Primary External Iliac Venous Aneurysm: A Case Report

Abstract

Primary iliac venous aneurysm is an exceedingly rare abnormality that can be complicated by pulmonary embolism, thrombosis, and rupture. Here we report the case of an otherwise healthy 40-year-old man with a unilateral external iliac vein aneurysm without any evidence of an arteriovenous fistula, proximal stenosis, or obstruction, as reported on computed tomography. Pulmonary embolism was diagnosed using 99mTc-macroaggregated albumin scintigraphy. To prevent life-threatening complications, we treated the patient with anticoagulant therapy and performed aneurysmectomy with reconstruction using a saphenous vein graft patch. Although postoperative venography showed obstruction of the external iliac vein, the patient remained asymptomatic.

Open aneurysmorrhaphy for repair of a massive iliac vein aneurysm and review of the recent literature

“…Three patients were conservatively managed (11.5%), and 11 (42.3%), 3 (11.5%), and 9 (34.6%) underwent open, hybrid, or endovascular repair, respectively. 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 …”

“… 10 , 11 , 28 The 11 patients who underwent open aneurysm repair were stable on follow-up, except for 1 patient with iliac vein thrombosis found on follow-up imaging that was asymptomatic and managed with anticoagulation therapy. 15 Several patients undergoing endovascular or hybrid repair (5 of 12; 41.7%) required reintervention or demonstrated stent thrombosis on follow-up imaging. 12 , 13 , 14 , 20 , 23 …”

Phlegmasia cerulea dolens secondary to an aortoiliac aneurysm

“…The stents were sized according to the diameter of the vessel diameter proximal and distal to the aneurysm. Few reports on aneurysmal iliac veins have been published, to our knowledge none on endovascular treatment 10 . The diameter of the venous aneurysm decreased from 39 to 24 mm during follow-up and may be related to decreased venous pressure after reopening the veins and/or an effect from the dual stent layers similar to the flow diverter stents used to treat arterial aneurysms 11 …”

Giant renal vein aneurysm

“…We are unaware of any reports of such an extensive abdominal venous aneurysmal pattern. Some authors have advocated for decompressive shunts in the case of portal venous aneurysms or excision and venorrhaphy with primary repair or patch reconstruction for iliocaval aneurysms 5, 10, 11. Direct caval repair would prove difficult in terms of exposure around a large, potentially thin-walled right RV aneurysm with potential for significant blood loss.…”