Iliac vein aneurysms: A comprehensive review

Abstract

Introduction: Iliac vein aneurysm is a rare clinical entity. Iliac venous tract is the least common location for venous aneurysms. There are a few cases of common, external and internal iliac vein aneurysms in the literature. However, undiagnosed and ruptured iliac venous aneurysms could have hazardous consequences. Herein, we reviewed all literature cases of iliac vein aneurysms. Their potential diagnostic and therapeutic challenges are discussed. Literature Review: Following a systematic search, 50 cases of iliac venous aneurysms were identified. We used MEDLINE [1900-March 2018] and EMBASE [until March 2018]. MeSH terms of iliac vein/veins/venous, hypogastric, inferior vena cava and aneurysm/aneurysms were used. Fifty patients with venous aneurysms located in common, external or internal iliac veins were found in our systematic search. Seventeen patients were female (35.4%) and 31 patients were male (64.6%). The age range was 13 to 70 years of age. The aneurysm was located in right side in 17 patients (34%). It was located in left side in 29 patients (58%) and it was bilateral in 4 patients (8%). The aneurysm was located in common, external and internal iliac veins in 15 (30%), 31 (62%) and 4 (8%) patients respectively. The aneurysm was due to a previous arteriovenous fistula (AVF) in 19 patients (38%) and of them, 16 patients (32%) had a history of AVF resulting from a previous trauma. 29 patients (59.2%) underwent open surgical treatment. Five patients (10.2%) underwent endovascular treatment. One patient (2.0%) underwent hybrid treatment. Conservative treatment was used in 14 patients (28.6%). Conclusion: Iliac vein aneurysms are extremely rare. Its diagnosis necessitates precise clinical suspicion and the treatment is based on patients' clinical scenario and radiological features. Both open and endovascular techniques could be feasible. Iliac vein aneurysms are more common in men. Left sided aneurysms are more common. The most common anatomic location is external iliac vein. The most common cause of iliac aneurysms is dilatation of vein secondary to a traumatic AVF.