warfarin and Vascular-Malformations

Although venous thromboembolism (VTE) including deep venous thrombosis (DVT) and pulmonary embolism is a major health problem in the world, it is an infrequent disease among young people. It is always mandatory to look at the underlying conditions for VTE, and in young patients, inherited prothrombotic factors should also be evaluated, especially in case of unprovoked VTE. Anomalies of inferior vena cava (IVC) are very rare in the general population. In this case report we describe rare occurrence of extensive DVT in a young male patient with rare anomaly of IVC - duplication of IVC - as a predisposition factor for DVT. Physicians need to be reminded of the IVC anomalies that should be considered in young patients with idiopathic DVT of lower extremity, which may require extended anticoagulant treatment.

Topics: Adult; Anticoagulants; Drug Therapy, Combination; Heparin, Low-Molecular-Weight; Humans; Male; Multidetector Computed Tomography; Vascular Malformations; Vena Cava, Inferior; Venous Thrombosis; Warfarin

Topics: Adult; Anticoagulants; Contraceptives, Oral, Hormonal; Enoxaparin; Ethinyl Estradiol; Female; Fibrinolytic Agents; Humans; Smoking; Thrombectomy; Thrombolytic Therapy; Urokinase-Type Plasminogen Activator; Vascular Malformations; Vena Cava, Inferior; Venous Thrombosis; Warfarin

Topics: Anticoagulants; Diagnosis, Differential; Female; Hepatic Veins; Humans; Liver Circulation; Liver Cirrhosis; Magnetic Resonance Imaging; Middle Aged; Phlebography; Portal Vein; Predictive Value of Tests; Ultrasonography, Doppler, Color; Vascular Malformations; Venous Thrombosis; Warfarin

Congenital anomalies of the inferior vena cava (IVC) are rare, but recognized, causing deep venous thrombosis. We present a case of a 50-year-old patient with trauma who suffered an intracranial hemorrhage secondary to a fall while on anticoagulation for deep vein thromboses. Venous return from the lower extremities was determined to be through dilated lumbar venous collaterals into the azygous and hemiazygous systems. A second interesting anatomic finding was a hypoplastic left kidney.

Topics: Accidental Falls; Acute Kidney Injury; Anticoagulants; Azygos Vein; Collateral Circulation; Dilatation, Pathologic; Humans; Intracranial Hemorrhage, Traumatic; Kidney; Magnetic Resonance Angiography; Male; Middle Aged; Phlebography; Regional Blood Flow; Vascular Malformations; Vena Cava, Inferior; Venous Thrombosis; Warfarin

To assess the effectiveness and clinical outcomes of catheter-directed thrombolysis in patients with atresia of the inferior vena cava (IVC) and acute iliofemoral deep vein thrombosis (DVT).. From 2001 to 2009, 11 patients (median age, 32 y) with atresia of the IVC and acute iliofemoral DVT in 13 limbs were admitted for catheter-directed thrombolysis. Through a multiple-side hole catheter inserted in the popliteal vein, continuous pulse-spray infusion of tissue plasminogen activator and heparin was performed. Thrombolysis was terminated when all thrombus was resolved and venous outflow through the paravertebral collateral vessels was achieved. After thrombolysis, all patients received lifelong anticoagulation and compression stockings and were followed up at regular intervals.. Ultrasound or computed tomography revealed absence of the suprarenal segment of the IVC in two patients, and nine were diagnosed with absence of the infrarenal segment of the IVC. Median treatment time was 58 hours (range, 42-95 h). No deaths or serious complications occurred. Overall, complications were observed in four patients, one of whom required blood transfusion. Three patients were diagnosed with thrombophilia. Median follow-up was 37 months (range, 51 d to 96 mo). All patients had patent deep veins and one developed reflux in the popliteal fossa after 4 years. No thromboembolic recurrences were observed during follow-up.. Catheter-directed thrombolysis of patients with acute iliofemoral DVT and atresia of the IVC is a viable treatment option, as reasonable clinical outcomes can be obtained.

Topics: Acute Disease; Adolescent; Adult; Anticoagulants; Catheterization, Peripheral; Denmark; Female; Femoral Vein; Fibrinolytic Agents; Heparin; Humans; Iliac Vein; Male; Middle Aged; Phlebography; Popliteal Vein; Retrospective Studies; Stockings, Compression; Thrombolytic Therapy; Time Factors; Tissue Plasminogen Activator; Tomography, X-Ray Computed; Treatment Outcome; Ultrasonography; Vascular Malformations; Vena Cava, Inferior; Venous Thrombosis; Warfarin; Young Adult

Tender lumps in the inguinal region are often explored emergently to treat suspected hernial strangulation. We discuss the case of an adult male who presented acutely with a tender inguinal swelling and raised inflammatory markers and was therefore deemed as requiring surgical exploration. However preoperative abdominal computerized tomography (CT) revealed an extensive thrombosing congenital venous malformation of portosystemic origin with extension into the symptomatic inguinal canal. A potentially lethal exsanguination from surgery was thus avoided.

Topics: Adult; Anticoagulants; Azygos Vein; Diagnosis, Differential; Hernia, Inguinal; Humans; Magnetic Resonance Angiography; Male; Phlebography; Portal Vein; Tomography, X-Ray Computed; Treatment Outcome; Vascular Malformations; Vena Cava, Inferior; Venous Thrombosis; Warfarin