Endovascular Treatment of Duplicated Inferior Vena Cava Compression From Retroperitoneal Fibrosis
Endovascular Treatment of Duplicated Inferior Vena Cava Compression From Retroperitoneal Fibrosis
Endovascular Treatment of Duplicated Inferior Vena Cava Compression From Retroperitoneal Fibrosis
ABSTRACT
A 68-year-old man with a history of retroperitoneal fibrosis was referred to our clinic because of disabling bilateral lower
extremity swelling and venous claudication, worse on the right side than on the left. He was noted to have a duplicated
inferior vena cava and an iliac vein obliteration from retroperitoneal fibrosis. The patient underwent bilateral iliac vein
stenting and had complete relief of symptoms through follow-up of 46 months with no recurrence. (J Vasc Surg Cases
and Innovative Techniques 2018;4:311-4.)
Keywords: Inferior vena cava duplication; Retroperitoneal fibrosis; Venous compression
311
312 Ochoa Chaar and Aurshina Journal of Vascular Surgery Cases and Innovative Techniques
December 2018
Fig 2. Pelvic venography. A and B, Stenosis and filling delay in left common iliac vein and right external iliac
vein, respectively (arrows). C and D, Postprocedural improvement after stent implantation.
Scientific, Marlborough, Mass) in the right external iliac vein (Fig 3). He continues to be asymptomatic, and his duplex ultra-
and another 16- 90-mm stent in the right-sided cava were sound examination showed patency of all stents 4 years after
deployed and postdilated with a 16-mm balloon (Fig 2, C). the procedure.
Next, two 14- 60-mm stents were deployed with overlap
on the left side and postdilated with a 14-mm balloon DISCUSSION
(Fig 2, D). At the end of the procedure, intravascular ultra- RPF, first described by Ormond in 1948, is an uncom-
sound was performed and confirmed no significant residual mon disorder that leads to fibrosis and compression
stenosis. of the structures in the retroperitoneum.1 It is most
The patient was observed for 24 hours and had moderate pain commonly idiopathic and rarely causes compression of
after the procedure. His symptoms improved significantly within the iliac artery or vein, leading to intermittent claudica-
a week of treatment. The edema resolved on follow-up, and tion, leg edema, and thrombosis.4 Symptomatic venous
he currently uses stockings only infrequently as needed. He obstruction has been reported rarely, occurring in 2% of
was prescribed clopidogrel 75 mg daily for a year and then the cases.5 Koep and Zuidema6 reported that only 2.4%
switched to aspirin. Computed tomography performed 3 years of their 491 cases with RPF had complications with iliac
after the procedure showed patent stents with no stenosis artery or vein stenosis.
Journal of Vascular Surgery Cases and Innovative Techniques Ochoa Chaar and Aurshina 313
Volume 4, Number 4
3. Lepor H, Walsh PC. Idiopathic retroperitoneal fibrosis. J Urol 10. Juhan C, Hartung O, Alimi Y, Barthelemy P, Valerio N,
1979;122:1-6. Portier F. Treatment of nonmalignant obstructive iliocaval
4. van Bommel EF. Retroperitoneal fibrosis. Neth J Med lesions by stent placement: mid-term results. Ann Vasc Surg
2002;60:231-42. 2001;15:227-32.
5. Rhee RY, Gloviczki P, Luthra HS, Stanson AW, Bower TC, 11. Neglen P, Raju S. Balloon dilation and stenting of chronic
Cherry KJ Jr. Iliocaval complications of retroperitoneal iliac vein obstruction: technical aspects and early clinical
fibrosis. Am J Surg 1994;168:179-83. outcome. J Endovasc Ther 2000;7:79-91.
6. Koep L, Zuidema GD. The clinical significance of retroperi- 12. Vorwerk D, Guenther RW, Wendt G, Neuerburg J,
toneal fibrosis. Surgery 1977;81:250-7. Schurmann K. Iliocaval stenosis and iliac venous thrombosis
7. Ilie CP, Pemberton RJ, Tolley DA. Idiopathic retroperitoneal in retroperitoneal fibrosis: percutaneous treatment by use of
fibrosis: the case for nonsurgical treatment. BJU Int 2006;98: hydrodynamic thrombectomy and stenting. Cardiovasc
137-40. Intervent Radiol 1996;19:40-2.
8. Hartung O, Alimi YS, Di Mauro P, Portier F, Juhan C. Endo- 13. Okuyama H, Hirono O, Ishigaki D, Yuki K, Kubota I. Percu-
vascular treatment of iliocaval occlusion caused by retro- taneous transvenous stent implantation to external iliac vein
peritoneal fibrosis: late results in two cases. J Vasc Surg stenosis in a patient with retroperitoneal fibrosis. Intern Med
2002;36:849-52. 2010;49:913-8.
9. Hartung O, Otero A, Boufi M, De Caridi G, Barthelemy P, 14. Aissi K, Rossi P, Demoux AL, Hartung O, Frances Y. Endo-
Juhan C, et al. Mid-term results of endovascular treatment vascular treatment of iliocaval occlusion due to idiopathic
for symptomatic chronic nonmalignant iliocaval venous retroperitoneal fibrosis. Eur J Intern Med 2004;15:534-6.
occlusive disease. J Vasc Surg 2005;42:1138-44; discussion:
1144. Submitted Apr 11, 2018; accepted Jul 7, 2018.