SURGICAL TREATMENT OF A GIANT EXTERNAL ILIAC VEIN ANEURYSM IN A PATIENT WITH A POST-TRAUMATIC FEMORAL ARTERIOVENOUS FISTULA : Perioperative view of left external iliac vein aneurysm
Method and Results:A 34 years old man was injured with gunshot 15 years ago. He made a full recovery and did not notice any sequelae of the trauma in the following years. He was admitted to our clinic because of his left leg swelling and numbness. Angiographic examination showed an arteriovenous fistula at the level of distal third of the superficial femoral artery and a giant aneurysm of the left iliac vein .Multislice computed tomography confirmed this giant aneurysm of the left external iliac vein without any thrombus formation. • Management consisted of separation of the arteriovenous fistula, lateral repair in femoral vein and end-to-end anastomosis in femoral artery. Then, left flank incision for retroperitoneal approach was performed reaching left inguinal incision.
After entering the retroperitoneal space, the aneurysm sac was dissected free from all surrounding tissue. Its distal and proximal necks were exposed .Moreover, it was observed that left iliac vein was dilated and kinking, compressing the external iliac vein proximally. A vascular clamp was placed tangentially, and aneurysm was resected. After declamping, a lateral venorraphy was created with a continuous 5-0 polyprolene suture. • Conclusion:We conclude that it had satisfactory results to excise the fistula and reconstruct the iliac vein aneurysm developing after posttraumatic arteriovenous fistula formation with lateral venorraphy within the same session. • Omer Tetik, Kazım Ergunes, Ismail Yurekli, Orhan Gokalp, Mehmet Bademci, Ali Gurbuz • Atatürk Training and Research Hospital, Department of Cardiovascular Surgery, İzmir-TURKEY