Venous Congestive Myelopathy due to Chronic Inferior Vena Cava Thrombosis Treated with Endovascular Stenting: Case Report and Review of the Literature

Abstract

Authors have no conflict of interest to disclose.
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.
Conclusion—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.