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Primary External Iliac Vein Aneurysm with Generalized Venomegaly

  • Justin M. George
    Affiliations
    Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
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  • Kelsey Berger
    Affiliations
    Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
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  • Jennifer M. Watchmaker
    Affiliations
    Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, New York, NY
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  • James F. McKinsey
    Correspondence
    Corresponding Author: James F. McKinsey, M.D., FACS The Mount Sinai Endowed Professor of Vascular Surgery and Interventional Radiology Vice Chairman Department of Surgery MSW Systems Chief of Aortic Intervention for Mount Sinai Health System Surgical Director of the Jacobson Aortic Center Mount Sinai Health System Mount Sinai West 425 W. 59th Street, 7th Floor New York, New York 10019 Phone: 212-523-7460 Fax: 212-523-3498
    Affiliations
    Division of Vascular Surgery, Department of Surgery, The Icahn School of Medicine at Mount Sinai, New York, NY
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Open AccessPublished:November 23, 2021DOI:https://doi.org/10.1016/j.jvscit.2021.11.004
      Primary iliac vein aneurysms are exceedingly rare. We present the case of a 62-year-old male who after left hip arthroplasty was found on surveillance computed tomography to have an incidental right external iliac vein aneurysm [solid white arrow] with dilation of the inferior vena cava (IVC) [hollow white arrow] (A). Magnetic resonance angiography demonstrated a 5.3 cm right external iliac vein aneurysm (B/Cover) as well as generalized venomegaly. The IVC was dilated to 36mm [hollow white arrow] (C) with renal vein ectasia. Duplex and axial imaging of the lower extremities did not demonstrate any venous ectasia or arteriovenous fistula. The patient did not have a family history of aneurysms or arteriovenous malformations. He had no lower extremity edema, varicose veins, or any evidence of venous insufficiency. Workup for connective tissue disorders was negative. Of note, the patient was an avid bicyclist for over 30 years. Duplex, angiogram, and venogram did not identify an arteriovenous fistula, but confirmed enlargement of IVC [hollow white arrow] (D).
      The iliac system is the least frequent location for venous aneurysms and can be primary or secondary to an underlying cause.
      • Ysa A.
      • Bustabad M.R.
      • Arruabarrena A.
      • Perez E.
      • Gainza E.
      • Alonso J.A.
      Thrombosed iliac venous aneurysm: a rare form of presentation of a congenital anomaly of the inferior vena cava.
      The most common etiology of secondary iliac vein aneurysm is arteriovenous fistula.

      DeWane MP, Fares WH, Ochoa Chaar CI. Endovascular Treatment of a Large Iliac Vein Aneurysm and High-Flow Arteriovenous Fistula. Annals of vascular surgery. Nov 2018;53:266 e265-266 e267.

      Complications of iliac vein aneurysms include thromboembolism and rupture which require prompt intervention.

      Park JS, Kim JY, Kim M, Park SC, Lee KY, Won YS. Ruptured aneurysm of the external iliac vein. Journal of vascular surgery. Venous and lymphatic disorders. Jan 2016;4(1):92-94.

      Given the complication profile, intervention is generally recommended for iliac vein aneurysms. Surgical treatment options include ligation, excision with interposition grafting, and tangential excision with lateral venorrhaphy.
      • Zarrintan S.
      • Tadayon N.
      • Kalantar-Motamedi S.M.R.
      Iliac vein aneurysms: a comprehensive review.
      Recently, endovascular therapy using arterial stent grafts for venous aneurysm exclusion has been described in the literature.

      Todorov M, Hernandez D. Endovascular exclusion of a large external iliac vein aneurysm. Journal of vascular surgery. Venous and lymphatic disorders. Jul 2013;1(3):301-303.

      This patient’s pathology was possibly the result of a genetic predisposition coupled with his strenuous, extensive cycling history. Given the absence of any symptoms, he has resumed his exercise regimen and is being observed every 6 months with alternating duplex studies and CT scans. Expectant management was selected given the patient’s preference and generalized venomegaly compromising definitive repair.
      While there have been few case reports describing iliac vein aneurysms, this is the first describing primary iliac vein aneurysm in the setting of generalized venomegaly.
      Informed consent has been obtained from the patient for publication of this report and accompanying images.

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      References

        • Ysa A.
        • Bustabad M.R.
        • Arruabarrena A.
        • Perez E.
        • Gainza E.
        • Alonso J.A.
        Thrombosed iliac venous aneurysm: a rare form of presentation of a congenital anomaly of the inferior vena cava.
        Journal of vascular surgery. Jul 2008; 48: 218-222
      1. DeWane MP, Fares WH, Ochoa Chaar CI. Endovascular Treatment of a Large Iliac Vein Aneurysm and High-Flow Arteriovenous Fistula. Annals of vascular surgery. Nov 2018;53:266 e265-266 e267.

      2. Park JS, Kim JY, Kim M, Park SC, Lee KY, Won YS. Ruptured aneurysm of the external iliac vein. Journal of vascular surgery. Venous and lymphatic disorders. Jan 2016;4(1):92-94.

        • Zarrintan S.
        • Tadayon N.
        • Kalantar-Motamedi S.M.R.
        Iliac vein aneurysms: a comprehensive review.
        Journal of cardiovascular and thoracic research. 2019; 11: 1-7
      3. Todorov M, Hernandez D. Endovascular exclusion of a large external iliac vein aneurysm. Journal of vascular surgery. Venous and lymphatic disorders. Jul 2013;1(3):301-303.