Embolization for massive bleeding due to spontaneous left external iliac vein rupture: report of a successful case

Abstract

Background Spontaneous rupture of the iliac vein has rarely been reported. Its associated hypovolemic shock-related symptoms and signs, including syncope and hypotension, have been observed in most of these cases. Successful transcatheter venous embolization for massive bleeding due to spontaneous rupture of the external iliac vein was herein reported. Case presentation An 82-year-old female patient developed sudden left lower abdominal and back pain. Immediately, she lost consciousness and went into shock. CT images of her abdomen revealed a huge retroperitoneal hematoma, with leakage of contrast medium in the hematoma in the left flank. These findings suggested left external iliac vein rupture. Open surgery was considered; however, since the patient’s condition may have deteriorated further due to the time needed to prepare for surgery, including general anesthesia, transcatheter venous embolization of the left iliac vein was selected. A 5.2-Fr compliant balloon catheter (nominal diameter of 10 mm) was inflated at the distal site of the external iliac vein to reduce extravasation. N-butyl-2-cyanoacrylate (NBCA) was mixed with Lipiodol at a ratio of 1:2. The left Iliac vein was filled and completely embolized with the NBCA/Lipiodol mixture (total injected volume, 5 mL) using a 1.8-Fr microcatheter. After embolization, the patient quickly. An inferior vena cava filter was placed 1 day after embolization. Conclusion Spontaneous rupture of the iliac vein is a very rare and lethal condition. Transcatheter venous embolization may control potentially life-threatening bleeding. Rapid bleeding control in a critical condition is facilitated by this minimally invasive approach.

Common and uncommon vascular injuries and endovascular treatment associated with pelvic blunt trauma: a real-world experience

“…Transcatheter venous embolization with NBCA can potentially control critical bleeding from the iliac vein. However, it may cause some complications, such as leg swelling, deep vein thrombosis, and pulmonary embolism by obstruction of venous flow [ 39 ]. Endovascular treatment with covered stents is considered a favorable treatment option [ 40 , 41 ], if an appropriately sized stent is readily available.…”

Clinical characteristics and treatment outcomes of 68 patients with spontaneous iliac vein rupture: A case report and systematic review

“…After a full-text review, 82 articles were considered for inclusion. Of these, 20 articles were excluded, resulting in the inclusion of 63 case reports comprising 68 patients, including the current case, from 1961 to 2022 [ [1] , [2] , [3] , [6] , [7] , [8] , [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] ]. The case reports were published in various languages, including English (n = 46), Spanish (n = 6), Japanese (n = 4), Chinese (n = 3), Portuguese (n = 1), Danish (n = 1), French (n = 1), and German (n = 1) ( Table 1 ).…”

Spontaneous Iliac Vein Ruptures: A Systematic Review

“…After full-text screening, 76 cases were included in this systematic review presented in 64 studies from all over the world ( Table 1 ). 2 , 3 , 6 - 67 Most patients underwent open surgery, the first reported in 1961. Endovenous procedures were reported since 2004.…”