Management of Venous Thromboembolism in a Patient with Duplicated Inferior Vena Cava: A Case Report and Literature Review
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https://doi.org/10.71079/ASIDE.CR.081525186Abstract
Anatomic variations of the inferior vena cava (IVC) are rare, occurring in less than 3% of the population, yet they can pose significant clinical and procedural challenges. We report the case of a 68-year-old male with a contraindication to anticoagulation due to gastrointestinal bleeding, in whom IVC filter placement was indicated for pulmonary embolism prophylaxis. During intra-procedural venography, the patient was found to have a duplicated inferior vena cava (DIVC), a rare vascular anomaly. Bilateral Denali filters were successfully deployed in both IVC limbs to ensure complete thromboembolic protection. This patient remains clinically stable at three-year follow-up with no recurrence of thromboembolism or filter-related complications. This case highlights the placement of bilateral filters in patients with DIVCs that do not converge below the renal veins. Recognizing this was crucial to ensure effective filter placement and avoid incomplete protection against embolism. This case underscores the importance of evaluating venous anomalies prior to interventional procedures involving the IVC. Failure to recognize such variations can lead to technical difficulties, procedural delays, or suboptimal outcomes, including persistent or recurrent thromboembolism. We also review the types of IVC anomalies, their embryology, and some of the potential complications they may cause. Careful procedural planning is essential for optimal patient management.
Keywords:
Case report, Duplicated IVC, DVT, Pulmonary Embolism, Inferior Vena Cava filter, Interventional Radiology, Interventional CardiologyReferences
1. Shammas NW, Rachwan RJ, Daher G, Bou Dargham B. Double Inferior Vena Cava and its Implications During Endovascular and Surgical Interventions: A Word of Caution. J Invasive Cardiol. 2017: 51 [PMID: 28145872,
2. Bass JE, Redwine MD, Kramer LA, Huynh PT, Harris JH, Jr. Spectrum of congenital anomalies of the inferior vena cava: cross-sectional imaging findings. Radiographics. 2000: 639 [PMID: 10835118, https://doi.org/10.1148/radiographics.20.3.g00ma09639] DOI: https://doi.org/10.1148/radiographics.20.3.g00ma09639
3. Gayer G, Luboshitz J, Hertz M, Zissin R, Thaler M, Lubetsky A, Bass A, Korat A, Apter S. Congenital anomalies of the inferior vena cava revealed on CT in patients with deep vein thrombosis. AJR Am J Roentgenol. 2003: 729 [PMID: 12591684, https://doi.org/10.2214/ajr.180.3.1800729] DOI: https://doi.org/10.2214/ajr.180.3.1800729
4. Morita S, Higuchi M, Saito N, Mitsuhashi N. Pelvic venous variations in patients with congenital inferior vena cava anomalies: classification with computed tomography. Acta Radiol. 2007: 974 [PMID: 17957511, https://doi.org/10.1080/02841850701499409] DOI: https://doi.org/10.1080/02841850701499409
5. Ng WT, Ng SS. Double inferior vena cava: a report of three cases. Singapore Med J. 2009: e211 [PMID: 19551299,
6. Shindo S, Kubota K, Kojima A, Iyori K, Ishimoto T, Kobayashi M, Kamiya K, Tada Y. Anomalies of inferior vena cava and left renal vein: risks in aortic surgery. Ann Vasc Surg. 2000: 393 [PMID: 10943793, https://doi.org/10.1007/s100169910071] DOI: https://doi.org/10.1007/s100169910071
7. Malgor RD, Oropallo A, Wood E, Natan K, Labropoulos N. Filter placement for duplicated cava. Vasc Endovascular Surg. 2011: 269 [PMID: 21278173, https://doi.org/10.1177/1538574410395041] DOI: https://doi.org/10.1177/1538574410395041
8. Stavropoulos SW, Chen JX, Sing RF, Elmasri F, Silver MJ, Powell A, Lynch FC, Abdel Aal AK, Lansky A, Muhs BE, Investigators DT. Analysis of the Final DENALI Trial Data: A Prospective, Multicenter Study of the Denali Inferior Vena Cava Filter. J Vasc Interv Radiol. 2016: 1531 [PMID: 27569678, https://doi.org/10.1016/j.jvir.2016.06.028] DOI: https://doi.org/10.1016/j.jvir.2016.06.028
