Iliocaval venous compression due to aneurysm of the abdominal aorta: report of ten cases.

Ten patients with symptomatic venous compression secondary to aneurysm of the infrarenal abdominal aorta are reported. Compression was responsible for edema of the lower extremities in seven cases, and, in three instances, for venous thromboembolic disease. The incidence of venous complications secondary to aneurysm (8.8% in our series) is close to that of urologic complications (10%), but their respective pathogeneses are different. Mechanical compression (nine patients) was the predominant mechanism and was due to retroperitoneal hematoma (two patients) and left-sided (three patients) or right-sided (four patients) development of the aneurysm. Noninvasive imaging, including computed tomographic scan and sonography, have replaced the more conventional invasive methods of diagnosis. The large diameter of the aneurysms generally found in these cases mandates rapid surgical treatment in order to avoid rupture and aortocaval fistula. Because of venous collateral circulation, caution must be exercised when working on the left side of the aorta above the aneurysm and at the level of the iliac vessels. Treatment consists of the inclusion prosthetic replacement. The insertion of a Greenfield filter is needed only when pulmonary embolism occurs or in the case of recent or life-threatening caval thrombosis.