2009 Volume 20 Issue 1 Pages 29-35
Introduction: Stenoses of the iliac veins are mainly caused by deep vein thrombosis and malignancy. We experienced three rare cases of the external iliac vein stenosis not caused by them. Case 1: The patient was 54-year-old female. She complained of edema of the right leg, which was not relieved by wearing elastic stocking. Venogram showed severe stenosis of the right external iliac vein. Computed tomography revealed neither tumor nor thrombus in the pelvis. Lung perfusion scintigram showed no pulmonary embolism. She was treated with PTA (percutaneous transluminal angioplasty) and stenting (PALMAZ™). Postoperative course was uneventful and she was relieved from complaint. Case 2: The patient was 78-year-old female. She had a past history of cellulitis of the left leg. Venogram showed severe stenosis of the left external iliac vein. She had been treated with elastic stocking and Warfarin. After six years she complained of dyspnea and sepsis, which was effectively treated with artificial ventilation. But inflammation remained in the left thigh, which was not relieved by wearing elastic stocking. Computed tomography revealed calcified lymphnodes in the pelvis which was caused by tuberculosis. Lung perfusion scintigram showed no pulmonary embolism. She was treated with PTA and stenting (SMART™). Postoperative course was uneventful and she was relieved from complaint. Case 3: The patient was 49-year-old female. She complained of edema of the right leg, which was not relieved by wearing elastic stocking. She had a past history of frozen pelvis caused by endometriosis. She received anastomosis of the right ureter because of the right hydronephrosis. Venogram showed severe stenosis of the right external iliac vein. Computed tomography revealed neither tumor nor thrombus in the pelvis. Lung perfusion scintigram showed no pulmonary embolism. She was treated with PTA and stenting (Self X™). Postoperative course was uneventful and she was relieved from complaint. Discussion: Stenosis of the common iliac vein such as iliac compression is compensated by the abundant collaterals in the pelvis. However stenosis of the external iliac vein is not relieved. So far many cases were reported as iliac vein stenosis caused by deep vein thrombosis or malignancy. But there were few case reports except them. Elastic stocking helps patients in the point of venous stagnation. In cases of ineffective stocking, PTA and stenting is a very effective treatment. Ultrasound and computed tomography are convenient but not specific in this etiology. Venography is necessary which shows the stenotic area.