9. Balawender K, Pliszka A, Kłos M, Orkisz S, Barszcz K, Dubrowski A, Matuszyk A, Żytkowski A. Duplication of the inferior vena cava - An anatomical case report with comments on embryological background and clinical implications. Translational Research in Anatomy. 2022: https://doi.org/10.1016/j.tria.2022.100221] DOI: https://doi.org/10.1016/j.tria.2022.100221
10. Al Hatmi A, Al Hajriy M. Inferior Vena Cava Filter Placement in a Duplicated Inferior Vena Cava: A Case Report. Oman Med J. 2021: e244 [PMID: 33898058, https://doi.org/10.5001/omj.2021.29] DOI: https://doi.org/10.5001/omj.2021.29
11. Deng Y, Yan Y, Li W, Feng H, Jin L, Liu Z, Xu B, Zhang Z. Left-Sided Inferior Vena Cava: A Retrospective Study and Literature Review. Ann Vasc Surg. 2025: 47 [PMID: 39341555, https://doi.org/10.1016/j.avsg.2024.07.123] DOI: https://doi.org/10.1016/j.avsg.2024.07.123
12. Kaufman JA, Barnes GD, Chaer RA, Cuschieri J, Eberhardt RT, Johnson MS, Kuo WT, Murin S, Patel S, Rajasekhar A, Weinberg I, Gillespie DL. Society of Interventional Radiology Clinical Practice Guideline for Inferior Vena Cava Filters in the Treatment of Patients with Venous Thromboembolic Disease: Developed in collaboration with the American College of Cardiology, American College of Chest Physicians, American College of Surgeons Committee on Trauma, American Heart Association, Society for Vascular Surgery, and Society for Vascular Medicine. J Vasc Interv Radiol. 2020: 1529 [PMID: 32919823, https://doi.org/10.1016/j.jvir.2020.06.014] DOI: https://doi.org/10.1016/j.jvir.2020.06.014
13. Lan X, Dong FY, Duan JJ. Successful Treatment Strategy for Duplicate Inferior Vena Cava and Deep Venous Thrombosis: Filter Placement and Thrombolysis Approach. Am J Case Rep. 2024: e942578 [PMID: 38630648, https://doi.org/10.12659/AJCR.942578] DOI: https://doi.org/10.12659/AJCR.942578
14. Sartori MT, Zampieri P, Andres AL, Prandoni P, Motta R, Miotto D. Double vena cava filter insertion in congenital duplicated inferior vena cava: a case report and literature review. Haematologica. 2006: ECR30 [PMID: 16785133,
15. Sinnott MJ, Kosoy D, Xing A. Double Inferior Vena Cava With Mega Cava: A Case Report. Cureus. 2025: e82639 [PMID: 40395266, https://doi.org/10.7759/cureus.82639] DOI: https://doi.org/10.7759/cureus.82639
16. Lagrotta G, Danckers M, Fourzali R. Vena cava filter placement in a duplicated infrarenal inferior cava venous system with azygous continuation. BMJ Case Rep. 2021: [PMID: 34479884, https://doi.org/10.1136/bcr-2021-243291] DOI: https://doi.org/10.1136/bcr-2021-243291
17. Li T, Wang Q, Wang W, Yang J, Dong S. One filter may be enough for duplicate inferior vena cava filter implantation in patients with deep venous thrombosis: Two cases report. Medicine (Baltimore). 2022: e32480 [PMID: 36596001, https://doi.org/10.1097/MD.0000000000032480] DOI: https://doi.org/10.1097/MD.0000000000032480
18. Oppenheim R, Kim GJ, Ramon N. Endovascular Inferior Vena Cava Filters Placed in Duplicated Inferior Vena Cava Syndrome. Cureus. 2024: e58044 [PMID: 38738166, https://doi.org/10.7759/cureus.58044] DOI: https://doi.org/10.7759/cureus.58044
19. Suzuki T, Fujino S, Aoyama T. Double inferior vena cava filter implantation in a patient with duplication of the inferior vena cava. J Vasc Surg Cases Innov Tech. 2021: 520 [PMID: 34401616, https://doi.org/10.1016/j.jvscit.2021.04.010] DOI: https://doi.org/10.1016/j.jvscit.2021.04.010
20. Patel S, Cheema A, Karawadia T, Carson M. Management of acute lower extremity deep venous thrombosis in a patient with duplicated inferior vena cava and contraindication to anticoagulation: case and review of the literature. BMJ Case Rep. 2018: [PMID: 29866665, https://doi.org/10.1136/bcr-2017-222974] DOI: https://doi.org/10.1136/bcr-2017-222974
21. Li WR, Feng H, Jin L, Chen XM, Zhang ZW. Duplication of the inferior vena cava: a case series. J Int Med Res. 2022: 3000605221100771 [PMID: 35607249, https://doi.org/10.1177/03000605221100771] DOI: https://doi.org/10.1177/03000605221100771
