Department of Vascular Surgery, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Anesthesiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands.
Vasc Endovascular Surg. 2023 Aug;57(6):617-625. doi: 10.1177/15385744231163707. Epub 2023 Mar 13.
Spontaneous iliac vein rupture is a rare, but frequently lethal condition. It is important to timely recognize its clinical features and immediately start adequate treatment. We aimed to increase awareness to clinical features, specific diagnostics, and treatment strategies of spontaneous iliac vein rupture by evaluating the current literature.
A systematic search was conducted in EMBASE, Ovid MEDLINE, Cochrane, Web of Science, and Google Scholar from inception until January 23, 2023, without any restrictions. Two reviewers independently screened for eligibility and selected studies describing a spontaneous iliac vein rupture. Patient characteristics, clinical features, diagnostics, treatment strategies, and survival outcomes were collected from included studies.
We included 76 cases (64 studies) from the literature, mostly presenting with left-sided spontaneous iliac vein rupture (96.1%). Patients were predominantly female (84.2%), had a mean age of 61 years, and frequently presented with a concomitant deep vein thrombosis (DVT) (84.2%). After various follow-up times, 77.6% of the patients survived, either after conservative, endovascular, or open treatment. Endovenous or hybrid procedures were frequently performed if the diagnose was made before treatment, and almost all survived. Open treatment was common if the venous rupture was missed, for some cases leading to death.
Spontaneous iliac vein rupture is rare and easily missed. The diagnose should at least be considered for middle-aged and elderly females presenting with hemorrhagic shock and concomitant left-sided DVT. There are various treatment strategies for spontaneous iliac vein rupture. An early diagnose brings options for endovenous treatment, which seems to have good survival outcomes based on previously described cases.
自发性髂静脉破裂是一种罕见但常致命的疾病。及时识别其临床特征并立即开始充分治疗非常重要。我们旨在通过评估当前文献，提高对自发性髂静脉破裂的临床特征、特定诊断和治疗策略的认识。
从开始到 2023 年 1 月 23 日，在 EMBASE、Ovid MEDLINE、Cochrane、Web of Science 和 Google Scholar 中进行了系统搜索，没有任何限制。两名审查员独立筛选合格研究，并选择描述自发性髂静脉破裂的研究。从纳入的研究中收集患者特征、临床特征、诊断、治疗策略和生存结果。
我们从文献中纳入了 76 例（64 项研究），主要表现为左侧自发性髂静脉破裂（96.1%）。患者主要为女性（84.2%），平均年龄 61 岁，常伴有深静脉血栓形成（DVT）（84.2%）。在各种随访时间后，77.6%的患者存活下来，无论是保守治疗、血管内还是开放治疗后。如果在治疗前做出诊断，经常进行静脉内或混合手术，几乎所有患者都存活下来。如果静脉破裂被遗漏，开放治疗很常见，有些病例会导致死亡。
自发性髂静脉破裂罕见且易被遗漏。对于出现出血性休克和伴发左侧 DVT 的中年和老年女性，至少应考虑诊断。自发性髂静脉破裂有多种治疗策略。早期诊断为静脉内治疗提供了选择，根据之前描述的病例，这种治疗似乎有良好的生存结果。
