Abstract:An 82-year-old woman who experienced an iatrogenic external iliac vein perforation during a left atrial appendage occlusion procedure was successfully treated by endovascular graft implantation. We report the short- and long-term outcomes of the procedure. (
Level of Difficulty: Advanced.
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“…Management of such injuries includes open surgical repair and endovascular stenting. Several successful endovascular repairs for iliac vein rupture were reported, demonstrating its feasibility and effectiveness [ 12 , 16 , 17 ]. While uncommon, covered stent grafts have proven, in selected cases, to be effective and allow hemorrhage control in difficult situations [ 18 ].…”
May-Thurner syndrome (MTS) is a vascular condition for which endovascular management is commonly chosen. We report an unusual presentation of this syndrome in a patient with previous Wertheim hysterectomy and pelvic radiotherapy, characterized by bilateral leg swelling due to radiation-induced right iliac vein stenosis. Endovascular left iliac vein stenting was performed. During the procedure, an iliac vein rupture occurred after stenting and was successfully treated using a stent graft. Two months follow-up showed a significant reduction of the leg swelling and the patency of the iliac stents. This rare case highlights a potential major risk of iliac vein rupture during the endovascular procedure in an irradiated pelvis.
“…Management of such injuries includes open surgical repair and endovascular stenting. Several successful endovascular repairs for iliac vein rupture were reported, demonstrating its feasibility and effectiveness [ 12 , 16 , 17 ]. While uncommon, covered stent grafts have proven, in selected cases, to be effective and allow hemorrhage control in difficult situations [ 18 ].…”
May-Thurner syndrome (MTS) is a vascular condition for which endovascular management is commonly chosen. We report an unusual presentation of this syndrome in a patient with previous Wertheim hysterectomy and pelvic radiotherapy, characterized by bilateral leg swelling due to radiation-induced right iliac vein stenosis. Endovascular left iliac vein stenting was performed. During the procedure, an iliac vein rupture occurred after stenting and was successfully treated using a stent graft. Two months follow-up showed a significant reduction of the leg swelling and the patency of the iliac stents. This rare case highlights a potential major risk of iliac vein rupture during the endovascular procedure in an irradiated pelvis.
“…Secondary outcomes examined included mortality, continued bleeding, need for additional stenting, and stent occlusion or thrombus formation. Included studies were published between 2003 and 2022, 11 of which were case reports 5-15 and 6 were case series. 16-21 Highlights from these studies are outlined in Table 1.Figure 6.Flow chart of the literature review search method.…”
Objective Iatrogenic injury to the large abdominopelvic veins can he highly morbid, and open surgical repair is technically challenging. Endovascular repair with covered stenting across the injured segment offers an alternative to open surgical management. We present a series of patients with operative injury to the inferior vena cava (IVC) and iliac veins who were treated utilizing an endovascular approach and review the available literature on this technique. Methods A PubMed keyword and MeSH term search was performed, and titles were reviewed for relevance by the first author. Studies related to endovascular repair of iatrogenic injury to the IVC and iliac veins were then read in detail for possible inclusion in the review. Those deemed appropriate were further analyzed for interventional approach, stent type and size, technical success, post-procedural pharmacologic management, complications and surveillance strategy. Results The initial search resulted in 6221 publications. A total of 17 met criteria for inclusion, all of which were case reports or series. Twenty-six patients were described as suffering iatrogenic injury to the IVC or iliac veins, treated with various types and sizes of stents. All cases achieved technical success with hemorrhage control. Procedural complications occurred in 15.4% of cases, including 3 cases of acute thrombus formation and 1 case of stenosis caudal to the initial stent edge requiring additional stenting. Two additional patients experienced stent occlusion in the surveillance period. Conclusions Endovascular repair of iatrogenic injury to the IVC and iliac veins can be an effective management option. However, due to limited data regarding this approach, many technical questions remain, including ideal size and type of stent graft, necessity and duration of post-procedural anticoagulant or antiplatelet therapy and appropriate surveillance. Additionally, long term outcomes in this population have not yet been described.
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