Inferior vena cava syndrome . About half of the cases are caused by thrombotic progression from the iliac vein area, the other half due to proliferative processes in the vicinity of that region.
Summary
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- 1 Etiology
- 2 Diagnosis
- 3 Treatment
- 4 Source
Etiology
It is rare that the condition is due to a primitive blood vessel tumor (leiomyosarcoma). In contrast, it is relatively common for a renal carcinoma to spread intraluminally from the renal veins to the inferior cava. Non-tumor causes include the membrane and hypoplasia of the inferior cava, generally retrohepatic, Cockett’s synechiae, retroperitoneal fibrosis, Weber-Christian disease, trauma, septic processes, aneurysm of the abdominal aorta, or therapeutic procedures such as prophylactic interruption of the inferior vena cava.
Diagnosis
Diagnostic suspicion, as for most nosological entities, starts from the history and physical examination. Knowledge or suspicion of an abdominal mass or the previous existence of venous thrombosisdeep of the lower extremity are antecedents to consider. The diagnostic confirmation must be established with the practice of ilio-cavography by bilateral femoral puncture. This informs us of the degree and level of occlusion and allows us to propose a therapeutic strategy. However, ultrasound, CT, and MRI help to determine the underlying cause, if any. These diagnostic techniques frequently do not allow to distinguish if what occupies the light is a thrombus or a tumor. This situation poses a problem for correctly proposing the therapy. Scintigraphy with labeled platelets or with antiplatelet mAbs helps to clarify some doubtful cases.
Treatment
If the symptoms are limiting for the patient, it is indicated to restore the flow of the vena cava. Treatment depends on the underlying cause. Tumors associated with the inferior cava syndrome have a better prognosis than those involving the upper cava. In these, the surgical removal of the neoplasm will be associated with the reconstruction of the vena cava. When it comes to unresectable proliferative processes, endoluminal techniques, transluminal angioplastyand the application of stents offer a good palliative alternative. When there is a thrombotic, non-tumor formation, the use of fibrinolytics has been shown to be effective and safe, especially if applied early. Surgical thrombectomies are rarely performed today. After any recanalization or revascularization of the inferior vena cava, anticoagulant treatment is recommended for a prolonged period.
