Andrea Annoni, Daniele Andreini, Daniela Trabattoni
Inferior vena cava (IVC) anomalies may display with different anatomical features due to the complexity of the embryogenetic process. These vascular anatomical variants occur in 0.4-3.5% of patients. We present the case of a 41 year old woman with a previous transient ischemic attack, positive brain Computed Tomography (CT) scan and Magnetic Resonance (MRI) showing an ischemic frontal area and Patent Foramen Ovale (PFO) with right to left shunt. During the advancement of a .035” J-tipped guide wire via the right femoral vein for PFO closure, a paravertebral supplementary venous circulation was detected and confirmed by CT scan. The incidental diagnosis of venous accessory circulation associated with PFO raised the awareness to the existence of these rare anatomical variations for both the clinician and the interventionalist.