22. Awashra A, Shubietah A, Rezkalla A, Villegas K, Rajab I. Duplicated Inferior Vena Cava: A Rare Anatomical Variation. Clin Case Rep. 2025: e70411 [PMID: 40226233, https://doi.org/10.1002/ccr3.70411] DOI: https://doi.org/10.1002/ccr3.70411
23. Anwar H, Pardi A, Patel M, Raquib AR, Andrews K, Broniak C, Sperling EE. Duplicated Inferior Vena Cava: A Case Study With Clinical Implications. Cureus. 2025: e81652 [PMID: 40322393, https://doi.org/10.7759/cureus.81652] DOI: https://doi.org/10.7759/cureus.81652
24. Habuchi T, Okagaki T, Arai K, Miyakawa M. Renal cell carcinoma extending into left side of double inferior vena cava. Urology. 1993: 181 [PMID: 8497995, https://doi.org/10.1016/0090-4295(93)90177-c] DOI: https://doi.org/10.1016/0090-4295(93)90177-C
25. Wang LT, Lo HC, Yu DS, Sun GH, Wu CC, Fong CJ. Ureteral obstruction caused by a duplicated anomaly of inferior vena cava. Int J Urol. 2005: 842 [PMID: 16201983, https://doi.org/10.1111/j.1442-2042.2005.01171.x] DOI: https://doi.org/10.1111/j.1442-2042.2005.01171.x
26. Doello K, Mesas C, Quinonero F, Perazzoli G, Prados J. Double inferior vena cava-an important anatomical variant in retroperitoneal surgery. ANZ J Surg. 2024: 265 [PMID: 37905697, https://doi.org/10.1111/ans.18751] DOI: https://doi.org/10.1111/ans.18751
27. Expert Panel on Interventional R, Minocha J, Smith AM, Kapoor BS, Fidelman N, Cain TR, Caplin DM, Eldrup-Jorgensen J, Farsad K, Gupta A, Lee MH, McBride JJ, Moores LK, Rochon PJ, Lorenz JM. ACR Appropriateness Criteria((R)) Radiologic Management of Venous Thromboembolism-Inferior Vena Cava Filters. J Am Coll Radiol. 2019: S214 [PMID: 31054748, https://doi.org/10.1016/j.jacr.2019.02.010] DOI: https://doi.org/10.1016/j.jacr.2019.02.010
28. Streiff MB, Holmstrom B, Angelini D, Ashrani A, Buckner T, Diep R, Fertrin KY, Fogerty AE, Crestani NG, Gangaraju R, Rojas-Hernandez C, Goldhaber SZ, Ibrahim I, Kubal T, Leavitt AD, Lim M, Mann J, Mantha S, Morton C, Nester A, O'Brien A, Ortel TL, Pine A, Pishko A, Ranade M, Salmasi A, Schaefer J, Williams E, Wool G, Wun T, Montgomery S, Nguyen J, Freedman-Cass D, Sliker B. Cancer-Associated Venous Thromboembolic Disease, Version 2.2024, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2024: 483 [PMID: 39236759, https://doi.org/10.6004/jnccn.2024.0046] DOI: https://doi.org/10.6004/jnccn.2024.0046
29. Qin L, Gu X, Wang K, Jia Z, Xue T, Li S, Wang K. Characteristics of Option and Denali Inferior Vena Cava Filters. Ann Vasc Surg. 2024: 349 [PMID: 37852367, https://doi.org/10.1016/j.avsg.2023.08.042] DOI: https://doi.org/10.1016/j.avsg.2023.08.042
30. Han K, Kim MD, Kim GM, Kwon JH, Lee J, Won JY, Moon S, An H. Comparison of Retrievability and Indwelling Complications of Celect and Denali Infrarenal Vena Cava Filters: A Randomized, Controlled Trial. Cardiovasc Intervent Radiol. 2021: 1536 [PMID: 34312689, https://doi.org/10.1007/s00270-021-02928-9] DOI: https://doi.org/10.1007/s00270-021-02928-9
31. Bos AS, Tullius T, Patel M, Leef JA, Navuluri R, Lorenz JM, Van Ha TG. Indwelling and Retrieval Complications of Denali and Celect Infrarenal Vena Cava Filters. J Vasc Interv Radiol. 2016: 1021 [PMID: 27212120, https://doi.org/10.1016/j.jvir.2016.03.034] DOI: https://doi.org/10.1016/j.jvir.2016.03.034
32. Ramaswamy RS, Jun E, van Beek D, Mani N, Salter A, Kim SK, Akinwande O. Denali, Tulip, and Option Inferior Vena Cava Filter Retrieval: A Single Center Experience. Cardiovasc Intervent Radiol. 2018: 572 [PMID: 29260304, https://doi.org/10.1007/s00270-017-1866-z] DOI: https://doi.org/10.1007/s00270-017-1866-z
Data Availability Statement
This is a case report. No datasets were generated or analyzed during the preparation of this manuscript. All relevant clinical information has been included within the article itself.
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Article history
- Received
- 20 Jul 2025
- Received in revised form
- 30 Jul 2025
- Accepted
- 4 Aug 2025
- Published
- 15 Aug 2025
