Diego Z Carvalho1, Joshua D Hughes2, Greta B Liebo3, Emily C Bendel4, Haraldur Bjarnason4, James P Klaas1. 1. Department of Neurology, Mayo Clinic, Rochester, MN, USA. 2. Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA. 3. Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA. 4. Department of Vascular & Interventional Radiology, Mayo Clinic, Rochester, MN, USA.
Abstract
OBJECTIVE: Impaired inferior vena cava (IVC) outflow can lead to collateralization of blood to the valveless epidural venous plexus, causing epidural venous engorgement and venous congestion. Herein we describe a case of chronic IVC thrombosis presenting as venous congestive myelopathy treated with angioplasty and endovascular stenting. The pathophysiological mechanisms of cord injury are hypothesized, and IVC stenting application is evaluated. METHODS: Case report and review of the literature. RESULTS: IVC outflow obstruction has only rarely been associated with neurologic dysfunction, with reports of lumbosacral nerve root compression in the cases of IVC agenesis, compression, or occlusion. Although endovascular angioplasty with stenting is emerging as a leading treatment option for chronic IVC thrombosis, its use to treat neurologic complications is limited to one case report for intractable sciatica. Our case is the first description of IVC thrombosis presenting with venous congestive myelopathy, and treated successfully with IVC stenting. CONCLUSION: Venous congestive myelopathy should be seen as a broader clinical condition, including not only typical dural arteriovenous fistulas, but also disorders of venous outflow. Therefore, identifying a rare, but potentially treatable, etiology is important to avoid permanent neurologic deficits. IVC stenting is proposed as a novel and effective treatment approach.
OBJECTIVE: Impaired inferior vena cava (IVC) outflow can lead to collateralization of blood to the valveless epidural venous plexus, causing epidural venous engorgement and venous congestion. Herein we describe a case of chronic IVC thrombosis presenting as venous congestive myelopathy treated with angioplasty and endovascular stenting. The pathophysiological mechanisms of cord injury are hypothesized, and IVC stenting application is evaluated. METHODS: Case report and review of the literature. RESULTS:IVC outflow obstruction has only rarely been associated with neurologic dysfunction, with reports of lumbosacral nerve root compression in the cases of IVC agenesis, compression, or occlusion. Although endovascular angioplasty with stenting is emerging as a leading treatment option for chronic IVC thrombosis, its use to treat neurologic complications is limited to one case report for intractable sciatica. Our case is the first description of IVC thrombosis presenting with venous congestive myelopathy, and treated successfully with IVC stenting. CONCLUSION:Venous congestive myelopathy should be seen as a broader clinical condition, including not only typical dural arteriovenous fistulas, but also disorders of venous outflow. Therefore, identifying a rare, but potentially treatable, etiology is important to avoid permanent neurologic deficits. IVC stenting is proposed as a novel and effective treatment approach.
Authors: Wouter W te Riele; Tim Th C Overtoom; Jos C van den Berg; Eric D W M van de Pavoordt; Jean-Paul P M de Vries Journal: J Endovasc Ther Date: 2006-04 Impact factor: 3.487
Authors: E N Hanley; B H Howard; C D Brigham; T M Chapman; W B Guilford; J M Coumas Journal: Spine (Phila Pa 1976) Date: 1994-09-15 Impact factor: 3.468