Unique variant of a double inferior vena cava with interiliac communication: Review of clinical and surgical relevance

Congenital variations of the inferior vena cava can result in grave consequences during abdominopelvic surgeries and clinical procedures. The presence of a double inferior vena cava (DIVC) variant can lead to misdiagnoses of paraaortic lymphadenopathy, saccular aortic aneurysms, pyeloureteric dilations, loops of small bowel, and retroperitoneal cysts among surgeons and radiologists. In this case study, a previously unreported variant of a DIVC with interiliac communication was identified in an 85-year-old Caucasian female cadaver. The interiliac communication, which crossed inferior to the sacral promontory at the S1 vertebral level, is particularly at risk during traumatic pelvic fractures, placement of a pelvic C-clamp to stabilize pelvic fractures, and anterior lumbar interbody fusion. Furthermore, an unidentified DIVC can lead to clinical complications, such as recurrent emboli following single IVC filter placement, difficulties inserting a guide wire during balloon mitral valvuloplasty, and hemorrhagic events following iatrogenic laceration of the DIVC during abdominopelvic surgeries. Knowledge of the embryological origin and anatomical categorization of DIVC variants is crucial to physicians treating these venous anomalies in a clinical setting.