Endovenous reconstruction of congenital iliocaval anomalies

This series demonstrates the feasibility, safety, and efficacy of endovascular reconstruction in three patients with congenital atresia of the inferior vena cava (IVC) or iliac veins.

This is a case series of three patients with central venous anomalies treated at a tertiary referral center. Two patients presented with acute deep vein thrombosis (DVT), and a third patient presented with chronic venous claudication and pelvic discomfort. All patients were categorized based on the 2021 SVP Classification based on their Symptoms, location of Varices, and the underlying Pathophysiology. The etiologies and endovenous management strategies are discussed in detail.

Technical success was achieved in all cases, with patency maintained on follow-up duplex and cross-sectional imaging. Two patients presented with symptomatic lower extremity DVT in the setting of segmental IVC atresia, whereas another patient presented with venous claudication and long-segment common iliac vein atresia with duplicated IVC. The two patients who initially presented with DVT were discharged on therapeutic Lovenox and clopidogrel after stenting, whereas one patient who did not present with thrombosis was discharged on clopidogrel. All patients achieved resolution of lower extremity pain, swelling, and venous claudication.

Through careful selection and understanding of the anatomy, etiology, and management strategies, patients can be successfully reconstructed with an endovascular approach.