection. Diagnostics (Basel) 2025; 15:441. [PMID: 40002592 PMCID: PMC11854636 DOI: 10.3390/diagnostics15040441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Revised: 02/08/2025] [Accepted: 02/10/2025] [Indexed: 02/27/2025] Open
Abstract
Background/Objectives: Although common anomalies of the left renal vein (LRV) are pretty well documented in the literature, the drainage of the left renal blood via the hemiazygos vein lacks comprehensive support. We, therefore, aimed to study the incidence of the reno-hemiazygos connection (RHC). Methods: A total of 150 computed tomography scans (85 men and 65 women) were documented for the origin of an RHC from the LRV. Results: RHCs were found in 14/150 cases (9.34%). They were more prevalent in women (71.43%). In 11/14 cases, type 1 RHCs ascended directly along the postero-lateral left side of the aorta (direct hemiazygos flow). In 3/14 cases, type 2 RHCs (indirect hemiazygos flow) had a lumbar segment corresponding to the second lumbar vein and a pretransversary segment corresponding to an ascending lumbar vein. In 9/14 cases (64.29%), the RHC was connected to a typical LRV. In 1/14 cases (7.14%), the RHC was connected to the junction between the LRV and a left retropelvic tributary. In another case (7.14%), the RHC was connected to a retroaortic LRV and, in three cases (21.43%), to a circumaortic LRV. Triple left renal arteries were found in type 1 and, respectively, type 2 cases. The vertebral level of the inferior end of the RHC was variable, from the L1/L2 disc level to the L3 level. Conclusions: When present, the RHC serves to connect the superior and inferior caval systems. This may be physiologically of use or not, but surgically, it is a major anatomical risk factor for bleeding if its presence is not checked preoperatively.
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Affiliation(s)
- Nawwaf Sebastian Damen
- Department of Anatomy and Embryology, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (N.S.D.); (A.M.J.)
| | - Adelina Maria Jianu
- Department of Anatomy and Embryology, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, 300041 Timișoara, Romania; (N.S.D.); (A.M.J.)
| | - Mihai Lazăr
- Department 2, Division of Physiopathology II, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania;
| | - Mugurel Constantin Rusu
- Division of Anatomy, Department 1, Faculty of Dentistry, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Gabriel Piţigoi
- Department 9—Physical and Rehabilitation Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.P.); (S.P.)
| | - Silviu Petrescu
- Department 9—Physical and Rehabilitation Medicine, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 020021 Bucharest, Romania; (G.P.); (S.P.)
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Uccella S, Caraffini A, Zorzato PC, Garzon S. Intraoperative Findings of Duplicated Inferior Vena Cava During Laparoscopic Para-Aortic Lymphadenectomy. J Minim Invasive Gynecol 2024; 31:551-552. [PMID: 38679195 DOI: 10.1016/j.jmig.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/10/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Stefano Uccella
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy (all authors)
| | - Andrea Caraffini
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy (all authors)
| | - Pier Carlo Zorzato
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy (all authors)
| | - Simone Garzon
- Unit of Obstetrics and Gynecology, Department of Surgery, Dentistry, Pediatrics, and Gynecology, AOUI Verona, University of Verona, Verona, Italy (all authors).
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Shreevastava AK, Das RS, Mishra A. Protean Drainage Patterns of the Left Renal Vein: A Cadaveric and Retrospective Clinical Study on the Surgical Implications and Technical Feasibility. Cureus 2024; 16:e63037. [PMID: 39050300 PMCID: PMC11268398 DOI: 10.7759/cureus.63037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The diverse drainage patterns of the left renal vein (LRV), often with asymptomatic congenital anomalies, present considerable challenges in renal and retroperitoneal surgical contexts. The potential for significant bleeding and subsequent renal compromise upon vascular injury highlights the need for increased surgical awareness. OBJECTIVE This study investigates the LRV's variable anatomical drainage patterns and morphometry. It also evaluates the embryological factors contributing to these variations and discusses their surgical implications and technical considerations. METHODS Anatomical dissections were conducted on 21 adult human cadavers within the Department of Anatomy. Concurrently, a retrospective analysis was conducted on 15 patients who underwent various retroperitoneal surgical interventions in the Urology Department. Demographic variables and intraoperative findings were recorded and analyzed. RESULTS Dissection analysis predominantly identified preaortic LRVs in 18 cadavers. Notable anatomical variations included a circumaortic left renal vein (CLRV), a delayed preaortic confluence of extrahilar duo LRVs, and an extrahilar tetramerous confluence with a retroiliac topography. The majority of LRVs usually end in the inferior vena cava. However, an extrahilar tetramerous variant had an unusual drainage pathway. Out of 15 cases, three (20%) had a retroaortic left renal vein (RLRV). One patient with a nonfunctioning kidney had type 1 RLRV, and another patient with pelvic ureteric junction obstruction had type 4 retroiliac left renal vein (RILRV). In both of these patients, symptoms were relieved after surgery. In a young patient with left varicocele and microscopic hematuria who had type 2 RLRV, symptoms resolved spontaneously after a few months. CONCLUSION A thorough understanding of the variable anatomical drainage patterns of the LRV is crucial for surgeons. Accurate preoperative identification can provide valuable insights, potentially leading to improved surgical outcomes in renal procedures.
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Affiliation(s)
| | - Rajat S Das
- Anatomy, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
| | - Amit Mishra
- Urology, All India Institute of Medical Sciences, Raebareli, Raebareli, IND
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6
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Li W, Liao Z, Yao L, Zhang L, Xiao J, Dong Z. Retroperitoneal lymphoma with double inferior vena cava shown using a 3D visualization model: A case report and literature review. Exp Ther Med 2023; 25:156. [PMID: 36911367 PMCID: PMC9996295 DOI: 10.3892/etm.2023.11855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/20/2023] [Indexed: 02/22/2023] Open
Abstract
Cases of a retroperitoneal tumor with double inferior vena cava (IVC) are rarely reported. The present report documents a case of a retroperitoneal lymphoma with double IVC, and discusses its embryological, clinical and radiological significance. In addition, previous cases of a double IVC are reviewed. In the present report, a 52-year-old male patient was hospitalized for a retroperitoneal lymphoma tumor and double IVC. CT urography was performed, whilst a three-dimensional visualization model was also established based on CT data, to reveal a retroperitoneal tumor with double IVC. The present case involved a double IVC with interiliac vein, which was type 2b from the left IVC. The retroperitoneal tumor was identified to be a lymphoma measuring 116x83 mm by percutaneous puncture biopsy. Surgical treatment is generally not recommended for lymphoma. Therefore, this patient was transferred to the Hematology Department for treatment according to the lymphoma management guidelines. The size of the tumor was reduced after chemotherapy during the patient's follow-up. In conclusion, the three-dimensional visualization model can directly and accurately present the anatomical features of the double IVC and its surrounding tissue structure. In addition, variations in the features of IVC can have important clinical significance. It is also important for surgeons, interventional radiologists and clinicians to understand such abnormalities in anatomical features to avoid misdiagnosis and reduce the occurrence of serious intraoperative complications.
