RESUMEN
The authors analysed the results of examination and dynamic follow up (from 2003 to 2011) of twenty-one 15-to-55-year-old male patients presenting with hypoplasia or aplasia of the inferior vena cava. The diagnosis was verified by means of SCT- or MRT-phlebography. The disease was newly diagnosed at the age of 15-55 years (mean 25.9±2.6). The pathology manifested itself as a clinical course of thrombosis of deep veins of lower limbs in 16 (76.2%) patients and by oedema thereof in 5 (23.8%) subjects. Of the 16 patients with symptomatology of deep vein thrombosis, 13 patients had proximal (iliofemoral) thrombosis and 3 patients had distal thrombosis. In the overwhelming majority of the patients, the pathological process was localized on the right. All the patients after 1.5-12 months developed signs of impaired patency of the IVC. 1.5-2.5 years later, the course of chronic venous insufficiency was complicated by the development of trophic ulcers of the crus in eight (38.1%) patients. Congenital abnormalities of the IVC are encountered predominantly in males, remaining for a long time latent to be newly manifested in the young age by symptoms of deep vein thrombosis (more often by right-sided iliac-femoral thrombosis). Suspecting this pathology should be followed by extended examination using SCT- or MRT-phlebography.
Asunto(s)
Diagnóstico por Imagen/métodos , Malformaciones Vasculares/diagnóstico , Vena Cava Inferior/anomalías , Trombosis de la Vena/etiología , Adolescente , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Malformaciones Vasculares/complicaciones , Trombosis de la Vena/diagnóstico , Adulto JovenRESUMEN
Analyzed herein are the findings obtained following an examination and medical treatment of five 17-to-39-year-old male patients (average age 25.0+/-1.83 years) presenting with congenital abnormalities of the inferior vena cava. The diagnosis was made and the level of aplasia was determined based on the findings of a comprehensive instrumental examination (computed and magnetic resonance tomography of the abdominal cavity, duplex scanning of the veins of the lower extremities, of the pelvis and the retroperitoneal space, as well as on the data of pelvic phlebography, and retrograde cavography). In three of the five patients, the disease appeared to have for the first time manifested itself by a clinical picture of peripheral thrombosis (oedema of the crus and femur), and in the remaining two by an elevated body temperature and shivering, followed by oedema of the both lower limbs. Two patients were found to have aplasia of the infrarenal segment of the inferior vena cava, two subjects had aplasia of the infra-, renal and partially suprarenal portions of the vessel, and one patient suffered from aplasia of virtually the whole vena cava, excepting a small part of the suprahepatic portion, toward which converged the hepatic veins and the superior polar renal vein. With the purpose of early diagnosis of congenital abnormalities of the inferior vena cava, the protocol of examination of patients with venous diseases should include ultrasonographic mapping of the supra-, renal and infrarenal portions of the vena cava, and if agenesis is revealed, the use of computed or magnetic resonance tomography, retrograde cavography is strongly recommended. When the diagnosis of IVC aplasia is confirmed, primary medical treatment should consist in prescribing venotonic agents, elastic compression and in cases of deep veins thrombosis -anticoagulant therapy.
Asunto(s)
Procedimientos Quirúrgicos Vasculares/métodos , Vena Cava Inferior , Insuficiencia Venosa , Adolescente , Adulto , Diagnóstico Diferencial , Diosmina/uso terapéutico , Combinación de Medicamentos , Fibrinolíticos/uso terapéutico , Heparina/uso terapéutico , Hesperidina/uso terapéutico , Humanos , Masculino , Ultrasonografía Doppler , Vena Cava Inferior/anomalías , Vena Cava Inferior/diagnóstico por imagen , Vena Cava Inferior/cirugía , Insuficiencia Venosa/congénito , Insuficiencia Venosa/diagnóstico , Insuficiencia Venosa/terapiaRESUMEN
Results of examination of 5 male patients aged 20 to 43 years with congenital anomaly of inferior vena cava are analyzed. Complex special examination (CT, MRI, duplex scanning, pelvic phlebography, retrograde cavagraphy) was used for correct diagnosis. Primary treatment of agenesis of inferior vena cava should consist of elastic compression and phlebotonics; in cases of deep vein thrombosis anticoagulants must be used.