Ramos Aranda J, Ramírez Cerda C, Cohen Mussali S, Valdés Flores J
General Surgery Department Resident, American British Cowdray Hospital, Mexico City, Mexico.
Vascular Surgery Department, American British Cowdray Hospital, Mexico City, Mexico.
EJVES Short Rep. 2018 Apr 22;39:12-15. doi: 10.1016/j.ejvssr.2018.03.005. eCollection 2018.
Inferior vena cava agenesis (IVCA) is one of the many anomalies of this vessel. It is one of the most uncommon anomalies, with an estimated prevalence of 0.0005-1% in the general population. Around 5% of the patients younger than 30 years with a diagnosis of deep vein thrombosis (DVT) have a total or segmental IVCA.
Here two unique cases of young and previously healthy male patients are reported: one with bilateral lower extremity DVT, the second with lower extremity DVT and pulmonary embolism. Both patients were found to have segmental agenesis of the inferior vena cava on computed tomography angiography (CTA). Treatment consisted of ultrasound enhanced thrombolysis (EKOS + alteplase) and venous angioplasty. Both patients were discharged with long-term (up to 24 months) oral anticoagulation and compression stockings. Follow up at 3 and 12 months revealed no new thrombotic episode.
IVCA can be asymptomatic but the majority of the symptomatic patients present with DVT. IVCA confers a risk factor for DVT. IVCA should be considered and ruled out as a rare but important risk factor and cause of DVT in previously young healthy patients. Once diagnosed, aggressive treatment must be started because of the high risk of post-thrombotic syndrome.
下腔静脉发育不全（IVCA）是该血管众多异常情况之一。它是最不常见的异常之一，在普通人群中的估计患病率为0.0005% - 1%。在诊断为深静脉血栓形成（DVT）的30岁以下患者中，约5%存在完全或节段性IVCA。
本文报告了两例年轻且既往健康的男性患者的独特病例：一例患有双侧下肢DVT，另一例患有下肢DVT和肺栓塞。在计算机断层扫描血管造影（CTA）检查中，两名患者均被发现存在下腔静脉节段性发育不全。治疗包括超声强化溶栓（EKOS + 阿替普酶）和静脉血管成形术。两名患者出院时均接受长期（长达24个月）口服抗凝治疗并穿着加压弹力袜。3个月和12个月的随访显示无新的血栓形成事件。
IVCA可能无症状，但大多数有症状的患者表现为DVT。IVCA是DVT的一个危险因素。在既往年轻健康的患者中，应考虑并排除IVCA作为一种罕见但重要的DVT危险因素和病因。一旦确诊，由于血栓后综合征的高风险，必须开始积极治疗。
