Venous thrombosis related to duplicated inferior vena cava: A case report and systematic review.

RATIONALE

Swollen legs are commonly observed in clinical practice, and deep vein thrombosis (DVT) is 1 of the causes. Duplicated IVC (DIVC) is a relatively rare anomaly that results in DVT.

PATIENT CONCERNS

A 52-year-old male patient presented to the emergency department because of right leg swelling, pain, and redness for 3 days. His right leg was swollen from the sole to the thigh, with mild tenderness and local heat, without pitting edema.

DIAGNOSES

Laboratory tests showed mild elevated C-reactive protein (CRP) 3.82 mg/dL (reference value: 0-0.79 mg/dL), and notably high levels of D-dimer (25,700 ng/mL; reference value: 0-653). Lower limb computed tomography angiography showed duplication of the IVC (DIVC) and was highly suspicious for venous thrombosis involving the right popliteal vein, superficial femoral vein, common femoral vein, external iliac vein, internal iliac vein, common iliac vein, and inferior vena cava (IVC).

INTERVENTIONS

Enoxaparin (80 mg) was administered subcutaneously, twice daily. After admission, catheter-directed thrombolysis and thrombectomy via the right superficial femoral and popliteal veins were performed.

OUTCOMES

The congestion in the right lower leg improved, and the patient was discharged with rivaroxaban 15 mg twice daily 3 days later.

LESSONS

A systematic review using the keywords "duplication IVC," "thrombosis" and "case report" was performed on PubMed until May 2023. Males accounted for 55.2% (16 of 29) of the cohort. The mean ± standard deviation age of the patients was 48.9 ± 17.9 years old. Pulmonary embolism was documented in 27.6% (8 29) of the cases. Regarding treatments, we found that 21 patients (72.4%) used anticoagulants, 20 patients (69.0%) received IVC filter placement, and 7 cases (24.1%) were treated by catheter-directed thrombolysis. Women had a higher proportion of popliteal vein and calf vein thrombosis, with a statistically significant difference (25% vs 61.5%, P = .047 < .05), (12.5% vs 53.8%, P = .017 < .05). The incidence of DIVC is around 0.3% to 0.7% with male predominance. A DIVC is a risk factor for DVT, especially in young people.