Duplication of the IVC has previously been reported to have an incidence of 0.2–3%,2
and the majority of cases are identified incidentally during imaging for various reasons. This duplication is a result of a failure in the embryological formation of the IVC. This complex process involves three pairs of veins and takes place between the sixth and tenth weeks of gestation.3
The author has identified only 13 previous cases of a duplicated IVC with associated DVT in the literature (age range 19–81). In all previous cases, the right IVC is noted to be wider than the left, making this case the first of its kind. Interestingly, a recent American case4
describes managing a similar scenario with thrombolysis, thrombectomy and stenting of a popliteal vein occlusion and both IVCs. Such dramatic variation in management highlights the fact that there are currently no guidelines to advise on the management of DVTs associated with IVC anomalies.
Chee et al
identified IVC anomalies in 5–6.7% of patients (<40 years) presenting with a DVT; a figure much higher than the expected rate, suggesting an increased risk. Some suggest that any anomaly in the IVC promotes thrombus formation due to venous stasis. However, Anne et al5
believe that any correlation between a duplicated IVC and DVT is purely incidental.
- Consider venous anomalies in patients with unexplained DVTs, particularly in the young.
- If the placement of an IVC filter is deemed appropriate, these patients require one in each system.
- Surgeons and radiologists must be cautious. Several adverse events have been reported in the literature due to a failure to appreciate these anatomical variations.