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Wilms tumor (WT) is the second most common solid tumor in pediatric population. Botryoid WT is an uncommon growth pattern of WT, which is characterized by tumor extension into collecting system. A case of a 27-month-old boy with botryoid WT and left-sided inferior vena cava is reported in this article to emphasize the importance of preoperative imaging in preoperative planning. [ABSTRACT FROM AUTHOR]

Detailed knowledge of the various venous anomalies is important to optimize the surgical approach and minimize catastrophic complications during retroperitoneal surgery. We report a rare case of an isolated left inferior vein cava (IVC) in a patient with left renal cell carcinoma with level IV IVC thrombus extension, which was successfully treated with terminal–lateral anastomoses between the left and right IVC. We also reviewed the types of duplicated IVCs and discussed the intraoperative management.

Objective: The Inferior vena cava (IVC) is formed by a complex process of embryogenesis during the sixth to tenth week of gestation. The incidence of this congenital anomaly of the cardinal system is approximately 0.2-0.5%, usually being an incidental discovery on Computed Tomography (CT) scans, or likewise during post-mortem dissection. Improper completion of the embryological process may result in four major anatomical abnormalities; duplication of the IVC, retro-aortic left renal vein, circumaortic left renal vein, and transposition or left-sided IVC as discussed in this case study. Methods: The dissection of a male cadaver specimen (90 years old) revealed a persistent left-sided IVC, with left-lateralisation occurring at the level of renal vein convergence into the IVC. The azygous system, iliac vessels, renal veins, and the left-sided IVC have not shown apparent pathology. Measurements of the IVC diameter are as follows; 34mm at the hepatic junction, maximum measurement of 33.61 mm and minimum of 32.35 mm upon passing of the aorta, and 39.19 at the point of bifurcation to iliac vessels. Results and Conclusion: Classically, anomalies such as this are picked up on CT scan, it is unknown whether this anatomical variant was recorded previously in medical records. Various surgical challenges are posed by this congenital venous anomaly, for example, cannulation during cardiopulmonary bypass during thoracoabdominal aortic aneurysm repair, and the persistent thrombotic events post IVC filter placement. In this case report, we explore the incidence, pathology and associated surgical and medical challenges that left-sided IVC presents and its clinical implications. [ABSTRACT FROM AUTHOR]

Evaluation for prospective donors in live-related renal transplantation poses many challenges. Anatomical anomalies are no longer considered red flags as long as the functionality is maintained. Vascular anomalies increase difficulty during live donor nephrectomy. We herein report a case of live donor nephrectomy in a donor with a duplicated left-sided inferior vena cava (IVC). Adequate length of the left renal vein was got by taking a cuff off the duplicated IVC. The postoperative period was uneventful. Duplicated IVC is not a contraindication for left donor nephrectomy and detailed preoperative imaging helps in delineating and planning such cases. [ABSTRACT FROM AUTHOR]

Atrial fibrillation is the most common sustained cardiac arrhythmia in adults and it is associated with a high burden of mortality and morbidity worldwide. Catheter ablation is increasingly used to improve symptoms and prognosis in selected patients. Lower limb venous access with subsequent transseptal approach to the left atrium is the standard procedure for atrial fibrillation catheter ablation. We report an unusual case of complex venous anomaly with a left-sided inferior vena cava with hemiazygos continuation to a persistent left superior vena cava draining in an enlarged coronary sinus in a patient with persistent atrial fibrillation scheduled for transcatheter ablation. Lower limb venous anomalies may limit a standard transseptal approach to the left atrium thus precluding an effective catheter ablation procedure for atrial fibrillation. Alternative interventions, such as unconventional percutaneous access, thoracoscopic approach and "ablate and pace" procedures, may be necessary in patients with symptomatic atrial fibrillation and complex venous anomalies. [ABSTRACT FROM AUTHOR]

• Surgical planning based on preoperative CTA is necessary in patients with vascular anomalies in order to avoid complications. • Intrabdominal adhesions are common in patients with previous abdominal surgery and can affect the surgical approach for donor nephrectomy. • Considering the extension of the donor eligibility criteria, it is expected to see cases with congenital vascular anomalies. The extension of donor eligibility criteria represents one of the possible ways to increase the organ shortage, thus decreasing the waiting time for kidney transplantation. Expectedly, this strategy is associated with a growing number of more technically demanding living donor nephrectomy procedures requiring careful assessment, and sound surgical experience in order to avoid intraoperative complications. After a thorough evaluation through preoperative imaging, we performed a hand-assisted left laparoscopic living donor nephrectomy in a 56 year-old overweight patient with history of prior abdominal surgery, harboring a left-sided inferior vena cava (IVC). This case describes our comprehensive approach in this complex surgical scenario to preserve donor safety and provide an optimal kidney graft. [ABSTRACT FROM AUTHOR]

Situs inversus totalis (SIT) is a rare entity characterized by mirror-image reversal of the viscera. The coexistence of SIT and Leriche syndrome has been rarely described. The authors describe the surgical management of juxtarenal aortic occlusion in a patient with SIT which was successfully managed with open aortic endarterectomy and distal bypass. The malposed organs are at a greater risk of operative injury, but surgical management is feasible with proper determination of the anomalies on preoperative imaging.

