Double vena cava filter insertion in congenital duplicated inferior vena cava: a case report and literature review.

The complex embryogenesis of the inferior vena cava (IVC) may result in several anomalies, often presenting as an incidental radiological finding. In addition to the differential diagnosis with pathological lesions, recognizing IVC defects is crucial for invasive procedures. This report describes a patient with a right femoral vein thrombosis who could not be given anticoagulant therapy due to a concomitant acute cerebral hemorrhage. He was found to have an asymptomatic duplicated IVC with interiliac communication. A filter had to be inserted in each vena cava to prevent pulmonary embolism. A review of the literature dealing with the few reported cases of filter insertion in congenital duplicated IVC is presented
Congenital anomalies of the inferior vena cava (IVC)
and its tributaries originate from a defective embryogenesis
of three paired embryonic veins and occur in about
3% of population. They can be identified by iv. contrastenhanced
radiological exams or magnetic resonance
imaging, and have been encountered more frequently
since the introduction of cross-sectional imaging.1
Ultrasound might also have a diagnostic role. In most
cases, the congenital anomaly is an incidental finding in
asymptomatic patients, but in rare instances, the IVC
anomaly is associated with congenital cardiac disorders,
as described in a patient with polysplenia and dextrocardia,
or with right renal aplasia/hypoplasia.2 A few anomalies
may be symptomatic, as observed in the retrocaval
ureter variant, causing ureteral obstruction and/or urinary
infections, and in the absent infrarenal inferior vena cava
abnormality, which predisposes patients to recurrent
venous thrombosis of the lower limbs.3
A radiological diagnosis of IVC anomalies is needed
before attempting any invasive procedures. We describe
a case of congenital duplicated IVC requiring the insertion
of two vena cava filters to prevent pulmonary
embolism. A review of the literature dealing with the
rare cases of filter insertion in congenital duplicated IVC
is also provided.