What causes inferior vena caval thrombosis (IVCT)?

Updated: Jun 12, 2018
  • Author: Luis G Fernandez, MD, FACS, FASAS, FCCP, FCCM, FICS, KHS, KCOEG; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Answer

To a large degree, the etiology of IVCT mirrors that of DVT in general. However, specific situations relate to the IVC only, but the wide variety of these situations all relate in one or more ways to Virchow's classic description.

Tumors

Numerous malignancies have been associated with IVCT. [3] Perhaps the most familiar is renal cell carcinoma (RCC). The intravascular tumor extends from the renal vein and can propagate as far as the heart. It can partially or completely occlude the IVC. Not all intravascular irregularities of the kidney represent tumor thrombus. In one case report, a patient who underwent radical nephrectomy for presumed RCC was subsequently found to have only renal vein thrombosis. [4] Other genitourinary tumors that reportedly cause IVCT are seminomas and teratomas.

Numerous other less common tumors reportedly involve the IVC. Intuitively, it is reasonable that any structure anatomically related to the IVC can generate either direct compression or vascular invasion. Retroperitoneal leiomyosarcoma, [5] adrenal cortical carcinoma, [6] and renal angiomyolipoma [7] have all presented in association with IVCT. Even hepatic hemangioma has caused IVCT from extrinsic compression. [8] Additionally, malignancy itself is a risk factor for DVT and thus represents a risk factor for the extension of DVT into the IVC.


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