Inferior Vena Cava Obstruction

Abstract

The syndrome of inferior vena caval obstruction is more prevalent than considered, heretofore. It should no longer be considered an anatomical rarity. Its presence can be diagnosed during life in the majority of patients, and amelioration may now be available for some. The etiology is varied and the lesion may mimic, or be associated with, other significant diagnostic and therapeutic problems. Symptoms are dependent on the level of obstruction, organ system involved, and adequacy of collateral circulation. Many complex pathophysiological changes may occur including, among others, nephrotic syndrome, gastrointestinal malabsorption, chronic Budd-Chiari Syndrome, secondary hyperaldosteronism, pulmonary embolism, and congestive heart failure. Five cases are presented, all diagnosed during life. Clinical manifestations and etiological backgrounds are discussed. The syndrome may be compatible with long-term survival as in 2 cases (19 and 6 years). Prognosis is dependent on the underlying cause and to a great extent on the anatomical segment and organs involved. Diagnostic and therapeutic modalities are discussed. Inferior venacavography and infra-red photography are among the most useful diagnostic tools. Other techniques available include intravenous injection of carbon dioxide, splenoportography; and the use of isotopes for renograms and other applications. At present, there is no universally acceptable therapy for this syndrome. Some therapeutic attempts are discussed. Sixty six references are included.