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Affiliation(s)
- Wanqiang Li
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei 443003, P.R. China
| | - Zhengquan Liao
- Department of Urology, Yidu People's Hospital, Yichang, Hubei 443300, P.R. China
| | - Ling Yao
- Intensive Care Unit, The First College of Clinical Medial Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei 443003, P.R. China
| | - Lusheng Zhang
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei 443003, P.R. China
| | - Jianhua Xiao
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei 443003, P.R. China
| | - Ziqiang Dong
- Department of Urology, The First College of Clinical Medical Science, China Three Gorges University, Yichang Central People's Hospital, Yichang, Hubei 443003, P.R. China
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Raviraj PS, Chandana V, Pradeep HN, Nanjaraj CP. Inferior Vena Cava Anomalies and Pathologies. JOURNAL OF GASTROINTESTINAL AND ABDOMINAL RADIOLOGY 2022. [DOI: 10.1055/s-0042-1758129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
AbstractWide array of anatomical variations and pathologies affect the inferior vena cava (IVC). Multidetector computed tomography remains the most important modality to diagnose and evaluate the extent of involvement. The congenital variations such as duplication, anomalous course of renal veins, azygos continuation of IVC, etc., remain clinically indolent and are detected incidentally in abdominal imaging. This article describes the various congenital variants which include abnormalities in drainage, failure of development, and regression of the IVC. This article also highlights the important pathological conditions such as Budd–Chiari syndrome, primary and secondary neoplasms of the IVC, bland thrombosis, and retrograde opacification of the IVC.
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Affiliation(s)
| | - Venkataswamy Chandana
- Department of Radiology, Mysore Medical College and Research Institute, Mysore, Karnataka, India
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8
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Jenab Y, Ghafouri P, Hosseini K, Shirani S, Shirzad M. Bilateral proximal deep vein thrombosis and COVID-19 in a patient with absence of inferior vena cava: A case report and review of literature. Clin Case Rep 2022; 10:e5972. [PMID: 35734187 PMCID: PMC9194465 DOI: 10.1002/ccr3.5972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 04/14/2022] [Accepted: 06/03/2022] [Indexed: 12/03/2022] Open
Abstract
Bilateral proximal deep vein thrombosis (DVT) in the lower extremities of young patients should raise suspicion over pro-thrombotic conditions and venous anatomical abnormalities, even in the presence of other precipitating factors, such as viral infection. The authors present a 33-year-old man with bilateral DVT and absence of inferior vena cava (AIVC), who also had concurrent COVID-19, and discuss the management of this patient.
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Affiliation(s)
- Yaser Jenab
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Parham Ghafouri
- School of MedicineTehran University of Medical SciencesTehranIran
- Students' Scientific Research CenterTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Shapour Shirani
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Mahmood Shirzad
- Tehran Heart CenterTehran University of Medical SciencesTehranIran
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9
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ASLAN S, ÇAKIR İM. Evaluation of the incidence of renal vein anomalies and their relationship with renal stone disease and renal tumors by abdominal multidetector computed tomography. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1031806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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10
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Paraaortic Lymphadenectomy in Gynecologic Oncology—Significance of Vessels Variations. J Clin Med 2022; 11:jcm11040953. [PMID: 35207226 PMCID: PMC8879527 DOI: 10.3390/jcm11040953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 02/04/2023] Open
Abstract
Lymphadenectomy has been an essential part of the surgical treatment in surgical oncology, as the lymphatic channels and nodes are the main dissemination pathway for most of the gynecological cancers. Pelvic and paraaortic lymphadenectomy are frequent surgical procedures in gynecologic oncology. Paraaortic lymph node dissection facilitates staging, prognosis, surgical and postoperative management of patients. It is one of the most challenging retroperitoneal surgeries. A comprehensive knowledge of the paraaortic region is mandatory. Intraoperative bleeding is the most common complication during lymphadenectomy due to direct vascular injury, poor tissue handling, exuberant retraction and possible anatomical variations of the vessels in the paraaortic region. Approximately, one-third of women will have at least one anatomic variation in the paraaortic region. It must be stressed that anomalous vessels may be encountered in every woman who will undergo surgery. Consequently, detailed knowledge of anatomical vessels variations is required in order to prevent iatrogenic vessel injury. The importance of these variations is well described in urology, vascular and general surgery. Conversely, in oncogynecological surgery, there are few articles, which described some of the vessels variations in the paraaortic region. The present article aims to propose a surgical classification and to describe the majority of vessels variation, which could be encountered during paraaortic lymphadenectomy in gynecologic oncology. Moreover, surgical considerations in order to prevent anomalous vessels injury are well described.
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11
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Association of anatomical defects of the inferior vena cava and gonadal veins with pelvic varicose veins. COR ET VASA 2021. [DOI: 10.33678/cor.2021.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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12
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Nigro B, Ayarragaray JEF. Anomalies of Inferior Vena Cava: Implications and Considerations in Retroperitoneal Surgical Procedures. Ann Vasc Surg 2021; 79:372-379. [PMID: 34644626 DOI: 10.1016/j.avsg.2021.07.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 06/24/2021] [Accepted: 07/04/2021] [Indexed: 11/01/2022]
Abstract
Anomalies of the inferior vena cava pose a great challenge to surgeons. Although uncommon, these congenital vascular malformations may have significant surgical implications. Awareness of their presence is essential to avoid inadvertent injury and major bleeding during retroperitoneal procedures. An accurate preoperative diagnosis and detailed planning play a crucial role to obtain successful outcomes when confronted with them. Several surgical techniques have been recommended to protect these anomalous venous structures. The aim of this review is to contribute to the knowledge of the most common types of anomalies of inferior vena cava encountered during retroperitoneal procedures. With this purpose, a summary of their anatomy, embryology, incidence, diagnosis and intra-operative management is presented.
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Affiliation(s)
- Belén Nigro
- Department of Cardiovascular Surgery, Sanatorio de La Trinidad Mitre, Capital Federal, Argentina.
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13
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Li SJ, Lee J, Hall J, Sutherland TR. The inferior vena cava: anatomical variants and acquired pathologies. Insights Imaging 2021; 12:123. [PMID: 34460015 PMCID: PMC8405820 DOI: 10.1186/s13244-021-01066-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/07/2021] [Indexed: 01/05/2023] Open
Abstract
The inferior vena cava (IVC) is the largest vein in the body, draining blood from the abdomen, pelvis and lower extremities. This pictorial review summarises normal anatomy and embryological development of the IVC. In addition, we highlight a wide range of anatomical variants, acquired pathologies and a common pitfall in imaging of the IVC. This information is essential for clinical decision making and to reduce misdiagnosis.
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Affiliation(s)
- Simon J Li
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.
| | - Jean Lee
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Jonathan Hall
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Department of Radiology, Austin Health, Heidelberg, VIC, Australia
| | - Tom R Sutherland
- Medical Imaging Department, St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, VIC, 3065, Australia.,Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
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Özgül E. Evaluating incidence and clinical importance of renal vein anomalies with routine abdominal multidetector computed tomography. Abdom Radiol (NY) 2021; 46:1034-1040. [PMID: 32914351 DOI: 10.1007/s00261-020-02716-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 08/08/2020] [Accepted: 08/21/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Renal vein anomalies are usually asymptomatic embryological developmental disorders. If unidentified, they can lead to significant morbidity during surgical explorations. This study aims to evaluate the type, frequency, clinical importance of renal vein anomalies in patients scanned with Multidetector Computed Tomography (MDCT). It was also investigated whether renal vein anomalies are associated with malignancies or their types. METHODS Abdominal MDCT images of 8517 patients were examined retrospectively. Renal vein anomaly types, gender, age, and symptoms were recorded. Renal vein anomalies were divided into three subgroups as retroaortic left renal vein (RLRV), circumaortic left renal vein (CLRV), and double right renal vein (DRRV). The presence of malignancy and their types in patients with renal vein anomalies were noted. Malignancies were divided into five subgroups as lung, gastrointestinal system (GIS), genitourinary system, breast, and others. RESULTS 156 patients had renal vein anomaly (1.8%). The prevalence of RLRV, CLRV, and DRRV were 1.1%, 0.3%, and 0.2%, respectively. Renal vein anomalies were more frequent in females. Malignancy was present in 89 (57.1%) out of 156 renal vein anomaly patients. Among these 89 patients, RLRV was found in 52 (58.4%), CLRV in 22 (24.7%), and DRRV in 15 (16.8%) patients. The presence of malignancy was present in more than half of the renal vein anomaly patients but there was no significant correlation (p = 0.1). This high ratio is probably due to the high number of cancer patients undergoing CT scan in our radiology department. CONCLUSIONS Renal vein anomalies are rare conditions, however, coexistence of renal vein anomalies and malignancies is not. An awareness of this entity before retroperitoneal surgeries is very important in order to avoid complications such as hemorrhage, transfusion, death, or conversion to open surgery.
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15
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Lachkar S, Iwanaga J, Newton E, Dumont AS, Tubbs RS. Split Azygos Vein: A Case Report. Cureus 2021; 13:e13362. [PMID: 33747658 PMCID: PMC7970156 DOI: 10.7759/cureus.13362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The azygos venous system, which comprises the azygos, hemiazygos, and accessory hemiazygos veins, assists in blood drainage into the superior vena cava (SVC) from the thoracic cage and portions of the posterior mediastinum. Routine dissection of a fresh-frozen cadaveric specimen revealed a split azygos vein. The azygos vein branched off the inferior vena cava (IVC) at the level of the second lumbar vertebra as a single trunk and then split into two tributaries after forming a venous plexus. The right side of this system drained into the SVC and, inferiorly, the collective system drained into the IVC. Variant forms in the venous system, especially the vena cavae, are prone to dilation and tortuosity, leading to an increased likelihood of injury. Knowledge of the anatomical variations of the azygos vein is important for surgeons who use an anterior approach to the spine for diverse procedures.
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Affiliation(s)
| | - Joe Iwanaga
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Emma Newton
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - Aaron S Dumont
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
| | - R Shane Tubbs
- Neurosurgery, Tulane University School of Medicine, New Orleans, USA
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16
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Prado VE, Rey-Mendoza JP, Wakefield CJ, Aqeel SB, Kumssa A. Infrarenal inferior vena cava agenesis and recurrent deep vein thrombosis: a case report and literature review. Oxf Med Case Reports 2021; 2021:omaa104. [PMID: 33469470 DOI: 10.1093/omcr/omaa104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/20/2020] [Accepted: 10/02/2020] [Indexed: 11/12/2022] Open
Abstract
Inferior vena cava agenesis is a rare congenital vascular defect often diagnosed as an incidental finding in asymptomatic patients. When symptoms arise, it can present with chronic venous stasis or unprovoked deep vein thrombosis (DVT). A 42-year-old man with history of unprovoked right lower extremity (RLE) DVTs was admitted for swelling, pain and erythema to the RLE, concerning for new DVT. Venous Doppler ultrasound showed a chronic DVT of the right proximal femoral vein in addition to an acute DVT of the distal femoral vein. Extensive thrombophilia workup was negative and additional imaging with abdominal computed tomography scan revealed the absence of the infrarenal inferior vena cava. Patient was treated with oral anticoagulation and compression stockings and discharged with clinical improvement. At 3-month follow-up, patient was completely asymptomatic. Recurrent unprovoked DVTs in young patients require exhaustive work up including imaging studies to rule out vascular anomalies.
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Affiliation(s)
- Victor E Prado
- Division of Internal Medicine, Department of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Juan Pablo Rey-Mendoza
- Division of Pulmonary and Critical Care, Department of Medicine, University of Wisconsin, Madison, WI, USA
| | | | - Sheeba Ba Aqeel
- Division of Internal Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Admasu Kumssa
- Division of Internal Medicine, Department of Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
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Inferior vena cava anomalies: review and surgical considerations. ANGIOLOGIA 2021. [DOI: 10.20960/angiologia.00282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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18
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Kawakami M, Nakazato H, Tomiyama T, Tomori T, Miyagi J, Nagayoshi S, Ohmine Y. Laparoscopic sigmoidectomy for sigmoid colon cancer with left-sided inferior vena cava and persistent descending mesocolon. J Surg Case Rep 2020; 2020:rjaa259. [PMID: 32760494 PMCID: PMC7394134 DOI: 10.1093/jscr/rjaa259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 06/23/2020] [Indexed: 01/29/2023] Open
Abstract
Left-sided inferior vena cava (IVC) is a rare congenital malformation, as is persistent descending mesocolon, a developmental anomaly in which the colonic mesentery does not fuse with the dorsal abdominal wall. Although these anomalies are mostly asymptomatic, they should be identified preoperatively to avoid iatrogenic injury. We report a case of sigmoid colon cancer in a patient with both anomalies. The patient was an 80-year-old man whose preoperative computed tomography (CT) scan showed that the IVC ascended vertically along the left side of the abdominal aorta, and the descending colon was at the abdominal midline. Coronal CT was particularly useful for visualizing these anomalies. With this better understanding of the malpositioned anatomy, we successfully performed laparoscopic sigmoidectomy with lymph node dissection. Careful evaluation of preoperative CT imaging based on a clear understanding of such anatomical anomalies is particularly important for performing safe laparoscopic surgery.
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Affiliation(s)
- Masayo Kawakami
- Department of Surgery, Okinawa Red Cross Hospital, Okinawa, Japan
| | | | - Takeshi Tomiyama
- Department of Surgery, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Takehiko Tomori
- Department of Surgery, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Jun Miyagi
- Department of Surgery, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Seiji Nagayoshi
- Department of Surgery, Okinawa Red Cross Hospital, Okinawa, Japan
| | - Yasushi Ohmine
- Department of Surgery, Okinawa Red Cross Hospital, Okinawa, Japan
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Consul N, Orman G, Huisman TAGM, Sorte DE, Gailloud P. Duplication of the Inferior Vena Cava Associated with Open Spinal Dysraphism. Clin Neuroradiol 2020; 31:273-275. [PMID: 32747974 DOI: 10.1007/s00062-020-00940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 07/09/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Nikita Consul
- Department of Radiology, Baylor College of Medicine, Houston, TX, USA.,Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, 77030, Houston, TX, USA
| | - Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, 77030, Houston, TX, USA.
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, 6701 Fannin Street, Suite 470, 77030, Houston, TX, USA.,Divisions of Interventional Neuroradiology and Pediatric Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Danielle Eckart Sorte
- Divisions of Interventional Neuroradiology and Pediatric Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA
| | - Philippe Gailloud
- Divisions of Interventional Neuroradiology and Pediatric Neuroradiology, The Johns Hopkins Hospital, Baltimore, MD, USA
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Dávalos GA, Muñoz CA, Cornejo FJ, Garcés J, Endara SA. Abnormal development of the inferior vena cava and its implications on distal venous drainage during cardiac surgery and other clinical entities. J Surg Case Rep 2019; 2019:rjz289. [PMID: 31700603 PMCID: PMC6827555 DOI: 10.1093/jscr/rjz289] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 08/28/2019] [Indexed: 12/27/2022] Open
Abstract
Congenital anomalies of the inferior vena cava (IVC) are caused by an abnormal persistence or regression of embryonic precursor veins; they are usually incidental findings on imaging studies. These rare conditions have a 0.6% prevalence in individuals with congenital heart diseases and 0.3% in healthy patients. The purpose of this paper was to report two cases of interruption of IVC with hemiazygos continuation and its implications during surgery, highlighting that after recognizing this anomalous drainage the surgeon should be prepared to change the surgical strategies, especially in cardiovascular surgery, in order to obtain adequate circulatory flows or surgical exposure where venous cannulation could be difficult. We have also reported two cases of healthy patients with the same isolated IVC anomaly with no clinical repercussions, which can develop in the future.
