Staged Approach for Surgical Management of External Iliac Vein Aneurysm Associated With Traumatic Femoral Arteriovenous Fistula

Abstract

Aneurysms of the iliac vein are rare. They can occur in association with arteriovenous fistulae located elsewhere. Here, we present a 30-year-old man who developed a large left external iliac vein aneurysm in association with a chronic traumatic arteriovenous fistula in the left thigh. Less than 25 cases of iliac vein aneurysms have been reported in the last 40 years. The presentation and treatment of this condition has been heterogeneous. We suggest that adequate surgical treatment can be offered in a staged approach: aneurysm resection with reconstruction should be done first, followed by closure of the arteriovenous fistula 6 months later.

Novel Approach to a Giant External Iliac Vein Aneurysm Secondary to Posttraumatic Femoral Arteriovenous Fistula

“…This method assumes that continued high blood flow in the venous system improves patency of the venous conduit. 9 While consensus data regarding the best treatment approaches have varied, authors uniformly agree that AVF’s should be surgically closed.…”

Iliac vein aneurysms: a comprehensive review

“…In primary iliac vein aneurysms, aneurysm resection is considered for open surgical management. 4,8,12 Following aneurysm resection, venorrhaphy, patch venoplasty 33,41 or venous bypass 2,18 are used to restore venous drainage. Traditionally, simple ligation of distal and proximal parts of venous aneurysm may be considered if collateral and superficial venous drainage is sufficient.…”

“…Presentation of iliac venous aneurysms is diverse and unclear due to its rarity. 4 Duplex ultrasound, CT venography, magnetic resonance venography and conventional venography are diagnostic tests to identify iliac vein aneurysms and to plan specific management. However, simple test has not yet been gold standard.…”