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Updated: May 24, 2025
Electrolytic Inferior Vena Cava Model EIM of Venous Thrombosis
Published on: July 12, 2011
Venous thrombosis related to duplicated inferior vena cava: A case report and systematic review
Chun Chen1, Di-Sheng Huang2, Kuo-Song Chang3,4
1Division of Disaster Medicine, Emergency Department, Mackay Memorial Hospital, Taipei Taiwan.
Insights
Duplicated inferior vena cava (DIVC) is a rare anomaly that can lead to deep vein thrombosis (DVT). This case report highlights the successful treatment of DVT in a patient with DIVC using anticoagulation and thrombolysis.
Area of Science:
- Vascular Surgery
- Radiology
- Hematology
Background:
- Deep vein thrombosis (DVT) is a common clinical presentation, with duplicated inferior vena cava (DIVC) being a rare predisposing anomaly.
- DIVC, an uncommon congenital vascular variation, significantly increases the risk of DVT, particularly in younger individuals.
- The incidence of DIVC ranges from 0.3% to 0.7%, with a noted male predominance.
Purpose of the Study:
- To present a case of deep vein thrombosis (DVT) in a patient with duplicated inferior vena cava (DIVC).
- To review the current literature on DVT associated with DIVC, including patient demographics, treatment modalities, and outcomes.
- To emphasize DIVC as a critical risk factor for DVT, necessitating prompt diagnosis and management.
Main Methods:
- A 52-year-old male presented with unilateral leg swelling and was diagnosed with DVT via computed tomography angiography, revealing DIVC.
- Laboratory investigations showed elevated D-dimer and C-reactive protein levels.
- Treatment involved anticoagulation with enoxaparin, followed by catheter-directed thrombolysis and thrombectomy.
Main Results:
- The patient's leg swelling and symptoms resolved following thrombolysis and thrombectomy.
- Discharge medication included rivaroxaban for continued anticoagulation.
- A systematic review of 29 cases indicated that 72.4% received anticoagulants, 69.0% had IVC filter placement, and 24.1% underwent catheter-directed thrombolysis.
Conclusions:
- DIVC is a significant risk factor for DVT, especially in younger populations.
- Treatment strategies for DVT in the context of DIVC may include anticoagulation, IVC filter placement, and thrombolytic therapy.
- Women demonstrated a higher incidence of calf and popliteal vein thrombosis compared to men in the reviewed cohort.
Rationale:
Swollen legs are commonly observed in clinical practice, and deep vein thrombosis (DVT) is 1 of the causes. Duplicated IVC (DIVC) is a relatively rare anomaly that results in DVT.
Patient Concerns:
A 52-year-old male patient presented to the emergency department because of right leg swelling, pain, and redness for 3 days. His right leg was swollen from the sole to the thigh, with mild tenderness and local heat, without pitting edema.
Diagnoses:
Laboratory tests showed mild elevated C-reactive protein (CRP) 3.82 mg/dL (reference value: 0-0.79 mg/dL), and notably high levels of D-dimer (25,700 ng/mL; reference value: 0-653). Lower limb computed tomography angiography showed duplication of the IVC (DIVC) and was highly suspicious for venous thrombosis involving the right popliteal vein, superficial femoral vein, common femoral vein, external iliac vein, internal iliac vein, common iliac vein, and inferior vena cava (IVC).
Interventions:
Enoxaparin (80 mg) was administered subcutaneously, twice daily. After admission, catheter-directed thrombolysis and thrombectomy via the right superficial femoral and popliteal veins were performed.
Outcomes:
The congestion in the right lower leg improved, and the patient was discharged with rivaroxaban 15 mg twice daily 3 days later.
Lessons:
A systematic review using the keywords "duplication IVC," "thrombosis" and "case report" was performed on PubMed until May 2023. Males accounted for 55.2% (16 of 29) of the cohort. The mean ± standard deviation age of the patients was 48.9 ± 17.9 years old. Pulmonary embolism was documented in 27.6% (8 29) of the cases. Regarding treatments, we found that 21 patients (72.4%) used anticoagulants, 20 patients (69.0%) received IVC filter placement, and 7 cases (24.1%) were treated by catheter-directed thrombolysis. Women had a higher proportion of popliteal vein and calf vein thrombosis, with a statistically significant difference (25% vs 61.5%, P = .047 < .05), (12.5% vs 53.8%, P = .017 < .05). The incidence of DIVC is around 0.3% to 0.7% with male predominance. A DIVC is a risk factor for DVT, especially in young people.
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