Annals of Vascular Surgery - Brief Reports and Innovations (Sep 2023)
Endovascular reconstruction in inferior vena cava atresia in a patient with sickle cell trait
Abstract
Atresia of the inferior vena cava (IVC) is a rare anomaly associated with increased risk of deep venous thrombosis and lower extremity venous stasis. A significant number of patients with caval atresia remain asymptomatic however, due to compensatory lower extremity collateral venous networks. Over time, these venous tributaries may become insufficient and lead to venous hypertension and subsequent ulcer formation. The following case report describes a 54-year-old male with sickle cell trait who presented with IVC atresia and successfully underwent a technically challenging endovascular reconstruction.Given the scarcity of the condition, there is no established treatment paradigm in patients with atresia of the IVC. Additionally, given the variety of clinical presentation, it is important to tailor treatment to the individual. Our patient's medical history, clinical course, and physical exam findings raised suspicion of a condition affecting the central venous system, confirmed by a CT angiogram with dedicated venous phase. Given his clinical picture as well as our prior experience with central venous pathology, an endovascular reconstruction was offered. Now more than 18 months after surgery, the patient is living well and has not presented any new thrombotic events.Although not all patients with atresia of the inferior vena cava require surgical intervention, we propose that an endovascular approach is a successful strategy that leads to prompt recovery and a favorable outcome.
