Management of inferior vena cava aneurysm

M. F. Montero-Baker, B. C. Branco, L. L. Leon, N. Labropoulos, A. Echeverria, J. L. Mills

Research output: Contribution to journalArticlepeer-review

11 Scopus citations

Abstract

Aim: Inferior vena cava (FVC) aneurysm is an infrequent but potentially lethal abnormality. We have seen one such case in our group practice. We have added this case to a review of 53 previously reported cases in order to develop a management algorithm for this entity. Methods. We conducted a MedLine search of all English-language articles from the first reported case in 1950 through August 2013. Patient demographics, clinical data, management and outcomes were extracted. FVC aneurysms were categorized in 4 types as per Gradman and Steinberg classification. Results: The mean patient age was 27.1 years (range 5-89) and 57.4% were male. A total of 11 (20.3%) had associated vascular anomalies and iliocaval thrombosis was found in 10 (18.5%). There were 23 type I aneurysms, 8 type IIs, 21 type IIIs and 2 type IVs. All but 1 type I was successfully managed conservatively without complications. For type IIs, only 3 patients were managed conservatively with 1 death related to stroke from paradoxical embolus. For type IIIs, resection was the most common management option (14 patients). One patient was treated endovascularly with aneurysm embolization. A total of 6 asymptomatic patients were treated conservatively with 1 death due to thromboembolism. For type IVs, all cases underwent expectant management with 1 death due to aneurysm rupture. Conclusion: IVC aneurysms are rare with only 54 cases reported in the literature. Associated vascular anomalies and iliocaval thrombosis should be expected in approximately 20% of cases. Type I aneurysms can be managed expectantly with close surveillance unless symptomatic. For type II-IV, surgical consideration should be given based on high rates of thromboembolic complications and non-negligible risk of rupture.

Original languageEnglish (US)
Pages (from-to)769-774
Number of pages6
JournalJournal of Cardiovascular Surgery
Volume56
Issue number5
StatePublished - Oct 2015

Keywords

  • Aneurysm
  • Disease management
  • Health care
  • Inferior
  • Outcome assessment
  • Review
  • Vena cava

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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