Spontaneous rupture of the iliac vein

Abstract

Platelet accumulation in vascular prostheses: 1. F. Lane et al. Wilkinson AR, Hawker RJ, Hawker LM. "'Indium labelledCrookston JH. Blood platelet survival. A case of spontaneous rupture of the left common iliac vein is reported and the possible aetiological findings discussed. Case reportA previously healthy 79-year-old woman was admitted to Ashington Hospital, having collapsed in the street. She described a 12 h history of swelling of the left leg associated with lower abdominal pain. The pain became severe and whilst walking she became dizzy and fainted. There was no history of trauma and she was not taking any medication. On admission, she was pale and sweaty. Her blood pressure was 100/45 mmHg and pulse regular at 80 min-'. Abdominal examination revealed the presence of a large, tender non-pulsatile mass in the left iliac fossa approximately 12 x 10 cm. Femoral pulses were both present and there were n o bruits. The left leg was warm and oedematous up to the groin. Rectal examination revealed a boggy swelling in the Pouch of Douglas. The haemoglobin was 6 g/dl and haematocrit 0224.Her condition rapidly improved on the administration of plasma expanders and blood. She was taken to theatre where she was found to have an extensive retroperitoneal haematoma which extended into the broad ligament, the anterior abdominal wall and up to the posterior abdominal wall as far as the left kidney. Exploration of the haematoma revealed normal iliac arteries but a 4cm tear in the anteromedial aspect of the left common iliac vein. The vein contained fresh thrombus but otherwise appeared healthy. After thrombectomy, there was satisfactory bleeding from the distal end but none from the proximal end of the vein. The proximal portion of the vein appeared to be compressed between the overlying right common iliac artery and the sacral promontory. By lifting the artery from the vein, free back bleeding was obtained and mobilization of the artery improved back bleeding to a lesser degree. The tear in the vein was sutured with 4/0 Ethibond.She was anticoagulated initially with heparin and then with warfarin but her recovery was complicated by atrial fibrillation and on the thirteenth day by a small pulmonary embolus. A venogram performed 4 weeks after operation showed that the common iliac vein still contained a thrombus with an extensive collateral circulation. Since then, the oedema of the left leg has resolved and she is now mobile and active.

A spontaneous rupture of the external iliac vein revealed as a phlegmasia cerulea dolens with acute lower limb ischemia: Case report and review of the literature

“…1,2 Ischemia of the left lower limb was noted in four other cases, [3][4][5][6] and a lower limb swelling occurred in three cases. [7][8][9] In our case, the patient had an acute ischemia of the lower limb with a sensiomotor deficiency without abdominal pain. Because of these symptoms, the patient was sent to the operating room with a diagnosis of phlegmasia cerulea dolens.…”

“…Proximal obstruction of the left common iliac vein was identified as a result of the overlying right common iliac artery in two cases 5,7 or of an intraluminal endothelialized band in three cases. 6,12 Because the rupture had occurred on the left in 19 cases (90%), proximal venous obstruction by the overlying right common iliac artery or the endoluminal spur (Cockett or May-Turner syndrome) could be a contributing factor.…”

“…Four patients died after surgery: two after vein ligation and two after vein repair. In the previously reported cases, vein repair was associated with thrombectomy in five cases 3,[7][8][9]19 or with implantation of a vena cava clip or filter in two cases. 6,11 We believe that even if a thrombectomy is performed, leg swelling could appear or increase after surgery because of obstruction of the common iliac vein.…”

Spontaneous Rupture of the Left External Iliac Vein

“…Tissue taken for histopathology, in only four cases, 1–4 showed inflammatory changes. Most cases 2–6,8,9 had a thrombus or a clot in the torn vein. Proximal obstruction of the left common iliac vein was identified either due to the overlying right common iliac artery in two 6,8 or by an intraluminal endothelialised band in one 4 .…”

Spontaneous retroperitoneal hematoma associated with iliac vein rupture

“…To date, 35 patients with spontaneous iliac vein rupture have been reported, [2][3][4] of which almost 79% had concomitant deep venous thrombosis (DVT) or thrombophlebitis 2 and approximately 28.6% had May-Thurner syndrome. 3,[5][6][7][8][9][10][11][12][13] In this study, we investigated SRH associated with iliac vein rupture. Owing to the inability to institute anticoagulation and initial uncertainty in diagnosis, management of these patients presents significant challenges.…”