title: Congenital retroperitoneal vascular anomalies: impact on pelvic surgery.
abstract: OBJECTIVE
  Congenital anomalies of the inferior vena cava (IVC) are not commonly recognized since they generally do not cause symptoms.
  
  
  METHODS
  Preoperative cross-sectional imaging can identify anomalies of vascular structures that are highly relevant to the pelvic surgeon. The clinical impact of congenital vascular variations of IVC, especially on paraaortic lymphadenectomy, is investigated.
  
  
  RESULTS
  In case the surgeon is unaware of these anomalies, impending differential diagnostic confusion (paraaortic adenopathy), intraoperative blood loss and the need for transfusion may occur. The development of IVC is a complex process concerning the formation of several anastomoses between three paired embryonic veins (posterior cardinal, subcardinal, supracardinal veins). In double IVC, the left IVC typically ends at the level of the left renal vein, in an anastomosis which crosses anterior to the aorta to join the normal right IVC.
  
  
  CONCLUSIONS
  Anomalies of IVC are present in 0.4-3.5% of women. As different aberrations of IVC have important clinical implications, awareness of retroperitoneal abnormal vessels is crucial to avoid diagnostic pitfalls and intraoperative complications.
authors.affiliation: Department of Obstetrics and Gynaecology, Kiel University Hospital, Arnold-Heller-Strasse 3, Building 24, 24105 Kiel, Germany. astrauss@email.uni-kiel.de
authors.forename: Alexander
authors.initials: A
authors.lastname: Strauss
authors.forename: Carolin
authors.initials: C
authors.lastname: Kuemper
authors.forename: Christoph
authors.initials: C
authors.lastname: Mundhenke
authors.forename: Fritz
authors.initials: F
authors.lastname: Schaefer
authors.forename: Walter
authors.initials: W
authors.lastname: Jonat
authors.forename: Felix
authors.initials: F
authors.lastname: Hilpert
mesh_terms: D000231:Adenocarcinoma, Papillary / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016190:Carboplatin / Q000627:therapeutic use; D003841:Deoxycytidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D010388:Pelvis / Q000098:blood supply* / Q000196:embryology / Q000601:surgery; D011859:Radiography; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000196:embryology / Q000601:surgery; D014682:Vena Cava, Inferior / Q000002:abnormalities* / Q000196:embryology / Q000601:surgery; D000093542:Gemcitabine
chemical_list: D000970:Antineoplastic Agents; D003841:Deoxycytidine; D016190:Carboplatin; D000093542:Gemcitabine