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Affiliation(s)
- Gerardo A Dávalos
- Division of Cardiothoracic Surgery, Department of General Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Carmina A Muñoz
- Urology Resident, Universidad de las Américas (UDLA), Quito, Ecuador
| | - Francisco J Cornejo
- Division of Urology, Department of General Surgery, Hospital Metropolitano, Quito, Ecuador
| | - Juan Garcés
- Division of Radiology, Department of Internal Medicine, Hospital Metropolitano, Quito, Ecuador
| | - Santiago A Endara
- Division of Cardiothoracic Surgery, Department of General Surgery, Hospital Metropolitano, Quito, Ecuador
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Hostiuc S, Minoiu C, Negoi I, Rusu MC, Hostiuc M. Duplication and transposition of inferior vena cava: A meta-analysis of prevalence. J Vasc Surg Venous Lymphat Disord 2019; 7:742-755. [PMID: 31068277 DOI: 10.1016/j.jvsv.2019.01.063] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 01/27/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVE The primary aim of this article was to establish the actual prevalence of transposition and duplication of the inferior vena cava and to increase awareness about them. METHODS A meta-analysis of prevalence was conducted of cases obtained from PubMed, Web of Science, and Scopus databases. RESULTS A total of 48 studies contained data that allowed us to estimate the prevalence of these variants (39 for duplication and 32 for transposition). The overall prevalence of duplication was 0.7%, with a 95% confidence interval between 0.5% and 0.9%; for transposition, the prevalence was 0.3%, with a 95% confidence interval between 0.2% and 0.5%. The publication bias was minimal. Duplication prevalence was significantly higher in anatomy studies compared with imaging and surgery studies; for transposition, there were no statistically significant differences by detection technique. CONCLUSIONS The overall prevalence of duplication of the inferior vena cava is 0.7%; for transposition, it is 0.3%. Even if they are obviously rare conditions, their presence must be suspected by practitioners as they can have important clinical consequences, may require changes in the surgery protocol, or can be associated with other congenital abnormalities.
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Affiliation(s)
- Sorin Hostiuc
- Department of Legal Medicine and Bioethics, Faculty of Dental Medicine, Bucharest, Romania.
| | - Costin Minoiu
- Department of Radiology, Floreasca Clinical Emergency Hospital, Bucharest, Romania
| | - Ionut Negoi
- Department of Surgery, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Mihaela Hostiuc
- Department of Internal Medicine and Gastroenterology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
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Tatarano S, Enokida H, Yamada Y, Nishimura H, Yoshino H, Ishihara T, Yonemori M, Eura R, Sakaguchi T, Nakagawa M. Anatomical Variations of the Left Renal Vein During Laparoscopic Donor Nephrectomy. Transplant Proc 2019; 51:1311-1313. [PMID: 31036354 DOI: 10.1016/j.transproceed.2019.01.132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 01/28/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVES The aim of this study is to investigate the outcome of laparoscopic donor nephrectomy with vascular anomalies of the left renal vein. PATIENTS AND METHODS Between August 2010 and September 2018, a total of 120 laparoscopic donor nephrectomies were performed at Kagoshima University. Among them, we experienced 7 cases of donors with anomalous left renal vein (circumaortic left renal vein n = 5, retroaortic left renal vein n = 1, left renal vein drainage into hemiazygos vein n = 1). We analyzed the following clinical outcomes: pneumoperitoneum time, estimated blood loss, warm ischemia time, length of hospital stay, and serum creatinine level of 1 month after surgery for evaluating the safety of laparoscopic donor nephrectomy. RESULTS Among the 7 cases, 3 cases underwent transperitoneal approach, and 4 cases underwent retroperitoneal approach. The median pneumoperitoneum time was 168 (108-191) minutes. The median estimated blood loss was 90 (23-170) mL, and no donor required a blood transfusion. Median warm ischemia time was 4 (3-7) minutes. Length of hospital stay was 7 (6-9) days, and no readmission occurred. Median serum creatinine level of 1 month after surgery was 1.19 (0.84-1.74) mg/dL. Kidneys were transplanted successfully, and none of recipients required dialysis. CONCLUSIONS Laparoscopic donor nephrectomy was safe for donors with an anomalous left renal vein. Preoperative recognition of anomalous left renal vein in computed tomography is important for avoiding hemorrhagic complication.
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Affiliation(s)
- Shuichi Tatarano
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
| | - Hideki Enokida
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yasutoshi Yamada
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hiroaki Nishimura
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Hirofumi Yoshino
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Tomoaki Ishihara
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masaya Yonemori
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Rumiko Eura
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Takashi Sakaguchi
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Masayuki Nakagawa
- Department of Urology, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
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Rampersad F, Chan A, Diljohn J. Retroaortic left renal vein (RLRV) draining into the left common iliac vein: a rare variant and its clinical implication. BMJ Case Rep 2019; 12:12/5/e230004. [DOI: 10.1136/bcr-2019-230004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Fontana F, Coppola A, Ossola C, Beneventi A, Macchi E, Fugazzola C. Hypoplasia of right renal vein with aberrant drainage into ipsilateral spermatic vein: Case report. Radiol Case Rep 2019; 14:156-159. [PMID: 30405867 PMCID: PMC6218701 DOI: 10.1016/j.radcr.2018.10.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 10/11/2018] [Accepted: 10/13/2018] [Indexed: 11/17/2022] Open
Abstract
The objective of this study was to describe a case of marked hypoplasia of the right renal vein with drainage into ipsilateral gonadal vein. A 66-year-old man, known for hypertension and previous smoking, underwent an abdominal ultrasound exam, which detected a juxtarenal aortic aneurysm. Computed tomography scan confirmed the presence of the aortic aneurysm; furthermore it showed an abnormal right kidney venous drainage consistent in a dilated and tortuous vein, which originated at the hilar region, heading caudally and joining the right spermatic vein at level of aortic carrefour. A thin vein—located more cranially with mild and late contrast enhancement—was also demonstrated from right kidney hilum to inferior vena cava, probably representing a remnant of the right main renal vein. To our knowledge, this anatomic variant was never reported in the peer-reviewed literature.
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25
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Guo F, Li T, Liu W, Wang G, Ma R, Wu R. Wilms tumor with inferior vena cava duplication: a rare case report. BMC Urol 2018; 18:88. [PMID: 30340580 PMCID: PMC6194641 DOI: 10.1186/s12894-018-0401-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 10/04/2018] [Indexed: 11/26/2022] Open
Abstract
Background Wilms tumor is the most common renal tumor of childhood. Duplication of the inferior vena cava is an uncommon anomaly. In the present study, we present a case of Wilms tumor with the inferior vena cava duplication, which has not been reported previously. Case presentation A 14-month-old female presented with an enlarging abdominal mass. Computed tomography imaging demonstrated a large mass in the right kidney, duplication of the inferior vena cava below the renal veins and compression of the right inferior vena cava caused by the enormous mass. A right radical nephrectomy was performed. Final pathology was consistent with Wilms tumor. Postoperative adjuvant chemotherapy was executed. Computed tomography imaging at 3 months postoperatively showed the right inferior vena cava played a dominant role and the left inferior vena cava was not detected clearly. During the follow-up of 18 months, no local recurrence or metastasis has been observed. Conclusion It is important to recognize the case of Wilms tumor with the inferior vena cava duplication to avoid injury of retroperitoneal venous anomalies and life-threatening hemorrhage during surgery through preoperative computed tomography. Electronic supplementary material The online version of this article (10.1186/s12894-018-0401-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Feng Guo
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, Shandong Province, People's Republic of China
| | - Tianyou Li
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, Shandong Province, People's Republic of China
| | - Wei Liu
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, Shandong Province, People's Republic of China
| | - Gang Wang
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, Shandong Province, People's Republic of China
| | - Rui Ma
- Shandong Medical Imaging Research Institute, Medical School of Shandong University, Jinan, Shandong Province, People's Republic of China
| | - Rongde Wu
- Department of Pediatric Surgery, Shandong Provincial Hospital Affiliated to Shandong University, 324 Jingwu Road, Jinan, 250021, Shandong Province, People's Republic of China.
