Which physical findings are characteristic of inferior vena cava 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

The classic presentation of IVCT includes bilateral lower-extremity edema with dilated, visible superficial abdominal veins. Intuitively, this constellation makes sense, though it is not universally found. In one study, almost 60% of patients did not have bilateral leg edema. In addition, if the thrombus is confined to the cava and does not involve the iliac or femoral system, the collateral pathways form along the posterior abdominal wall. This scenario may have significant impact on surgical procedures involving this anatomic region.

Occlusive thrombus of the IVC at the juxtarenal level can affect renal function by altering renal perfusion.

It is hypothesized that blood return with an absent IVC is inadequate, despite adequate collaterals, resulting in chronic venous hypertension in the lower extremities and causing venous stasis that precipitates thrombosis.


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