Endovascular repair of right-sided iliac vein aneurysm and iliac arteriovenous fistula

Abstract

A 72-year-old man receiving anticoagulation therapy for chronic bilateral deep vein thromboses presented with acute right leg swelling. Right-sided imaging showed deep femoral vein thrombosis, chronic partial femoral vein thrombosis, and 4.8-cm distal external iliac vein dilation with possible right iliac vein stenosis. Venography confirmed common iliac vein occlusion and an aneurysm, with a fistula to the right internal iliac artery found by angiography. Aneurysm obliteration was achieved via arterial embolization with coils and an Amplatzer plug (Abbott, Chicago, IL). The patient continued with anticoagulation therapy, with patent common and external iliac arteries and a stable right external iliac vein aneurysm without arterial waveforms found on follow-up. His clinical manifestations were improved.

Keywords: Arteriovenous fistula; Iliac vein; Venous aneurysm.

Fig 1

Photograph showing acute swelling of the right lower extremity in the setting of chronic bilateral deep vein thromboses.

Fig 2

A, Venogram revealing a right common iliac vein (CIV) occlusion (arrow) and a 4.8-cm right CIV aneurysm (arrowhead). B, Angiogram confirming anterior and posterior branches of the right internal iliac artery (IIA) emptying into the right CIV aneurysmal sac.

Fig 3

Coil embolization of the right internal iliac artery (IIA) with initial use of seven coils (A), and repeat angiogram after deployment of an additional two coils and Amplatzer plug confirming exclusion of the aneurysm and fistula (B).