Left-sided inferior vena cava in patients submitted to aorto iliac surgery- Our experience and review of the literature

We present two cases of left sided inferior vena cava, one unexpectedly obs erved during an operation of aorto bifemoral bypass in a patient with sever e Leriche syndrome and almost complete obstruction of the infrarenal aorta, the second in a patient with an aneurysm of the abdominal aorta, in whom t he anomaly was recognized before the operation. This very rare congenital m alformation (0.2-0.5%) was not recognized in the first patient by the duple x scanner performed preoperatively, probably because of the low level of su spicion carried on by an experienced operator. Computer tomography angiogra phy or magnetic resonance angiography, which would have surely shown us the anomaly, were not done in the first patient because, in the lack of an ane urysmal disease or other abdominal pathological situations, these investiga tions were not required before operation. The possible hazards of such an u nrecognized malformation are great, mostly in terms of incontrollable intra operative hemorrhages, but the final outcome of this case was positive.