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Kim SS, Shin HC, Hwang JA, Jou SS, Lee WH, Choi SY, Park CH. Various congenital anomalies of the inferior vena cava: review of cross-sectional imaging findings and report of a new variant. Abdom Radiol (NY) 2018; 43:2130-2149. [PMID: 29264715 DOI: 10.1007/s00261-017-1430-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The inferior vena cava (IVC) is an important structure receiving a large amount of venous return and is associated with various congenital disorders. Advances in diagnostic imaging and its increasing accessibility have led to an increase in the incidental detection of IVC anomalies. Congenital anomalies of the IVC are not uncommon and are occasionally critical to treatment planning. However, they are frequently overlooked in abdominal imaging. The IVC is composed of four segments (intrahepatic, suprarenal, renal, and infrarenal), and each segment arises from different embryonic structures in a complex process. Anomalies of the IVC can be classified according to the involved segment. Familiarity with the variety of IVC anomalies seen on imaging is vital for correctly diagnosing and managing patients in daily practice.
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Affiliation(s)
- Seung Soo Kim
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
| | - Hyeong Cheol Shin
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea.
| | - Jeong Ah Hwang
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
| | - Sung Shick Jou
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
| | - Woong Hee Lee
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
| | - Seo-Youn Choi
- Department of Radiology, Soonchunhyang University College of Medicine, Bucheon Hospital, Bucheon, Republic of Korea
| | - Chan Ho Park
- Department of Radiology, Soonchunhyang University College of Medicine, Cheonan Hospital 31 Soonchunhyang6-gil, Dongnam-gu, Cheonan-si,, Chungcheongnam-do, 330-721, Republic of Korea
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Kanno K, Andou M, Yanai S, Shirane A, Nakajima S, Ebisawa K, Hada T, Ota Y. Retroperitoneoscopic Para-Aortic Lymphadenectomy with High-Level Vena Cava Bifurcation. J Minim Invasive Gynecol 2018; 25:761-762. [DOI: 10.1016/j.jmig.2017.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 11/24/2022]
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Patel S, Cheema A, Karawadia T, Carson M. Management of acute lower extremity deep venous thrombosis in a patient with duplicated inferior vena cava and contraindication to anticoagulation: case and review of the literature. BMJ Case Rep 2018; 2018:bcr-2017-222974. [PMID: 29866665 PMCID: PMC5990095 DOI: 10.1136/bcr-2017-222974] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Duplication of the inferior vena cava (DIVC) is an uncommon embryological anatomic phenomenon.We report a 63-year-old woman with extensive right leg deep vein thrombosis who required an IVC filter due to contraindications for anticoagulation, but was found to have DIVC which required the placement of two IVC filters with good result. This report will review and summarise past reports of DIVC management to provide a guide for future clinicians, and review the embryological development, diagnosis and IVC filter placement options as they are based on the type of anatomic malformation encountered.
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Affiliation(s)
- Shrinil Patel
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Anmol Cheema
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Tejas Karawadia
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Michael Carson
- Department of Medicine, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
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Potgieter RE, Taylor AM, Wessels Q. A rare combined variation of the coeliac trunk, renal and testicular vasculature. Anat Cell Biol 2018; 51:62-65. [PMID: 29644111 PMCID: PMC5890018 DOI: 10.5115/acb.2018.51.1.62] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/16/2017] [Accepted: 12/26/2017] [Indexed: 01/04/2023] Open
Abstract
The authors report a rare variation of the coeliac trunk, renal and testicular vasculature in a 27-year-old male cadaver. In the present case, the coeliac trunk and superior mesenteric artery was replaced by a modified coeliacomesenteric trunk formed by hepato-gastric and superior mesenteric arteries. Here the hepato-gastric artery or trunk contributed towards the total hepatic inflow as well as a gastro-duodenal artery. A separate right gastric artery and an additional superior pancreatico-duodenal artery was also found in addition with a retro-aortic left renal vein and a bilateral double renal arterial supply. The aforementioned coeliac trunk variation, to our knowledge, has never been reported before and this variation combined with the renal vasculature requires careful surgical consideration.
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Affiliation(s)
| | - Adam Michael Taylor
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
| | - Quenton Wessels
- Department of Anatomy, School of Medicine, University of Namibia, Windhoek, Namibia
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Abstract
The aim of the study was to determine the incidence of renal venous system congenital anomalies in the Polish population. MATERIAL AND METHOD Vascular kidney samples were investigated by means of preparations and X-ray contrasting. The study the group comprised 281 male and 269 female specimens. RESULTS Congenital anomalies were diagnosed in 186 patients (33 8% of all cases), and they were more frequent in men than in women, albeit that difference was non-significant. The following anomalies were most commonly observed: multiple venous variations on the right side (20.4%), retroaortic course of the left renal vein (4.2%), and circumaortic venous ring of the left renal vein (3.8%). Other anomalies were diagnosed in 1%-2% of cases. CONCLUSIONS Awareness and preoperative assessment of the venous system before abdominal aortic surgery, isolated collection of renal venous blood samples, and urological or kidney transplantation procedures is essential.
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Affiliation(s)
- Henryk Sośnik
- Department of Pathomorphology, Regional Specialist Hospital, Wrocław, Poland
| | - Katarzyna Sośnik
- Department of Pathomorphology, Regional Specialist Hospital, Wrocław, Poland
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What Each Clinical Anatomist Has to Know about Left Renal Vein Entrapment Syndrome (Nutcracker Syndrome): A Review of the Most Important Findings. BIOMED RESEARCH INTERNATIONAL 2017; 2017:1746570. [PMID: 29376066 PMCID: PMC5742442 DOI: 10.1155/2017/1746570] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2017] [Accepted: 10/12/2017] [Indexed: 12/21/2022]
Abstract
Nutcracker syndrome (NCS) is the most common term for compression of the left renal vein between the superior mesenteric artery and the abdominal aorta. The development of NCS is associated with the formation of the left renal vein (LRV) from the aortic collar during the sixth to eighth week of gestation and abnormal angulation of the superior mesenteric artery from the aorta. Collateralization of venous circulation is the most significant effect of NCS. It includes mainly the left gonadal vein and the communicating lumbar vein. Undiagnosed NCS may affect retroperitoneal surgery and other radiological and vascular procedures. The clinical symptoms of NCS may generally be described as renal presentation when symptoms like haematuria, left flank pain, and proteinuria occur, but urologic presentation is also possible. Radiological methods of confirming NCS include Doppler ultrasonography as a primary test, retrograde venography, which can measure the renocaval pressure gradient, computed tomography angiography, which is faster and less traumatic, intravascular ultrasound, and magnetic resonance angiography. Treatment can be conservative or surgical, depending on the severity of symptoms and degree of LRV occlusion. Nutcracker syndrome is worth considering especially in differential diagnosis of haematuria of unknown origin.
