Developmental or Procedural Vena Cava Interruption and Venous Thromboembolism: A Review

Area of Science:

• Vascular Surgery
• Cardiology
• Radiology

Background:

• The inferior vena cava (IVC) and superior vena cava are critical for systemic venous return to the heart.
• Interruption of the vena cava, whether congenital or procedural, can lead to venous stasis, deep vein thrombosis (DVT), and pulmonary embolism (PE).

Purpose of the Study:

• To review the causes of congenital and procedural vena cava interruptions.
• To analyze the impact of these interruptions on venous thromboembolism (VTE).

Main Methods:

• A systematic literature search was conducted using PubMed, adhering to PRISMA guidelines.
• Delphi methods were employed for management questions lacking high-quality evidence or consensus.

Main Results:

• Inferior vena cava agenesis is the most common congenital interruption, linked to a higher risk of DVT, especially in young patients with unexplained bilateral DVTs.
• Surgical vena cava interruption techniques (ligation, clipping, plication) are rarely used due to risks; vena cava filters are now standard, typically placed in the infrarenal IVC.
• The primary indication for vena cava filters is acute VTE with contraindications to anticoagulation.

Conclusions:

• Understanding various vena cava interruption types and their complications is crucial for minimizing adverse events.
• Vena cava filters are the current standard for procedural interruption, with specific indications for VTE management.