Regular article
Etiology and VTE risk factor distribution in patients with inferior vena cava thrombosis

https://doi.org/10.1016/j.thromres.2008.01.004Get rights and content

Abstract

Introduction

Inferior vena cava (IVC) thrombosis is a rare event and data detailing the underlying etiology are scarce.

Materials and methods

Therefore, we reviewed all available cases of IVC thrombosis consecutively registered in the MAISTHRO (MAin-ISar-THROmbosis) database and described the prevalence of VTE risk factors and other conditions contributing to IVC thrombosis development.

Results

53 patients (35 F, 18 M) with IVC thrombosis aged 12 to 79 years were identified. 40 patients (75.5%) developed thrombosis under the age of 45. Local problems, such as IVC anomalies or external venous compression, contributed to the development of thrombosis in 12 cases (22.6%). Lupus anticoagulants (10.9 vs. 2.3%, p = 0.013) and malignoma (17.0 vs. 6.4%, p = 0.023) were more prevalent in IVC thrombosis patients compared to 265 age and sex matched controls with isolated lower extremity DVT. No difference was identified with regard to inherited thrombophilia or other known VTE risk factors. Symptomatic pulmonary embolism (PE) occurred in 32.1% of IVC thrombosis patients compared to 15.2% of controls (p = 0.005).

Conclusions

Local problems such as IVC anomalies and external venous compression, malignancy and the presence of lupus anticoagulants contribute to the risk of IVC thrombosis. The risk of symptomatic pulmonary embolism in the acute setting is high.

Introduction

Thrombosis of the inferior vena cava (IVC) is a rare event and has been described to occur in association with various systemic and local disorders such as congenital IVC anomalies [1], [2], [3], [4], thrombophilic disorders [5], [6], pregnancy [7], [8], [9], inflammation [10], [11], [12] and malignancy [13], [14], [15]. IVC compression by neighbouring pathologic processes such as aortic aneurysm [16], large renal and hepatic cysts or massive hydronephrosis [17] has also been reported to cause IVC thrombosis. Following liver transplantation, it can result from technical problems with vascular anastomoses [18]. IVC thrombosis has also been described after endovascular therapy such as IVC filter placement [19], [20] or transjugular intrahepatic portosystemic shunt (TIPS) [21]. To the best of our knowledge, no systematic analysis of IVC thrombosis patients exists concerning the question of IVC thrombosis etiology. To determine an optimal treatment strategy, it is essential to know whether patients with IVC thrombosis share VTE risk factors and predisposing disorders such as patients with isolated deep vein thrombosis (DVT) of the lower extremities or if other etiologies contribute to the development of IVC thrombosis. Therefore, we reviewed all consecutive cases of IVC thrombosis registered between 2000 and 2006 in the MAISTRHO (MAin-ISar-THROmbosis) database to describe etiologic factors contributing to IVC thrombosis development and compare IVC thrombosis patients to age and sex matched controls with isolated lower extremity DVT.

Section snippets

Data sources and patients

Patient data were obtained from the MAISTHRO (MAinISarTHROmbosis) registry [22], which enrolled 1770 consecutive patients with a documented history of acute venous thromboembolism treated at the University Hospitals of Frankfurt and Würzburg, Germany. The MAISTHRO registry has been approved by the local Ethics Committees and all patients provided written, informed consent to participate. Using a standardized questionnaire, clinical data detailing venous thromboembolism and contributing VTE risk

Baseline characteristics

Among the 1770 VTE patients enrolled in the MAISTHRO registry we identified 53 (3.0%) with thrombosis involving the inferior vena cava. The IVC thrombosis cohort comprised 35 women (66%) and 18 men (34%). Patient age at IVC thrombosis manifestation ranged from 12 to 79 years (median 35.6 years). 40 patients (75.5%) developed thrombosis under the age of 45 (Fig. 1). Thrombosis was located in the suprarenal segment of the IVC in 3 cases (6%) and the infrarenal segment in the remaining 50 cases

Discussion

Among 1770 patients assessed in the MAISTHRO Database for acute or a history of venous thromboembolism we identified 53 (3.0%) patients with IVC involvement. Thrombosis limited to the IVC is rare with the majority extending to the iliac and lower extremity veins. Although IVC thrombosis may be considered a subset of DVT and as such should share common etiologies, there are some aspects that require closer reflection. First, local disorders such as congenital anomalies or external compression

References (40)

  • N. Anne et al.

    Inferior vena cava duplication and deep venous thrombosis: case report and review of literature

    Ann Vasc Surg

    (2005)
  • V. Disanto et al.

    Retroperitoneal laparoscopic radical nephrectomy for renal cell carcinoma with intrahepatic vena caval thrombus

    Eur Urol

    (2005)
  • M. Greaves

    Antiphospholipid antibodies and thrombosis

    Lancet

    (1999)
  • C. Seinturier et al.

    Site and clinical outcome of deep vein thrombosis of the lower limbs: an epidemiological study

    J Thromb Haemost

    (2005)
  • J.C. Evans et al.

    Thrombosed double inferior vena cava mimicking paraaortic lymphoadenopathy

    Br J Radiol

    (2001)
  • S. Lau et al.

    Venous thrombosis complicating inferior vena cava anomalies in a 7-year old boy

    Pediatr Radiol

    (2003)
  • M. Higa et al.

    Portal and mesenteric vein and inferior vena cava thrombosis associated with antiphospholipid syndrome

    Intern Med

    (2001)
  • D. Sinha et al.

    Postpartum inferior vena cava and ovarian vein thrombosis – a case report and review of the literature

    J Obstet Gynaecol

    (2005)
  • F. Banduer et al.

    Deep vein thrombosis and acute cytomegalovirus infection: case report and review of the literature

    Blood Coagul Fibrinolysis

    (2003)
  • S.K. Ma et al.

    Renal vein and inferior vena cava thrombosis associated with acute pancreatitis

    Nephron

    (2002)
  • Cited by (0)

    View full text