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Monroe EJ, Carney BW, Ingraham CR, Johnson GE, Valji K. An Interventionist's Guide to Endocrine Consultations. Radiographics 2017; 37:1246-1267. [PMID: 28696848 DOI: 10.1148/rg.2017160102] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Endocrinopathies are a heterogeneous group of disorders often resulting from pathologic sources of hormone production. When the clinical scenario, laboratory testing, and noninvasive imaging fail to aid confident identification of the source of hormone excess, endocrine venous sampling may localize obscure lesions to guide subsequent treatment. Knowledge of basic hormone signaling pathways, common pathophysiologic disruptions of these pathways, and serologic evaluation fosters informed conversations with referring physicians and effective patient selection. Success in the angiography suite requires familiarity with normal and variant anatomy of the multiple organs of the endocrine system, patient preparation, stimulation and sampling techniques, specimen handling, and results interpretation. ©RSNA, 2017.
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Affiliation(s)
- Eric J Monroe
- From the Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S MA.7.220, Seattle, WA 98105 (E.J.M.); and Department of Radiology, University of Washington, Seattle, Wash (E.J.M., B.W.C., C.R.I., G.E.J., K.V.)
| | - Benjamin W Carney
- From the Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S MA.7.220, Seattle, WA 98105 (E.J.M.); and Department of Radiology, University of Washington, Seattle, Wash (E.J.M., B.W.C., C.R.I., G.E.J., K.V.)
| | - Christopher R Ingraham
- From the Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S MA.7.220, Seattle, WA 98105 (E.J.M.); and Department of Radiology, University of Washington, Seattle, Wash (E.J.M., B.W.C., C.R.I., G.E.J., K.V.)
| | - Guy E Johnson
- From the Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S MA.7.220, Seattle, WA 98105 (E.J.M.); and Department of Radiology, University of Washington, Seattle, Wash (E.J.M., B.W.C., C.R.I., G.E.J., K.V.)
| | - Karim Valji
- From the Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, M/S MA.7.220, Seattle, WA 98105 (E.J.M.); and Department of Radiology, University of Washington, Seattle, Wash (E.J.M., B.W.C., C.R.I., G.E.J., K.V.)
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Ghandour A, Partovi S, Karuppasamy K, Rajiah P. Congenital anomalies of the IVC-embryological perspective and clinical relevance. Cardiovasc Diagn Ther 2016; 6:482-492. [PMID: 28123970 DOI: 10.21037/cdt.2016.11.18] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
With the increased use of cross-sectional imaging, systemic venous anomalies are more frequently being recognized in asymptomatic patients. Accurate characterization of systemic venous anomalies plays a major role in the appropriate selection of a surgical approach or interventional procedure. In this article, we review common and uncommon inferior vena cava (IVC) anomalies. We describe the embryological basis and clinical implications of these anomalies, particularly from an interventional radiology perspective. We also discuss the complications and treatments of these anomalies.
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Affiliation(s)
- Abed Ghandour
- Imaging Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sasan Partovi
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Prabhakar Rajiah
- Cardiothoracic Imaging, Radiology Department, UT Southwestern Medical Center, Dallas, Texas, USA
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Wu LH, Xie HN, Paladini D, Zheng J, Du L, Lin MF. Azygos Vein Z Scores in Healthy Fetuses and Fetuses With Venous Malformations Related to the Azygos Vein. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2563-2574. [PMID: 27738290 DOI: 10.7863/ultra.16.01087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/20/2016] [Accepted: 03/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To establish fetal azygos vein and descending aorta sonographic Z score formulas based on femur length and gestational age and to determine the value of azygos vein diameter variation for potential use in the diagnosis of fetal venous malformations related to the azygos vein. METHODS A total of 452 healthy singleton fetuses and 25 fetuses with venous malformations related to the azygos vein underwent prenatal sonography in this retrospective study. Azygos vein and descending aorta diameters were measured offline after spatiotemporal image correlation volume acquisition. Normal azygos vein and descending aorta Z score formulas were constructed for these measurements based on femur length by performing standard regression analysis followed by weighted regression of absolute residual values. The azygos vein-to-descending aorta ratio was calculated. Three parameters were compared between venous malformations related to the azygos vein and healthy fetuses. RESULTS Azygos vein and descending aorta Z score formulas were constructed. Both showed a positive linear correlation with femur length (r = 0.79 and 0.90, respectively; P < .01) and gestational age (r = 0.79 and 0.91; P < .01). The azygos vein Z scores and azygos vein-to-descending aorta ratios of fetuses with malformations were significantly higher than those of healthy fetuses (P < .01). In the abnormal group, 96.0% of azygos vein Z scores (24 of 25) were greater than ±2, and 96.0% of azygos vein-to-descending aorta ratios (24 of 25) were greater than the 95% confidence interval. CONCLUSIONS The azygos vein Z score formulas we developed can provide a quantitative basis for prenatal screening of venous malformations related to the azygos vein. Azygos vein dilatation and an abnormal azygos vein-to-descending aorta ratio may contribute to increasing the recognition of venous malformations involving the azygos vein.
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Affiliation(s)
- Li-Hong Wu
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Hong-Ning Xie
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Dario Paladini
- Department of Fetal Medicine and Surgery Unit, Istituto G. Gaslini, Genoa, Italy
| | - Ju Zheng
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liu Du
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Mei-Fang Lin
- Department of Ultrasonic Medicine, Fetal Medical Center, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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Inferior Vena Cava Duplication: Incidental Case in a Young Woman. Case Rep Radiol 2016; 2016:3071873. [PMID: 27217964 PMCID: PMC4863078 DOI: 10.1155/2016/3071873] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 04/12/2016] [Indexed: 11/17/2022] Open
Abstract
A case of a double inferior vena cava (IVC) with retroaortic left renal vein, azygos continuation of the IVC, and presence of the hepatic portion of the IVC drained into the right renal vein is reported and the embryologic, clinical, and radiological significance is discussed. The diagnosis is suggested by multidetector computed tomography (MDCT), which reveals the aberrant vascular structures. Awareness of different congenital anomalies of IVC is necessary for radiologists to avoid diagnostic pitfalls and they should be remembered because they can influence several surgical interventions and endovascular procedures.
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Аliev MM, Yuldashev RZ, Аdilova GS, Dekhqonboev АА. Renal venous hypertension. World J Hypertens 2016; 6:60-65. [DOI: 10.5494/wjh.v6.i1.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 10/30/2015] [Accepted: 01/04/2016] [Indexed: 02/06/2023] Open
Abstract
Renal venous hypertension usually seen in young, otherwise healthy individuals and can lead to significant overall morbidity. Aside from clinical findings and physical examination, diagnosis can be made with ultrasound, computed tomography, or magnetic resonance conventional venography. Symptoms and haemodynamic significance of the compression determine the ideal treatment method. This review of the literature discusses normal and pathological developmental aspects of renocaval venous segment and related circulatory disorders, summarizes congenital and acquired changes in left renal vein and their impact on development of renal venous hypertension. Also will be discussed surgical tactics of portosystemic shunting and their potential effects on renal hemodynamics.
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38
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[Vascular reconstruction in visceral transplantation surgery]. Chirurg 2015; 87:114-8. [PMID: 26541451 DOI: 10.1007/s00104-015-0108-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Vascular reconstruction is obligatory in transplantation surgery. A differentiation is made between routine vascular reconstructions, which are required for all solid organ transplantations and special cases. Because of the shortage of organs it is often necessary to use organs with complex anatomical vascular prerequisites, which requires high vascular surgical expertise for individualized reconstruction. Non-routine reconstructions are often also necessary on the side of the recipient. This review article presents both the routine and exceptional types of reconstruction.
