title: Management of inferior vena cava aneurysm.
abstract: OBJECTIVE
  Inferior vena cava (IVC) aneurysm is an infrequent but potentially lethal abnormality. We have seen one such case in our group practice. We have added this case to a review of 53 previously reported cases in order to develop a management algorithm for this entity.
  
  
  METHODS
  We conducted a MedLine search of all English-language articles from the first reported case in 1950 through August 2013. Patient demographics, clinical data, management and outcomes were extracted. IVC aneurysms were categorized in 4 types as per Gradman and Steinberg classification.
  
  
  RESULTS
  The mean patient age was 27.1 years (range 5-89) and 57.4% were male. A total of 11 (20.3%) had associated vascular anomalies and iliocaval thrombosis was found in 10 (18.5%). There were 23 type I aneurysms, 8 type IIs, 21 type IIIs and 2 type IVs. All but 1 type I was successfully managed conservatively without complications. For type IIs, only 3 patients were managed conservatively with 1 death related to stroke from paradoxical embolus. For type IIIs, resection was the most common management option (14 patients). One patient was treated endovascularly with aneurysm embolization. A total of 6 asymptomatic patients were treated conservatively with 1 death due to thromboembolism. For type IVs, all cases underwent expectant management with 1 death due to aneurysm rupture.
  
  
  CONCLUSIONS
  IVC aneurysms are rare with only 54 cases reported in the literature. Associated vascular anomalies and iliocaval thrombosis should be expected in approximately 20% of cases. Type I aneurysms can be managed expectantly with close surveillance unless symptomatic. For type II-IV, surgical consideration should be given based on high rates of thromboembolic complications and non-negligible risk of rupture.
authors.affiliation: Division of Vascular Surgery, University of Arizona, Tucson, AZ, USA - jmills@u.arizona.edu.
authors.forename: M F
authors.initials: MF
authors.lastname: Montero-Baker
authors.forename: B C
authors.initials: BC
authors.lastname: Branco
authors.forename: L L
authors.initials: LL
authors.lastname: Leon
authors.forename: N
authors.initials: N
authors.lastname: Labropoulos
authors.forename: A
authors.initials: A
authors.lastname: Echeverria
authors.forename: J L
authors.initials: JL
authors.lastname: Mills
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000783:Aneurysm / Q000145:classification / Q000175:diagnosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D002675:Child, Preschool; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D014682:Vena Cava, Inferior / Q000601:surgery*; D055815:Young Adult