Duplicated Inferior Vena Cava in Living Kidney Donor: Lessons From Two Cases With Contrasting Outcomes

Duplicated inferior vena cava (IVC) is a rare congenital anomaly. In living‑donor nephrectomy, a left‑sided duplicated IVC may be mistaken for an enlarged gonadal vein and inadvertently ligated, risking acute venous outflow obstruction.

We report 2 contrasting cases of living kidney donors with duplicated IVC below the level of the left renal vein. In Case 1, the anomaly was not recognized preoperatively and the duplicated IVC was clamped intraoperatively, causing immediate renal vein distension. Prompt recognition and clamp removal averted thrombosis. In Case 2, the duplicated IVC was identified prospectively by computed tomographic angiography and meticulously preserved, allowing uneventful recovery.

These cases highlight the critical need for systematic preoperative imaging review and intraoperative vigilance to distinguish a duplicated IVC from a gonadal vein by its larger caliber, medial course, and connection to the iliac system. Awareness of this variation is essential to prevent iatrogenic injury and ensure donor safety.