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Watson CJE, Harper SJF. Anatomical variation and its management in transplantation. Am J Transplant 2015; 15:1459-71. [PMID: 25981150 DOI: 10.1111/ajt.13310] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 03/05/2015] [Indexed: 01/25/2023]
Abstract
Variant anatomy may be challenging at retrieval, with failure to identify variance being associated with organ damage, particularly vascular damage. On implantation, some variants demand nonstandard techniques of reconstruction or implantation. This review covers the common and less common anatomical variants of the liver, kidney and pancreas, and gives guidance as to how they may be managed during organ retrieval and implantation.
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Affiliation(s)
- C J E Watson
- Department of Surgery, University of Cambridge, Cambridge, UK.,Cambridge NIHR Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
| | - S J F Harper
- Department of Surgery, University of Cambridge, Cambridge, UK.,Cambridge NIHR Biomedical Research Centre, Addenbrooke's Hospital, Cambridge, UK
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Hikspoors JPJM, Soffers JHM, Mekonen HK, Cornillie P, Köhler SE, Lamers WH. Development of the human infrahepatic inferior caval and azygos venous systems. J Anat 2015; 226:113-25. [PMID: 25496171 PMCID: PMC4304567 DOI: 10.1111/joa.12266] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2014] [Indexed: 11/29/2022] Open
Abstract
Differences in opinion regarding the development of the infrahepatic inferior caval and azygos venous systems in mammals centre on the contributions of 'caudal cardinal', 'subcardinal', 'supracardinal', 'medial and lateral sympathetic line' and 'sacrocardinal' veins. The disagreements appear to arise from the use of topographical position rather than developmental origin as criterion to define separate venous systems. We reinvestigated the issue in a closely spaced series of human embryos between 4 and 10 weeks of development. Structures were visualized with the Amira(®) reconstruction and Cinema4D(®) remodelling software. The vertebral level and neighbouring structures were used as topographic landmarks. The main results were that the caudal cardinal veins extended caudally from the common cardinal vein between CS11 and CS15, followed by the development of the subcardinal veins as a plexus sprouting ventrally from the caudal cardinal veins. The caudal cardinal veins adapted their course from lateral to medial relative to the laterally expanding lungs, adrenal glands, definitive kidneys, sympathetic trunk and umbilical arteries between CS15 and CS18, and then became interrupted in the part overlaying the regressing mesonephroi (Th12-L3). The caudal part of the left caudal cardinal vein then also regressed. The infrarenal part of the inferior caval vein originated from the right caudal cardinal vein, while the renal part originated from subcardinal veins. The azygos veins developed from the remaining cranial part of the caudal cardinal veins. Our data show that all parts of the inferior caval and azygos venous systems developed directly from the caudal cardinal veins or from a plexus sprouting from these veins.
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Affiliation(s)
- Jill P J M Hikspoors
- Department of Anatomy & Embryology, Maastricht UniversityMaastricht, The Netherlands
| | - Jelly H M Soffers
- Department of Anatomy & Embryology, Maastricht UniversityMaastricht, The Netherlands
| | - Hayelom K Mekonen
- Department of Anatomy & Embryology, Maastricht UniversityMaastricht, The Netherlands
| | - Pieter Cornillie
- Department of Morphology, Faculty of Veterinary Medicine, Ghent UniversityMerelbeke, Belgium
| | - S Eleonore Köhler
- Department of Anatomy & Embryology, Maastricht UniversityMaastricht, The Netherlands
| | - Wouter H Lamers
- Department of Anatomy & Embryology, Maastricht UniversityMaastricht, The Netherlands
- Tygat Institute for Liver and Intestinal Research, Academic Medical CentreAmsterdam, The Netherlands
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Heidler S, Hruby S, Schwarz S, Sellner-Zwieauer Y, Hoeltl W, Albrecht W. Prevalence and incidence of clinical symptoms of the retroaortic left renal vein. Urol Int 2015; 94:173-6. [PMID: 25661199 DOI: 10.1159/000367697] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 08/19/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the prevalence and incidence of clinical symptoms of retroaortic left renal vein (RLRV) diagnosed incidentally over 10 years by computed tomography (CT). PATIENTS AND METHODS 7,929 consecutive patients (out- and inpatients) were studied with multidetector CT from January 2000 to April 2011. We retrospectively reviewed RLRV patients' medical records and analyzed their clinical characteristics. RESULTS A total of 61 out of 7,929 patients had a RLRV, therefore the prevalence was 0.77%. Only 4 of 61 (6.6%) RLRV patients diagnosed by CT scan were clinically symptomatic. RLRV was associated with flank pain and microhematuria in one patient (1.6%), in another one with microhematuria only and in one with ureteropelvic junction obstruction. Furthermore, one patient suffered from arterial hypertension associated with a RLRV. CONCLUSIONS RLRV is a rare finding, and only a small minority of RLRVs causes symptoms.
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Affiliation(s)
- Stefan Heidler
- Department of Urology, Landesklinik Weinviertel Mistelbach-Gänserndorf, Mistelbach, Austria
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Steinhaus J, Berent A, Weisse C, Eatroff A, Donovan T, Haddad J, Bagley D. Clinical presentation and outcome of cats with circumcaval ureters associated with a ureteral obstruction. J Vet Intern Med 2015; 29:63-70. [PMID: 25270055 PMCID: PMC4858092 DOI: 10.1111/jvim.12465] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/24/2014] [Accepted: 08/25/2014] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Circumcaval ureters (CU) are a rare embryological malformation resulting in ventral displacement of the caudal vena cava, which crosses the ureter, potentially causing a ureteral stricture. OBJECTIVES To evaluate cats with obstructed CU(s) and report the presenting signs, diagnostics, treatment(s), and outcomes. Cats with obstructed CU(s) were compared to ureterally obstructed cats without CU(s). ANIMALS 193 cats; 22 circumcaval obstructed (Group 1); 106 non-circumcaval obstructed (Group 2); 65 non-obstructed necropsy cases (Group 3). METHODS Retrospective study, review of medical records for cats treated for benign ureteral obstructions from AMC and University of Pennsylvania between 2009 and 2013. INCLUSION CRITERIA surgical treatment of benign ureteral obstruction, complete medical record including radiographic, ultrasonographic, biochemistry, and surgical findings. RESULTS Seventeen percent (22/128) of obstructed cats had a CU (80% right-sided) compared to 14% (9/65) non-obstructed necropsy cats (89% right-sided). Clinical presentation, radiographic findings, and creatinine were not statistically different between Groups 1 and 2. Strictures were a statistically more common (40%) cause of ureteral obstruction in Group 1 compared to Group 2 (17%) (P = .01). The MST for Groups 1 and 2 after ureteral decompression was 923 and 762 days, respectively (P = .62), with the MST for death secondary to kidney disease in both groups being >1,442 days. Re-obstruction was the most common complication in Group 1 (24%) occurring more commonly in ureters of cats treated with a ureteral stent(s) (44%) compared to the subcutaneous ureteral bypass (SUB) device (8%) (P = .01). CONCLUSIONS AND CLINICAL IMPORTANCE Ureteral obstructions in cats with a CU(s) have a similar outcome to those cats with a ureteral obstruction and normal ureteral anatomy. Long-term prognosis is good for benign ureteral obstructions treated with a double pigtail stent or a SUB device. The SUB device re-obstructed less commonly than the ureteral stent, especially when a ureteral stricture was present.
