Iliac vein dissection secondary to femoral artery puncture: an extremely rare complication

초록

Vein wall dissection has been sporadically reported during puncture of an arteriovenous fistula (AVF) for hemodialysis. However, dissection of a healthy iliac vein after femoral artery puncture is an extremely rare complication which has not been literally documented yet. We herein describe a case of iliac vein dissection with flow obstruction and thrombosis treated by endovascular intervention. A 55-year-old woman presented to our institution with right leg swelling 2 weeks after a transfemoral cerebral angiography. She was previously healthy and was not taking any medication. She denied past history of surgery, allergy, smoking, alcohol consumption, hypertension and diabetes mellitus. Laboratory tests were within normal limits except for a raised D-dimer level of 0.64 μg/ml. Computed tomographic venogram demonstrated a focal acute thrombosis of the right iliofemoral vein. The venous wall from the proximal common femoral vein to the entire external iliac vein was extensively thickened and enhanced. A double venous lumen and intimal flap were evident suggesting a vein dissection. The false lumen was filled with thrombus whereas the true lumen was significantly collapsed. The diagnosis was confirmed by phlebography, followed by angioplasty using 8 x 100 mm balloon. However, recoil persisted despite repeated inflation up to burst pressure. A 10 x 100 mm self-expandable stent was eventually implanted to ensure the patency of the venous flow. Completion venogram demonstrated direct flow to the inferior vena cava. The patient discharged uneventfully 3 days later and remained asymptomatic at the 2-month follow-up.