Thrombolysis for deep venous thrombosis associated with inferior vena cava agenesis in a young patient

Abstract

Malformations of inferior vena cava (IVC) as agenesis are a rare congenital anomaly and cause of deep venous thrombosis (DVT) of lower limbs and should be investigated in young patients of unknown aetiology. Treatment with mechanical thrombectomy and thrombolysis can be considered in certain cases of DVT, promoting rapid clot removal, and has also been shown to be an effective treatment in acute DVT. We present a case of acute lower limb DVT associated with IVC agenesis in which Alteplase thrombolysis was used and thrombus aspiration with catheter bilaterally, with subsequent angioplasty of the common and external iliac, obtaining satisfactory results.

Keywords: portal vein; vascular surgery; venous thromboembolism.

Figure 1

Computed angiotomography: (A) (coronal view) inferior vena cava agenesis to third lumbar vertebra; (B) (coronal view) portal vein thrombosis.

Figure 2

Doppler ultrasound: (A) acute venous thrombosis of the inferior vena cava in the infrarenal segment; (B) presence of retroaortic left renal vein with present flow draining into the azygos vein.

Figure 3

Phlebography with popliteal vein puncture: (A) several negative images (thrombi) in superficial femoral vein; (B) negative images in iliac veins and inferior vena cava, visualised up to the third lumbar vertebra; (C) bilaterally catheter implant (Fountain).

Figure 4

Phlebography: (A) control after 48-hour evidencing significant reduction of thrombi, (B) angioplasty performed with a 9×80 mm balloon catheter in iliac veins, (C) final control showing minimal residual thrombi in the lumen of the veins.