title: Venous Congestive Myelopathy due to Chronic Inferior Vena Cava Thrombosis Treated with Endovascular Stenting: Case Report and Review of the Literature.
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.
  
  
  CONCLUSIONS
  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.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Diego Z
authors.initials: DZ
authors.lastname: Carvalho
authors.affiliation: Department of Neurosurgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Hughes
authors.affiliation: Department of Neuroradiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Greta B
authors.initials: GB
authors.lastname: Liebo
authors.affiliation: Department of Vascular & Interventional Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Emily C
authors.initials: EC
authors.lastname: Bendel
authors.affiliation: Department of Vascular & Interventional Radiology, Mayo Clinic, Rochester, MN, USA.
authors.forename: Haraldur
authors.initials: H
authors.lastname: Bjarnason
authors.affiliation: Department of Neurology, Mayo Clinic, Rochester, MN, USA.
authors.forename: James P
authors.initials: JP
authors.lastname: Klaas
keywords: Endovascular; Inferior vena cava; Myelopathy; Stenting; Thrombosis
references.citation: J Neurol Neurosurg Psychiatry. 1999 Dec;67(6):827-8
references.pmid: 10617383
references.citation: J Neurol Neurosurg Psychiatry. 2007 Nov;78(11):1283-4
references.pmid: 17940177
references.citation: J Neurosurg Spine. 2012 Feb;16(2):201-5
references.pmid: 22117140
references.citation: Spine (Phila Pa 1976). 1994 Sep 15;19(18):2122-6
references.pmid: 7825056
references.citation: J Neurosurg Spine. 2007 Jun;6(6):552-8
references.pmid: 17561744
references.citation: J Endovasc Ther. 2009 Apr;16(2):233-7
references.pmid: 19456201
references.citation: Spine (Phila Pa 1976). 2004 Nov 1;29(21):2419-24
references.pmid: 15507805
references.citation: J Endovasc Ther. 2006 Apr;13(2):249-53
references.pmid: 16643081
references.citation: Phlebologie. 1993 Jul-Sep;46(3):411-4; discussion 415
references.pmid: 8248307
references.citation: Neurology. 2008 Jul 1;71(1):e1
references.pmid: 18591496
references.citation: J Neurosurg. 2006 Jan;104(1 Suppl):46-9
references.pmid: 16509481
references.citation: Spine (Phila Pa 1976). 2010 Aug 15;35(18):E921-4
references.pmid: 21381233
references.citation: Radiology. 2000 Jan;214(1):133-8
references.pmid: 10644112
references.citation: Spine (Phila Pa 1976). 2006 May 20;31(12):E383-6
references.pmid: 16721285
references.citation: J Bone Joint Surg Br. 2012 Sep;94(9):1292-4
references.pmid: 22933506
references.citation: Schweiz Med Wochenschr. 1988 Aug 27;118(34):1209-12
references.pmid: 2972060
references.citation: Spine (Phila Pa 1976). 2003 Sep 1;28(17):E347-50
references.pmid: 12973161
references.citation: AJNR Am J Neuroradiol. 2004 Jan;25(1):69-73
references.pmid: 14729531