Regular articleEtiology and VTE risk factor distribution in patients with inferior vena cava thrombosis
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)
- et al.
Congenital absence of the inferior vena cava: a rare risk factor for idiopathic deep-vein thrombosis
Lancet
(2001) - et al.
Congenital absence of inferior vena cava
Lancet
(2001) - et al.
Protein C deficiency as a cause of simultaneous acute thrombosis of the superior mesenteric vein and inferior vena cava with jejunal infarction
Surgery
(2005) - et al.
Acute thrombosis of inferior vena cava in a pregnant woman presenting with sciatica: a case report
Ann Vasc Surg
(2005) - et al.
Experience of temporary inferior vena cava filters inserted in the perinatal period to prevent pulmonary embolism in pregnant women with deep vein thrombosis
J Vasc Surg
(2005) - et al.
Fatal tumor thrombosis due to an inferior vena cava leiomyosarcoma in a patient with antiphospholipid antibody syndrome
Mayo Clin Proc
(2002) - et al.
Outcome and complications of retrievable inferior vena cava filters
Am J Cardiol
(2004) - et al.
Inferior vena cava thrombosis after transjugular intrahepatic portosystemic shunt revision with a covered stent
J Vasc Interv Radiol
(2004) - et al.
International consensus statement on an update of the classification criteria for definite antiphospholipid syndrome (APS)
J Thromb Haemost
(2006) - et al.
Deep venous thrombosis caused by congenital absence of inferior vena cava, combined with hyperhomocysteinemia
Ann Vasc Surg
(2004)