Qi Hao-Shan, Kwan Kristine J S, Li Hai-Lei
Division of Vascular Surgery, Department of Surgery, 12648Qingdao Municipal Hospital, China.
International School, 47885Jinan University, China.
Vasc Endovascular Surg. 2023 Apr;57(3):257-263. doi: 10.1177/15385744221130855. Epub 2022 Oct 14.
Spontaneous rupture of the iliac vein is a rare cause of retroperitoneal hematoma. A misdiagnosis may delay the treatment and consequently put the patient in a life-threatening emergency. We report the case of a 73-year-old woman who presented with hemorrhagic shock from bleeding caused by a large left retroperitoneal hematoma. She was successfully treated with an endovascular approach by using a double bare stent technique. An extensive review of the literature was conducted and a total 44 articles with 50 patients were identified. Among these patients, 88.2% were women, 94.1% presented with a left-sided rupture, and the mortality rate was 13.7%. Spontaneous iliac vein rupture was more likely to occur in the left side in female patients. Conservative treatment was an option in hemodynamically stable patients. Exploratory laparotomy and surgical iliac vein repair was necessitated in most patients. Endovascular treatment including placement of covered stent and coil embolization had been widely used to treat spontaneous vein rupture since 2003. Double bare stent technique was also an effective alternative if a suitable covered stent was unavailable.
髂静脉自发性破裂是腹膜后血肿的罕见原因。误诊可能会延误治疗，从而使患者处于危及生命的紧急状态。我们报告一例73岁女性患者，因巨大左侧腹膜后血肿出血导致失血性休克。采用双裸支架技术通过血管内途径成功治疗了该患者。我们对文献进行了广泛回顾，共确定了44篇文章中的50例患者。在这些患者中，88.2%为女性，94.1%为左侧破裂，死亡率为13.7%。女性患者中髂静脉自发性破裂更易发生在左侧。血流动力学稳定的患者可选择保守治疗。大多数患者需要进行剖腹探查和手术修复髂静脉。自2003年以来，血管内治疗包括置入覆膜支架和弹簧圈栓塞已被广泛用于治疗自发性静脉破裂。如果没有合适的覆膜支架，双裸支架技术也是一种有效的替代方法。