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Affiliation(s)
- J. Steinhaus
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - A.C. Berent
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - C. Weisse
- Department of Interventional Radiology and EndoscopyThe AMCNew YorkNY
| | - A. Eatroff
- Department of Internal MedicineBluePearl Veterinary PartnersNew YorkNY
| | - T. Donovan
- Department of Anatomic PathologyThe AMCNew YorkNY
| | - J. Haddad
- Department of Anatomic and Clinical PathologyIdexx LaboratoriesNew YorkNY
| | - D. Bagley
- Thomas Jefferson UniversityPhiladelphiaPA
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Resorlu M, Sariyildirim A, Resorlu B, Sancak EB, Uysal F, Adam G, Akbas A, Aylanc N, Gulpinar MT, Karatag O, Ozdemir H. Association of congenital left renal vein anomalies and unexplained hematuria: multidetector computed tomography findings. Urol Int 2014; 94:177-80. [PMID: 25138660 DOI: 10.1159/000365664] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 07/02/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To investigate whether congenital renal vein anomalies are involved in the etiology of hematuria by analyzing abdominal multidetector computed tomography (MDCT) results. METHODS Six hundred and eighty patients undergoing MDCT for various abdominal pathologies in whom possible causes of hematuria were excluded were retrospectively assessed in terms of left renal vein anomalies, such as circumaortic left renal vein (CLRV), retroaortic left renal vein (RLRV) and multiple renal vein (MRV). Patients with CLRV, RLRV or MRV and patients with normal left renal veins were compared in terms of the presence of hematuria. RESULTS Left renal vein anomalies were detected in 100 patients (14.7%). RLRV, CLRV and MRV were identified in 5.4, 2.5 and 6.8% of patients, respectively. Hematuria was determined in 8.1% of patients with an RLRV anomaly and in 10.5% of patients with no RLRV anomaly (p=0.633). Hematuria was detected in 23.5% of patients with a CLRV anomaly and 10.1% of those without (p=0.074), and in 21.7% of patients with an MRV anomaly and 9.6% of those without (p=0.009). CONCLUSIONS In addition to increasing risk of complication during retroperitoneal surgery, numeric congenital renal vein anomalies are also significant in terms of leading to clinical symptoms such as hematuria.
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Affiliation(s)
- Mustafa Resorlu
- Department of Radiology, Canakkale Onsekiz Mart University, Canakkale, Turkey
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Spentzouris G, Zandian A, Cesmebasi A, Kinsella CR, Muhleman M, Mirzayan N, Shirak M, Tubbs RS, Shaffer K, Loukas M. The clinical anatomy of the inferior vena cava: a review of common congenital anomalies and considerations for clinicians. Clin Anat 2014; 27:1234-43. [PMID: 25042045 DOI: 10.1002/ca.22445] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Revised: 06/27/2014] [Accepted: 07/02/2014] [Indexed: 12/15/2022]
Abstract
Anomalies in the course and drainage of the Inferior Vena Cava (IVC) may complicate normal functioning, correct diagnosis, and therapeutic interventions within the abdomen. Development of the IVC occurs during the 4th to 8th week of gestation, and due to its developmental complexity, there are many opportunities for malformations to occur. Although most IVC anomalies are clinically silent and are usually discovered incidentally on abdominal imaging, aberrations may be responsible for formation of thrombosis, back pain, and anomalous circulation of blood to the heart. In this review, we will discuss the most common variations and abnormalities of the IVC, which include the posterior cardinal veins, the subcardinal veins, the supracardinal veins, persistent left IVC, IVC duplication, situs inversus, left retroaortic renal vein, left circumaortic renal collar, scimitar syndrome, and IVC agenesis. For each abnormality outlined above, we aim to discuss relevant embryology and potential clinical significance with regards to presentation, diagnosis, and treatment as is important for radiologists, surgeons, and clinicians in current clinical practice.
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Affiliation(s)
- Georgios Spentzouris
- Department of Anatomical Sciences, School of Medicine, St. George's University, St. George's, Grenada, West Indies
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Verma H, Hiremath N, George RK, Tripathi RK. Endovascular management of venous ulcer in a patient with occluded duplicated inferior vena cava and review of inferior vena cava development. Vasc Endovascular Surg 2013; 48:162-5. [PMID: 24226789 DOI: 10.1177/1538574413510627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Duplication of inferior vena cava (IVC) is the most common IVC anomaly. We report a successful iliac vein and collateral stenting for venous decompression in a patient with an occluded right femorocaval graft with a duplicated IVC. We also review the literature of embryological development of IVC.
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Affiliation(s)
- Himanshu Verma
- 1Narayana Hrudayalaya Institute of Vascular Sciences, Narayana Hrudaylaya Hospitals, Bangalore, India
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47
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Kim MK, Ku YM, Chun CW, Lee SL. MDCT findings of right circumaortic renal vein with ectopic kidney. Korean J Radiol 2013; 14:786-8. [PMID: 24043973 PMCID: PMC3772259 DOI: 10.3348/kjr.2013.14.5.786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 05/09/2013] [Indexed: 11/15/2022] Open
Abstract
Anomalies of renal vasculature combined with ectopic kidneys were found on a multi-detector CT scan. Knowledge of renal vascular variation is very important for surgical exploration, radiologic intervention and staging for urologic cancer. We present an extremely rare case of a right circumaortic renal vein combined with a right ectopic kidney. The right kidney was located at the level between the third and fifth lumbar vertebra. The right circumaortic renal vein crossed the aorta and returned to the inferior vena cava behind the aorta.
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Affiliation(s)
- Min-Kyun Kim
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu 480-717, Korea
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López-Núñez M, Tuneu-Valls A, Jaka-Moreno A, Lopez-Obregon C, Ormaechea-Perez N. Cutaneous aspects of congenital absence of the inferior vena cava in a newborn. Pediatr Dermatol 2013; 30:e18-9. [PMID: 22747743 DOI: 10.1111/j.1525-1470.2012.01774.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We present the case of a 9-day-old girl with venous dilatations in lower abdomen and legs associated to cyanosis. Radiological studies revealed a congenital agenesis of the entire inferior vena cava.
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Affiliation(s)
- María López-Núñez
- Dermatology Department, Hospital Donostia, San Sebastián, Spain Dermatology Department, Hospital Marqués de Valdecilla, Santander, Spain.
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Keskin S. Angiography of Azygos Continuation of Inferior Vena
Cava with Polysplenia. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Ang WC, Doyle T, Stringer MD. Left-sided and duplicate inferior vena cava: a case series and review. Clin Anat 2012; 26:990-1001. [PMID: 22576868 DOI: 10.1002/ca.22090] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 03/23/2012] [Accepted: 03/31/2012] [Indexed: 01/21/2023]
Abstract
Left-sided and duplicate inferior vena cava (IVC) are two major anatomical variants within the spectrum of IVC malformations, both of which are developmental abnormalities of the supracardinal veins. Four clinical cases are described to highlight the computed tomographic appearances of these vascular malformations and provide novel data on venous dimensions. A systematic review of the recent literature (2000-2011) was conducted focusing on the anatomy, demographics, and associated pathology (congenital and acquired) of isolated left-sided and duplicate IVC. A total of 73 relevant articles were retrieved, consisting of case reports and small case series. The prevalence of left-sided IVC is about 0.1-0.4% and that for duplicate IVC about 0.3-0.4%; both anomalies show a slight male preponderance. In each condition, there are documented variations in the course and tributaries of the IVC. The clinical importance of these anomalies lies in three principal areas: the potential for misdiagnosis on imaging; technical difficulties during retroperitoneal surgery (particularly abdominal aortic aneurysm repair and live donor nephrectomy); and their significance in relation to the etiology and management of venous thromboembolism.
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Affiliation(s)
- Wee Choen Ang
- Department of Anatomy, Otago School of Medical Sciences, University of Otago, Dunedin, New Zealand
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