Management of inferior vena cava aneurysm

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

Research output: Contribution to journalArticle

8 Citations (Scopus)

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 1 2015

Fingerprint

Inferior Vena Cava
Aneurysm
Blood Vessels
Rupture
Thrombosis
Group Practice
Thromboembolism
Embolism
Language
Stroke
Demography

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Medicine(all)

Cite this

Montero-Baker, M. F., Branco, B. C., Leon, L. L., Labropoulos, N., Echeverria, A., & Mills, J. L. (2015). Management of inferior vena cava aneurysm. Journal of Cardiovascular Surgery, 56(5), 769-774.

Management of inferior vena cava aneurysm. / Montero-Baker, M. F.; Branco, B. C.; Leon, L. L.; Labropoulos, N.; Echeverria, A.; Mills, Joseph L.

In: Journal of Cardiovascular Surgery, Vol. 56, No. 5, 01.10.2015, p. 769-774.

Research output: Contribution to journalArticle

Montero-Baker, MF, Branco, BC, Leon, LL, Labropoulos, N, Echeverria, A & Mills, JL 2015, 'Management of inferior vena cava aneurysm', Journal of Cardiovascular Surgery, vol. 56, no. 5, pp. 769-774.
Montero-Baker MF, Branco BC, Leon LL, Labropoulos N, Echeverria A, Mills JL. Management of inferior vena cava aneurysm. Journal of Cardiovascular Surgery. 2015 Oct 1;56(5):769-774.
Montero-Baker, M. F. ; Branco, B. C. ; Leon, L. L. ; Labropoulos, N. ; Echeverria, A. ; Mills, Joseph L. / Management of inferior vena cava aneurysm. In: Journal of Cardiovascular Surgery. 2015 ; Vol. 56, No. 5. pp. 769-774.
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AU - Leon, L. L.

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AU - Echeverria, A.

AU - Mills, Joseph L

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N2 - 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.

AB - 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.

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KW - Disease management

KW - Health care

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KW - Outcome assessment

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