INFERIOR VENA CAVA SYNDROME SYAFIRUZ AFIRA SALEH HUDIN

MAIN ORGAN : DIRECT CONNECT TO IVC

Inferior vena cava syndrome (IVCS) is a result of obstruction of the inferior vena cava

It can be caused by… invasion or compression by a pathological process thrombosis in the vein itself

F REQUENCY … Epidemiological data is elusive owing to the wide variety of clinical presentation. In the U.S., incidence is estimated to be at 5–10 cases per 100'000 per year.

C AUSES … 1.Obstruction by deep vein thrombosis or tumors (most commonly renal cell carcinoma).

2.Compression through external pressure by neighbouring structures or tumors, either by significantly compressing the vein or by promoting thrombosis by causing turbulence by disturbing the blood flow. This is quite common during the third trimester of pregnancy when the uterus compresses the vein in the right side position.

3.Iatrogenic causes may be suspected in patients with a medical history of liver transplantion, vascular catheters, dialysis and other invasive procedures in the vicinity. Biliary and vascular complications after liver transplantation. IVC, inferior vena cava.

4.Budd-Chiari syndrome is the clinical picture caused by occlusion of the hepatic veins. It presents with the classical triad of abdominal pain, ascites, and hepatomegaly. ascites + hydrocele congestion = hepatomegaly

S YMPTOMS … IVCS presents with a wide variety of signs and symptoms, making it difficult to diagnose clinically. Edema of the lower extremities Tachycardia In pregnant women, signs of fetal hypoxia and distress may be seen in the cardiotocography

S IGNS & S YMPTOMS Bilateral ankle swelling Bilateral leg edema/swelling Bilateral severe leg edema Bilateral thigh edema Inguinal/axillary vein dilated/flows upward/bilateral Postural Hypotension Non-neural Thorax/vein distension Increased ankle pigmentation/stasis

Swelling of scrotum Scrotal edema/swelling Abdominal venous engorgement/collaterals Abdominal wall edema Chest/truncal venous distension Edema of Lower Extremities Legs itch on standing Acutely ill patient/signs

D IAGNOSTIC T EST … X-RAY Angiography Duplex scanning CT scanning MRI

L ABORATORY S TUDIES … No specific laboratory test includes or excludes the diagnosis of inferior vena caval thrombosis (IVCT). Assessing clotting and fibrinolytic systems may be helpful. Protein C, protein S, antithrombin III, and anticardiolipin studies may all be helpful, but many of these assessments can only be made after the fact.

TREATMENT… 1. Medical Therapy : Thrombolysis, Anticoagulation.

2. Surgical Therapy : Angioplasty, Caval interruption, Thrombectomy, Balloon Dilatation, Intravascular Stents.

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