title: A rare cause of claudication treated with IVC reconstruction: A case report.
abstract: BACKGROUND
  Inferior vena cava (IVC) agenesis is one of rare entities of IVC anomalies which presents in young patients with unprovoked deep venous thrombosis (DVT) or unexplained bilateral lower venous insufficiency. We are presenting a case of IVC agenesis which was treated with IVC reconstruction.
  
  
  METHODS
  We describe a case of 28 years old male with painful bilateral lower extremity varicose veins and a history of right lower extremity DVT and was on anticoagulation with warfarin. He was found to have extensive bilateral greater saphenous veins (GSVs) and right femoral vein reflux with patent bilateral deep veins. He was treated with bilateral GSV ablation and microphlebectomies. Six weeks later he presented with acute bilateral iliofemoral DVTs treated with tissue plasminogen activator thrombolysis tPA via bilateral popliteal vein access which helped relieve his leg swelling but he continued to have debilitating venous claudication. A computed tomography (CT scan) demonstrated resolution of DVT but revealed IVC agenesis. He underwent IVC reconstruction with prosthetic graft which helped complete resolution of his chronically debilitating bilateral lower extremity claudication.
  
  
  CONCLUSIONS
  In young patients with severe manifestations of lower extremity venous hypertension i.e. edema, varicosity and DVT, central venous anomaly should be considered. Severely symptomatic cases of IVC agenesis can be treated with IVC reconstruction.
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA. Electronic address: bali@salud.unm.edu.
authors.forename: Barkat
authors.initials: B
authors.lastname: Ali
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ali Rana
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Langsfeld
authors.affiliation: Department of Surgery, Division of Vascular Surgery, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
authors.forename: John
authors.initials: J
authors.lastname: Marek
keywords: DVT-Deep Vein Thrombosis; IVC-Inferior Vena Cava; PTFE-Polytetrafluoroehtylene