Successful Endovascular Management of Post-Traumatic Phlegmasia Cerulea Dolens from Rupture of the External Iliac Vein

We report a rare case of a 47-year-old male with posttraumatic phlegmasia cerulea dolens caused by a ruptured right external iliac vein and treated with an endovascular venous stent graft. The patient was the victim of motor vehicle accident, and suffered direct injuries to the head and abdomen. The patient had a cyanotic and swollen right lower leg. Abdominal and lower extremity computed tomography angiography revealed a large retroperitoneal hematoma caused by a ruptured right external iliac vein, and grade I liver injury. The right external iliac vein rupture was successfully treated with a venous stent graft, followed by inferior vena cava filtering, because a venous thrombus was identified below the stent graft. He initially was hemodynamically unstable but recovered following treatment. The patient was comatose when presenting at the emergency department. He was discharged, fully recovered, on hospital day 18.

Survival of analysis of older patients with external iliac vein tunneled cuffed catheters on maintenance hemodialysis / 中华肾脏病杂志

Objective To investigate the survival of older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis. Methods A total of 70 older patients with external iliac vein tunneled cuffed catheters on maintenace hemodialysis were included in this study, there were 94 patients with internal jugular vein tunneled cuffed catheters as control group. The baseline anthropometric and 1aboratory parameters were measured. The catheter dysfunction and catheter related complications were documented. Results There were lower survival rate and catheter survival in the external iliac vein group compared with internal jugular vein group(χ2=13.714, P<0.01; χ2=13.093, P<0.01). Compared with internal jugular vein group, there was lower rate of catheter infection in external iliac vein group(χ2=9.416, P<0.01); In addition, there were higher rate of cardiovascular disease(CVD) events and catheter dysfunction among patients in external iliac vein group (χ2=7.492, P<0.01; χ2=5.912, P<0.05). Furthermore, the incidence of catheter dysfunction and cardiovascular disease events were the independent risk factors of mortality for older patients with iliac vein tunneled cuffed catheters on maintenance hemodialysis by Cox regression model. Conclusions Patients with iliac vein tunneled cuffed catheters have a shorter survival time. Those with catheter dysfunction or cardiovascular disease events are in higher risk of mortality.

Incidence of Vascular Complications Arising from Anterior Spinal Surgery in the Thoraco-Lumbar Spine

STUDY DESIGN: Modern biomaterials and instrumentation have popularised surgery of the thoraco-lumbar spine through an anterior route. The advantage of anterior surgery is that it allows for a direct decompression of the compromised spinal canal. However, the potential for devastating long-term sequelae as a result of complications is high. PURPOSE: The aim of this study was to give a general overview and identify the incidence of vascular complications. OVERVIEW OF LITERATURE: There is limited literature describing the overall incidence and complications of anterior spinal surgery. METHODS: A retrospective review of a prospective database of 1,262 consecutive patients with anterior surgery over a twelve-year period. RESULTS: In our study, 1.58% (n=20) of patients suffered complications. Injury to a major vessel was encountered in 14 (1.11%) cases, of which nine involved an injury to the common iliac vein. In six cases, the original procedure was abandoned due to a life-threatening vascular injury (n=3) and unfavourable anatomy (n=3). CONCLUSIONS: The incidence of vascular and other complications in our study was relatively low. Nevertheless, the potential for devastating long-term sequelae as a result of complications remains high. A thorough knowledge and awareness of normal and abnormal anatomy should be gained before attempting such a procedure, and a vascular surgical assistance especially should be readily accessible. We believe use of access surgeons is mandatory in cases with difficult or aberrant anatomy.

Adventitial Cystic Disease of the External Iliac Vein in a Patient Presenting with Leg Edema

A 69-year-old male patient presented with a 2 week history of left leg swelling. The past medical history was unremarkable. On physical examination, his left leg was swollen up to the thigh and Homan's sign was positive. Duplex ultrasound revealed a solid and cystic lesion localized only at the iliac vein. Surgical exploration was performed under the suspicion of adventitial cystic disease (ACD). The final pathologic diagnosis was ACD. Although ACD has usually been reported in arterial segments, venous involvement has been reported. In the majority of these reported patients, the common femoral vein is associated with venous ACD. According to a Medline search, there have been nine reports related with venous ACD. Only two cases of external iliac vein (EIV) involvement of ACD have been previously reported, including one Korean report. We report here on a case of recently experienced EIV ACD.

Intravenous Pyogenic Granuloma (or Lobular Capillary Hemangioma) Developed within the Right External Iliac Vein

A pyogeinc granuloma, also known as a lobular capillary hemangioma, is a benign vascular tumor of the skin and mucous membranes, which is common in infants and children. It usually presents as a rapidly evolving solitary, sessile, or polypoid vascular nodule. An intravenous pyogenic granuloma (IVPG) is a rare form of pyogenic granuloma, in which the whole lesion appears as a single polypoid mass projecting into the lumen of a vein. All reported cases of IVPG have been limited the head, neck, and upper extremity. We report a case of an intravenous pyogenic granuloma located within the iliac vein of a lower extremity.