March/April - West Virginia State Medical Association

| Scientific Article
Figure 2.
CT chest abdomen pelvis coronal view: absent IVC (arrow)
Diagram 1.
Arteriovenous fistula construction in the groin: anastamoses with color codes.
or hereditary risk factors. CAIVC is
one such rare genetic risk factor. 3,4
The development of the infrahepatic-IVC
begins between 6-12
weeks of gestation. It involves a
complex process comprising 3-pairs
of embryogenic veins: posterior
cardinal (iliac and confluent),
subcardinal (renal and hepatic)
and supracardinal (prerenal).
Developmental disruptions may
result in several variants of partial
or complete IVC anomalies. 5
CAIVC is often reported
incidentally since most patients are
asymptomatic due to the presence of
extensive collateral veins. 6 Patients
are more likely to be symptomatic
in the presence of other associated
anomalies such as congenital heart
disease, asplenia, polysplenia
or inversion of the bowel. 7
The diagnostic accuracy of
B-mode ultrasonography in CAIVC
is limited secondary to its inability
to evaluate noncompressible
abdominal veins (especially in the
retroperitoneal-space). 8 CT scan
is a better screening method to
better visualize the retroperitoneal
space and collateral circulation.
Treatment for patients with
CAIVC and DVT is still debatable.
Surgical benefit was reported in
only two cases. 7,9 Surgical Treatment
for Agenesis of the Vena Cava is
performed using various surgical
approaches with thoraco-abdominoinguinal
incision (such as abdominoinguinal,
thoraco-abdominal and
abdominal incision) and constructing
arteriovenous fistula in the groin
as described in (Diagram 1)
creating various anastomoses:
i) Right iliac vein--left
persistent IVC
i) Both iliac veins-- IVC infrarenal
ii)
Both iliac veins-- IVC intrarenal
iii) Left iliac vein—right atrium
iv) Right iliac vein—right atrium
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