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.

Keywords: iliac vein; primary venous aneurysm; treatment.

Fig. 1 Preoperative imaging in a 40-year-old male with a unilateral EIV aneurysm. (A) A 3D-reconstructed computed tomography angiogram shows an aneurysm of the right EIV, with a maximal diameter of 66 mm×72 mm. (B) An ascending venogram reveals a large saccular aneurysm of the right EIV. EIV: external iliac vein

Fig. 2 Intraoperative findings of the external iliac venous aneurysm. (A) The venous aneurysm (white arrow), which was exposed through a retroperitoneal incision in the right lower quadrant, did not have feeding vessels. (B) After the excess vein wall was resected, the vessel wall was reconstructed using a saphenous vein graft patch that was taken from the opposite side. The patch was wrapped in the remaining wall of the aneurysmal vein.