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Spontaneous Iliac Vein Ruptures: A Systematic Review
Alexander L Kooiman1, Jay M Bakas1, Joris M K van Fessem2
1Department of Vascular Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Vascular and Endovascular Surgery
|March 13, 2023
Summary
Spontaneous iliac vein rupture is a rare, life-threatening condition. Early diagnosis in middle-aged to elderly females with hemorrhagic shock and left-sided deep vein thrombosis (DVT) is crucial for timely intervention and improved survival.
Area of Science:
- Vascular Surgery
- Emergency Medicine
- Radiology
Background:
- Spontaneous iliac vein rupture is a rare but often fatal vascular emergency.
- Timely recognition of clinical signs and prompt treatment are critical for patient survival.
- This study aims to enhance awareness of clinical features, diagnostics, and treatment strategies through literature evaluation.
Approach:
- A comprehensive systematic literature search was performed across major databases (EMBASE, MEDLINE, Cochrane, Web of Science, Google Scholar) up to January 2023.
- Two independent reviewers screened studies for eligibility, extracting data on patient characteristics, clinical presentation, diagnostic methods, treatment approaches, and outcomes.
- Seventy-six cases from 64 studies were included in the analysis.
Key Points:
- The majority of spontaneous iliac vein ruptures occur on the left side (96.1%) and predominantly affect females (84.2%) around 61 years old.
- A significant association exists with deep vein thrombosis (DVT), present in 84.2% of cases.
- Overall survival was 77.6%, with endovenous or hybrid procedures showing excellent outcomes when diagnosed pre-treatment, while missed diagnoses often led to mortality.
Conclusions:
- Spontaneous iliac vein rupture is an easily missed diagnosis, particularly in middle-aged and elderly females presenting with hemorrhagic shock and left-sided DVT.
- Diverse treatment strategies exist, but early diagnosis facilitates less invasive endovenous interventions.
- Prompt diagnosis and appropriate endovenous treatment appear to correlate with favorable survival rates.
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