Developmental or Procedural Vena Cava Interruption and Venous Thromboembolism: A Review.

The inferior vena cava (IVC) and superior vena cava are the main conduits of the systemic venous circulation into the right atrium. Developmental or procedural interruptions of vena cava might predispose to stasis and deep vein thrombosis (DVT) distal to the anomaly and may impact the subsequent rate of pulmonary embolism (PE). This study aimed to review the various etiologies of developmental or procedural vena cava interruption and their impact on venous thromboembolism. A systematic search was performed in PubMed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines per each clinical question. For management questions with no high-quality evidence and no mutual agreements between authors, Delphi methods were used. IVC agenesis is the most common form of congenital vena cava interruption, is associated with an increased risk of DVT, and should be suspected in young patients with unexpected extensive bilateral DVT. Surgical techniques for vena cava interruption (ligation, clipping, and plication) to prevent PE have been largely abandoned due to short-term procedural risks and long-term complications, although survivors of prior procedures are occasionally encountered. Vena cava filters are now the most commonly used method of procedural interruption, frequently placed in the infrarenal IVC. The most agreed-upon indication for vena cava filters is for patients with acute venous thromboembolism and coexisting contraindications to anticoagulation. Familiarity with different forms of vena cava interruption and their local and systemic adverse effects is important to minimize complications and thrombotic events.
Competing Interests: Dr. Bikdeli reports that he was a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters. Dr. Bikdeli has not been involved in the litigation in 2022 or 2023 nor has he received any compensation in 2022 or 2023. Dr. Bikdeli reports that he is a member of the Medical Advisory Board for the North American Thrombosis Forum, and serves in the Data Safety and Monitory Board of the NAIL-IT trial funded by the National Heart, Lung, and Blood Institute, and Translational Sciences. Dr. Mena-Hurtado was consultant for Abbott, cook, penumbra, Optum labs. Dr. Hanke received consulting fees from Bayer and Janssen. Dr. Bashir has an equity interest in Thrombolex, Inc. He is also supported by an NHLBI grant under the SBIR grant mechanism. Dr. Wasan received speaker fees from Janssen and is on the steering committee of the C-TRACT trial. Dr. Lang is receiving research support from AOP-Health, Janssen, and Neutrolis, and consulting fees from AOP-Health, Janssen, and Medtronic. Dr. Giri is on advisory boards and receives research funds from the institutions of Abiomed, Boston Scientific, Abbot Vascular, Recor Medical, and Inari Medical. Dr. Middeldorp reports grants and personal fees from GSK, Aspen, Pfizer, Daiichi-Sankyo, Bayer, Pfizer, Boehringer-Ingelheim, Portola/Alexion, Astra Zeneca, Abbvie, Pfizer/Bristol-Meyers Squibb, Norgine, Viatris, and Sanofi, all outside the submitted work. Dr. Krumholz received expenses and/or personal fees from UnitedHealth, Element Science, Aetna, Reality Labs, Tesseract/4Catalyst, the Siegfried and Jensen Law Firm, Arnold and Porter Law Firm, Martin/Baughman Law Firm, and F-Prime; is a cofounder of Refactor Health and HugoHealth; and contracts through Yale New Haven Hospital from the Centers for Medicare & Medicaid Services and through Yale University from Johnson & Johnson. Dr. Piazza has received research support from Bristol-Myers Squibb/Pfizer Alliance, Bayer, Janssen, Alexion, Amgen, and Boston Scientific Corporation, and consulting fees from Bristol-Myers Squibb/Pfizer Alliance, Boston Scientific Corporation, Janssen, NAMSA, Prairie Education and Research Cooperative, Boston Clinical Research Institute, and Amgen. Other authors report no disclosures.
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