Inferior vena cava occlusion causing syncope during upper extremity exertion treated with iliocaval venous revascularization

Inferior vena cava (IVC) thrombosis is rare, but its incidence is increased in those with IVC filters or inflammatory bowel disease. Once the IVC is thrombosed, venous return is via collateral channels on the torso and retroperitoneum. Limitations in this collateral venous return can result in symptoms, usually in the lower extremities. Syncope and dyspnea are rare. We report a patient with a 1-year history of worsening syncope when working with his upper extremities. Iliocaval venous occlusion with lack of accommodation of venous return at the thoracic outlet was diagnosed. Treatment with iliocaval stenting resolved his symptoms.