This is a venous research presentation I gave at the Patewood branch of Greenville Hospital System.

1. Inferior Vena Cava Disorders
By: Hollie Peterson

2. Objectives
At the end of this presentation you will be able to:
 Describe the anatomy & physiology of the IVC
Understand the pathologic conditions & anatomic
variants of the Inferior Vena Cava
Identify and discuss the Theory of Virchow’s Triad
Define Inferior Vena Cava filter placement and uses

3.  Largest vein of the body that drains the
LE & abdomen into the RA of the heart
 The Inferior Vena Cava is a continuation of
the common femoral vein (CFV)
 Right & left CFV join to form IVC
 Travels cephalad and terminates in the RA
What is the Inferior Vena Cava?

4. Overview:
Disorders/Treatments
Anatomic Variants
Neoplastic Obstructions (Rare)
Acute Thrombosis
 Extrinsic Compression
 Theory of Virchow’s Triad
 Pulmonary Embolism (PE)
IVC Filter Placement

5.  Asymptomatic
 The hepatic segment of
the IVC is absent and
the hepatic veins join and
drain directly into
the right atrium.
Absent Intrahepatic IVC
“Azygos Continuation”
Left sided IVC
 Paired IVC (duplication
terminates at level of
renal veins)
 IVC on left side only (can
terminate in left renal
vein or extend cranially
to drain into azygos vein
in the chest)
Anatomic Variants
“Azygos Vein”: a large vein on the right
side at the back of the thorax, draining
into the superior vena cava.

6. Neoplastic Obstruction
(Rare)
Typically: Intraluminal tumors arising from renal or hepatic veins
that secondarily obstruct or thrombose the IVC
 Leimyosarcoma:
 Rare intraluminal tumor that develops in the middle portion of
the IVC
 Primarily found in women
 Discovered by German doctor in 1871
 By 2006, <300 cases have been reported
 Unknown cause
 Asymptomatic (due to deep origin)
 Vague Symptoms: abdominal pain, palpable mass, LE
edema
 Treatment: surgical removal of tumor & surrounding tissue.
(Resection necessary)

7. Acute Thrombosis
Obstruction of venous outflow within the deep or superficial vein
by thrombosis
Location: valve site, venous confluences
Patient history: Previous DVT, Post-op, Persistent swelling ( usually
unilateral ), clotting issues, localized pain/burning/itching,
symptoms of PE
 Causes: Virchow’s Triad, Varicose veins, Extrinsic Compression
 Once thrombosis forms it:
1) Stabilizes (adheres to vessel wall)
2) Propagate (“growth of thrombus” in size)
3) Shed/Embolize
(portion of thrombus breaks free & travels)

8. Theory of Virchow’s Triad
 States that venous thrombus is caused by combination of:
A) Venous Stasis
 Non-movement of blood that leads to coagulation
 Platelets become trapped behind valve cusp (recirculation)
 Results from: obesity, post-op, immobility, etc.
B) Hypercoaguble State
 Increased activation of coagulation factors along with a
decrease of coagulation inhibitors
 Results from: cancer, pregnancy, etc.
C) Endothelial Damage (Intimal Injury)
 Results from: Surgery, trauma, central catheterization, IV
drug abuse

9. Theory of Virchow’s Triad
Combination of any of these can result in venous thrombosis

10. Extrinsic Compression
Paget-Syndrome
 Refers to axillary-subclavian vein thrombosis associated with
strenuous + repetitive activity of upper extremity
 Unusual cause of venous compression & intimal injury leading
to thrombosis
May-Thurner Syndrome (MTS)
 Caused when the left iliac vein is compressed by the right iliac
artery, which increases risk of Deep Vein Thrombosis (DVT) in
left extremity

11. Pulmonary Embolism (PE)
The occlusion of a pulmonary artery by a thromboembolus
o Complication of venous thrombosis
o Third most common cause of death in the United States
 Top “unexpected death” in ANY age group
o 1/3 patients are asmptomatic
o Source is typically iliofemoral thrombus
(LE deep veins involved 90% of time)
IVC RA RV
Pulmonary
Artery

12. What is an IVC filter?
A device that traps large clots from the lower extremity
o Consist of thin metal struts that converge together to form
a cone shape

13. IVC Filter Placement
Aim of procedure is to “catch” any thrombi floating in the blood
stream from the LE (legs + pelvis) that occasionally travel to the
lungs causing a PE
Who gets one?
 Patients with a history/ at risk for developing blood clots in
the legs
 Patients unable to tolerate blood thinning agents
 Inserted via catheter (using the CFV, EIV, or jugular access)
 Patient under local anesthesia
 Hospital stay: 12-24 hours (back to normal activity in 1-2 days)

14. Retrieval of IVC Filter
A: Infrarenal IVC surrounded by scar tissue (tan color) on endoluminal surface
B: Filter is beginning to be sheathed
C: Filter is sheathed from top to bottom in preparation for removal
D: Laser sheath is activated and removal occurs by detaching filter from wall of IVC

15. Quiz
1. is a device used to traps large clots from the lower
extremity that consists of a metal frame that converges into a
cone shape.
1. The Theory of Virchow’s Triad states that a combination of
stasis, hypercoaguable state, and endothelial damage leads to
.
2. is considered to be the most
common cause of venous thrombosis.
IVC filter
thrombosis
Pulmonary Embolism (PE)

16. References
 http://go.galegroup.com.libproxy.clemson.edu/ps/i.do?p=HRCA&u=clemsonu_main&id=GALE|A2092
39110&v=2.1&it=r&sid=summon&userGroup=clemsonu_main&authCount=1
 http://www.sciencedirect.com.libproxy.clemson.edu/science/article/pii/S1936879813006699
 http://search.credoreference.com.libproxy.clemson.edu/content/entry/ehsdorland/may_thurner_syndrom
e
 http://www.surgicalcasereports.com/content/1/1/35
 Kupinski, Ann Marie. "The Inferior Vena Cava and Iliac Veins." Diagnostic Medical Sonography.
Philadelphia: Wolters Kluwer/Lippincott Williams & Wilkins, 2013. 323-330. Print.
 Size, Gail P., and Laurie Lozanski. Inside Ultrasound Vascular Reference Guide. Inside Ultrasound,
Incorporated, 2013. 19, 67, 76-77, 209,. Print.