Miron Fasoulakis1, Alexandros Blionas1, Evridiki Karanikola1, George Galyfos2*, Emannuel Barbaressos1 and Konstantinos Filis2
1Vascular Surgery Unit, Elpis General Hospital, Athens, Greece
21st Department of Propaedeutic Surgery, University of Athens Medical School, Hippocration Hospital, Athens, Greece
Received: 10 August, 2015; Accepted: 28 September, 2015; Published: 30 September, 2015
George Galyfos, 6 Melinas Merkouri Street, Neon Iraklion, 14122, Athens, Greece. Tel.: +30-213-2086343; Fax: +30-210-7707574; E-mail:
Fasoulakis M, Blionas A, Karanikola E, Galyfos G, Barbaressos E, et al. (2015) Management of a Common Iliac Artery Aneurysm Causing Contralateral Iliac Venous Thrombosis. Int J Vasc Surg Med 1(1): 009-011. DOI: 10.17352/2455-5452.000004
© 2015 Fasoulakis M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Isolated common iliac artery aneurysm; Contralateral deep vein thrombosis; Open surgery; Endovascular repair
A 73-year-old male patient was diagnosed with thrombotic obstruction of the left common iliac vein (LCIV). Computed tomography imaging revealed a known -under follow-up- isolated aneurysm of the right common iliac artery that seemed to directly obstruct the LCIV. Given the patient’s renal insufficiency as well as the size and anatomy of the aneurysm, the patient underwent open repair. The decision between open and endovascular repair, given the proximal DVT, is a dilemma, considering the risk for pulmonary embolism perioperatively as well as the venous thrombosis outcome postoperatively. Therefore, we present such an unusual case and discuss proper management.
Aneurysms of the common iliac artery are rare, consisting less than 2% of all aneurysms . Rarely, iliac artery aneurysms of significant size can obstruct venous outflow, manifesting as deep venous thrombosis (DVT). In these cases, DVT usually involves the ipsilateral, to the iliac artery aneurysm, iliac vein [2-5]. To our knowledge, there has been no case report to date referring to an isolated unilateral iliac artery aneurysm causing contralateral deep venous thrombosis due to iliac vein compression. Our aim is to present such an unusual case and make useful conclusions regarding proper management.
A 73-year-old male patient presented in the emergency department complaining of pain and oedema in his left lower extremity for the last three days. His medical history revealed coronary artery disease under treatment, a recent percutaneous coronary angioplasty and renal insufficiency (serum creatinine: 2.2 mg/dl, clearance: 29.61 ml/min). The patient reported a known right common iliac artery aneurysm as well, followed-up closely with computed tomography (CT) imaging every year, for the last two years, in another institution. The patient reported that he had refused aneurysm treatment.
The previous CT evaluations revealed a steady increase in maximum aneurysm diameter: 5.5 cm at the beginning, 5.8 cm after one year, and finally, 6.2 cm with a 2.8 cm true lumen diameter on patient’s admission CT (Figure 1). Ultrasound examination, as well as CT imaging, confirmed his clinical picture by illustrating a thrombosis of the left common iliac vein (CIV). Coloured duplex ultrasonography revealed a complete left CIV thrombosis extending from the iliac vein bifurcation to the origin of the left CIV. No floating thrombus extending proximally into the inferior vena cava, and no thrombosis of the right iliac veins were observed either. According to CT 3D-reconstruction analysis, there was a direct pressure effect from the right common iliac artery on the left common iliac vein, which was the primary cause for iliac vein thrombosis and subsequent iliac vein obstruction (Figure 2). The aneurysm extended from precisely bellow the aortic bifurcation until just proximal to the right common iliac artery bifurcation, without affecting the aorta or the internal/external iliac arteries.
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