Abstract Congenital arteriovenous fistulas involved with the abdominal aorta are very rare. Left-sided subrenal inferior vena cava (IVC) with normal connection to the heart is also rare and has not been reported prenatally. In this article, we described a fetus with aorta-porto-umbilical vein fistulas combined with a left-sided IVC.

Systemic venous anomalies without other congenital heart defects are usually asymptomatic and often found incidentally during a vascular intervention or other surgery. A 60-year-old man with DDD cardiac permanent pacemaker was admitted to the emergency department with syncope and total atrioventricular block due to end-of-life of the permanent pacemaker. The lead of the transient pacemaker could not be advanced via transfemoral access to the right ventricle. Venography revealed that the left-sided inferior vena cava drained into the persistent left superior vena cava, and both continued with the coronary sinus. To avoid unexpected events, venography should be performed to detect venous congenital anomalies during transient or persistent pacemaker implantation. [ABSTRACT FROM AUTHOR]

Spinal fusion via anterior lumbar interbody fusion ( ALIF) can offer symptomatic relief to patients that suffer severe low back pain, radiculopathy, and claudication. However, a detailed working knowledge of the thoracic, abdominal, and lumbar anatomy, particularly of the vasculature, is vital. We report the case of a 68-year-old man who presented with radiculopathy and progressively worsening low back pain despite 9 months of unsuccessful conservative therapy and pain management. Preoperative computed tomography and magnetic resonance imaging revealed a rare anatomical variation, with an anomalous left-sided inferior vena cava and anomalous aorta. The patient was surgically treated with ALIF at L4,5 and L5S1 via an altered surgical window. Given the anomalous anatomy of the patient, instead of performing the procedure after mobilizing both of the transposed abdominal great vessels, the inferior vena cava and the abdominal aorta, the ALIF was uneventfully performed in the window between these vessels. There were no perioperative or postoperative complications. At 12-week postoperative follow-up, X-ray imaging demonstrated successful implantation of ALIF cages with no recurrence of symptoms. A detailed working knowledge of anatomy is important, particularly if anatomical variations are present. This has implications for preoperative surgical planning, which is integral to the safety and the success of procedures. [ABSTRACT FROM AUTHOR]

The term nutcracker syndrome refers to compression of left renal vein between aorta and superior mesenteric artery causing renal venous hypertension. Right nutcracker syndrome associated with a left-sided inferior vena cava is an extremely rare anomaly. Reported two cases in English literature were diagnosed by ultrasonography and computed tomography angiography in adulthood. Herein, we present a case of right nutcracker syndrome with left-sided inferior vena cava and hemiazygos continuation in a 12-year-old girl. [ABSTRACT FROM AUTHOR]

Report on a 63-year-old man with an abdominal aortic aneurysm (AAA) complicated with a left-sided inferior vena cava (It-IVC). A computerized tomographic scan showed that the It-IVC crossed anteriorly over the AAA body from the left to the right side. A superimposed digital subtraction angiogram of the AAA and the It-IVC disclosed a topographic relationship between the two, and also provided useful preoperative imaging data. By dissecting the It-IVC through a transection of several lumbar veins and cranial traction of a transverse portion of the It-IVC, safe proximal aortic control was achieved. The aneurysm was successfully replaced with a bifurcated woven Dacron graft. The development of the It-IVC anomaly and methods for exposing the neck of the AAA when this anomaly is present are also discussed. [ABSTRACT FROM AUTHOR]

Abstract: Introduction: We report a case of a ruptured abdominal aortic aneurysm (RAAA) with atypical localisation of inferior vena cava (IVC), successfully managed with open surgery repair. Case Report: A 52-year-old male patient presented with a 2-day duration of acute abdominal pain and acute left limb pain. Computed tomographic angiography demonstrated ruptured abdominal aortic aneurysm with massive retroperitoneal haematoma and occluded left superficial femoral artery. In addition, left-sided infrarenal IVC, ventrally crossing the aneurysmal neck, supposed difficult clamping and anastomosing. After transection of IVC, the AAA was successfully repaired with tube graft interposition. Subsequently, IVC was reconstructed with a short 20-mm Dacron graft. The patient had an uneventful recovery. Conclusion: The case demonstrates the importance of pre-operative imaging for successful treatment of RAAA in the presence of a challenging venous anomaly and one technical decision for this type of cases. [Copyright &y& Elsevier]