Abstract
Aneurysms of the iliofemoral venous system are rare. In particular, primary aneurysmal dilatations of the vein without evidence of prior trauma, inflammatory disease, arteriovenous communication or abnormal pressure within the system have been described in only a few reported studies. We report a surgically treated case of a saccular aneurysm of the external iliac vein. A 29-year-old woman in excellent general health was admitted to a gynecological clinic for investigation of infertility. The patient was found to have a pulsing cystic mass beside her right ovary on ultrasonography, and was subsequently referred to our hospital for further evaluation. Doppler ultrasound examination revealed aneurysmal dilatation of the right external iliac vein with mural thrombosis (3×4 cm in diameter). An ascending phlebogram showed a venous aneurysm with no evidence of stenosis, occlusion or rich collateral circulation of the iliofemoral venous system or the inferior vena cava. Angiography of the pelvic and femoropopliteal arterial system did not reveal any abnormal arteriovenous connection. The patient underwent surgery, and exposure of the venous aneurysm was obtained through a right lower quadrant retroperitoneal incision and a vertical right femoral incision. The venous aneurysm was opened longitudinally. After the mural thrombus within the aneurysm had been removed, the aneurysmal wall was cut, and the external iliac vein was reconstructed using a patch of the autologous great saphenous vein with a continuous 7-0 polypropylene suture. The patient received anticoagulation therapy postoperatively consisting of 6 months of warfarin and 1 subsequent year of aspirin without any recurrence of symptoms. Two years after the operation, ultrasonography showed no recurrence of the aneurysm, mural thrombus or stenosis of the right external iliac vein.
