Author + information
- Muhammad Noor1,
- Jeffrey Forris Beecham Chick2,
- Matthew L. Osher2,
- Steven David Abramowitz3 and
- David M. Williams2
To report the technical success, complications, and long-term patency of iliocaval reconstruction for the treatment of inferior vena cava (IVC) agenesis.
Materials and Methods
30 (3%) patients with suspected IVC agenesis were identified from a venous registry of 994 patients from 2000 until 2016. Patients included 23 males and 7 females with mean age of 32 years (range: 13-63 years). Computed tomography (CT), magnetic resonance imaging (MRI), both CT and MRI, or prior venography was available in 20, 5, 4, and 1 patient, respectively. Review of imaging demonstrated true IVC agenesis in 27 (90%) patients and IVC atresia/chronic thrombosis in 3 (10%). In those with true IVC agenesis, imaging demonstrated complete absence of the entire IVC (n=6), infrarenal IVC (n=6), hepatic IVC (n=5), infrahepatic IVC (n=4), segmental absence of the IVC between the liver and kidney (n=3), suprahepatic IVC (n=2), and suprarenal IVC (n=1). Patients presented with lower extremity deep venous thrombosis (n=10), iliocaval thrombosis (n=9), lower extremity swelling (n=6), and lower extremity varicosities (n=5). Treatment type, technical success, stent type, number, and diameter, anticoagulation, and complications were recorded. 6, 12, and 24-month primary and secondary patencies were calculated.
3 patients failed to present for treatment. 25 (93%) patients underwent iliocaval reconstruction. Technical success was 92%. 2 patients underwent thrombolysis only. Stents and endografts included Wallstents, Gianturco-Rösch Z-stents, AneuRx, Medtronic Endurant, and Epic in 21, 4, 2, 1, and 1 patient, respectively. Mean number of stents placed was 6 (range: 2-10). Mean stent diameter was 16 mm (range 8-22 mm). 23 patients were maintained on enoxaparin, clopidogrel, and aspirin. 1 minor complication, IVC and femoral vein perforation, and 1 major complication, right and left femoral arteriovenous fistulas, were reported. 6, 12, and 24-month primary patencies were 83%, 82%, and 72%. 6, 12, and 24-month secondary patencies 100%, 100%, and 100%, respectively.
Iliocaval reconstruction is a successful treatment for IVC agenesis and is associated with good long-term patency and few complications.