Abdominal Aortic Aneurysm Repair Requiring Left-Sided Inferior Vena Cava Interposition

Left-sided inferior vena cava (IVC) is a rare congenital venous anomaly. We describe a case of open repair of a nonruptured abdominal aortic aneurysm (AAA) in a patient with left-sided inferior vena cava requiring IVC transection and reconstruction with interposition graft.

A 56-year-old man presented for elective repair of a 6.2-cm AAA with preoperative imaging demonstrating a left-sided IVC. Intraoperatively, IVC crossing at the aneurysm neck conferred inadequate exposure for arterial anastomosis. After transection of the IVC, the AAA was repaired, and the IVC was reconstructed with a 24-mm Dacron tube graft. His recovery was uneventful, and grafts were patent at 3-month follow-up.

Left-sided IVC is a rare anomaly encountered during abdominal aortic surgery that presents technical challenges. Division of the IVC and reconstruction with interposition graft is a possible solution if other techniques fail to provide adequate exposure.