Surgical Treatment for Agenesis of the Vena Cava: A Single-centre Experience in 15 Cases T.A. Sagban*, D. Grotemeyer, K.M. Balzer, B. Tekath, M. Pillny, K. Grabitz, W. Sandmann Department for Vascular Surgery and Kidney Transplantation, Heinrich-Heine University Du¨sseldorf, Moorenstrasse 5, 40225 Du¨sseldorf, Germany Submitted 20 August 2009; accepted 11 April 2010 Available online 7 June 2010 KEYWORDS Vena cava agenesis; Thrombosis in young age; Thrombophilia in vena cava agenesis; Cavoatrial bypass Abstract Objective: Agenesis of the inferior vena cava (IVC) is a rare vascular malformation. Deep vein thrombosis (DVT) and bilateral pelvic thrombosis develop quite frequently, making surgical therapy necessary. Patients and methods: Between 1982 and 2006, 15 patients (nine male, six female, mean age 28 standard deviance 9 years) with agenesis of the IVC (IVCA) were treated surgically because of acute or subacute DVT. These patients underwent bilateral transfemoral ante- and retro- grade thrombectomy of the iliofemoral and sometimes popliteal veins and replacement of the IVC with an external ring supported PTFE-graft. Bi- or unilateral arteriovenous fistulae were created in the femoral region. The fistulae were closed, on average, 8 months after trans-arterial venography was performed. These patients were examined clinically and by duplex ultrasound imaging during follow-up to assess graft patency and to allow CEAP classifi- cation. Patients were assessed for the development of post-thrombotic syndrome (PTS). Results: No patient died during any part of their treatment or within 60 days. Primary patency of the venous reconstruction was 53%, secondary and long time follow-up patency was 83%. The mean duration of follow-up was 41 SD 12 months. Minor complications were observed in five cases (33%). PTS showed no progression during a follow-up of 41 SD 12 months in all patients. There was no change in the CEAP clinical stage during follow-up nor did any leg ulcer develop. Conclusion: A surgical approach to restore venous patency is effective and appears to prevent the deterioration of CVI over time. ª 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. * Corresponding author. Tel.: þ49 211 8117090; fax: þ49 211 8116603. E-mail address: drsagban@yahoo.de (T.A. Sagban). Eur J Vasc Endovasc Surg (2010) 40, 241e245 1078-5884/$36 ª 2010 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.ejvs.2010.04.009 CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector