Membranous Obstruction of the Inferior Vena Cava Associated with Antiphospholipid Syndrome Presenting with Bilateral Lower Limb Edema A Case Report

Main Article Content

Hugues Allard-Chamard
Marco Lefebvre
Andrew Benko
Martine Chamberland

Keywords

Membranous obstruction of the inferior vena cava, antiphospholipid syndrome

Abstract

Abstract
Membranous obstruction of the inferior vena cava (MOIVC) is an infrequent disorder characterized by an acquired intrinsic obstruction of the hepatic portion of the vena cava. Clinical presentation may vary from an asymptomatic state, to a slowly evolving course of lower extremity swelling, ascites, and progressive cirrhosis. MOIVC may rarely be caused by prothrombotic disorders. Herein, we describe a patient with lupus-erythematosus-associated antiphospholipid syndrome (APS) who presented with subacute venous claudication and bilateral lower limb edema while on oral anticoagulation. Cavography confirmed a diagnosis of MOIVC. The patient successfully underwent percutaneous balloon angioplasty for definitive management and remained symptom-free at 4-year follow-up on long-term anticoagulation therapy. To our knowledge, this is the fourth case description of MOIVC associated with APS successfully treated with balloon angioplasty, but the first with a subacute clinical presentation.
Résumé
L’obstruction membraneuse de la veine cave inférieure est une pathologie peu fréquente caractérisée par une obstruction intrinsèque de la portion hépatique de la veine cave. La présentation clinique varie et inclut une absence de symptômes, des signes congestifs progressifs tels que de l’œdème des membres inférieurs, de l’ascite et une cirrhose progressive. L’obstruction membraneuse peut rarement être causée par des états pro-thrombotiques. Nous rapportons le cas d’une patiente porteuse d’un syndrome des antiphospholipides associé au lupus érythémateux et qui s’est présentée avec de l’œdème subaigu et bilatéral des membres inférieurs sous anticoagulothérapie orale. La cavographie a confirmé le diagnostic d’obstruction membraneuse de la veine cave. La patiente a bénéficié avec succès d’un traitement d’angioplastie par ballon et elle demeure asymptomatique sous anticoagulants après 4 ans de suivi. A notre connaissance, ce cas représente la 4ième description d’obstruction membraneuse de la veine cave associée au syndrome des antiphospholipides et traitée par angioplastie, mais la première avec une présentation clinique subaiguë.

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