RESUMO

BACKGROUND: In the distribution of the veins, it corresponds in the path and by its affluent to their arterial counterpart. For the pelvic surgeon faced with pelvic surgical pathology, the knowledge of the distribution of the venous vessels is especially important in view of novel surgical techniques and current approaches. The majority of the reports are on common iliac vein (CIV) or the inferior vena cava. To the best of our knowledge, there are no papers describing posterior extrapelvic affluents that drain into the internal iliac vein (IIV). OBJECTIVE: The aim of this work was to describe the pattern of the constitution of the IIV in 17 dissection specimens taken at our institution. MATERIALS AND METHODS: We dissected and registered the anatomic variations of the posterior extrapelvic tributaries to the IIVs. RESULTS: Moreover, we describe the presence of a vein here that is, as far as we know, the first report of a vein that is formed from the posterior extrapelvic veins that drain exactly onto the anterior surface of the CIV. We also describe herein the variants that we have found. CONCLUSIONS: The ignorance of the anatomic variations in the posterior extra-pelvic tributaries to the IIVs (internal iliac veins) can lead to fatal consequences in the patients undergoing pelvic surgery.

ANTECEDENTES: En la descripción de los trayectos venosos, estos corresponden casi exactamente a la distribución de su contraparte arterial, como es el caso de la vena iliaca interna. Para el cirujano que se enfrenta a la patología pélvica, el conocimiento de la distribución de los vasos venosos es de particular importancia. Los reportes que describen los grandes vasos venosos pélvicos se enfocan en las venas iliacas comunes o la vena cava inferior. En nuestro conocimiento, no existen ­reportes que describan los afluentes venosos posteriores que drenan a la vena iliaca interna ni las distancias que separan los vasos entre sí. OBJETIVO: Describir el patrón de constitución de la vena iliaca interna en 17 especímenes cadavéricos disecados en nuestra institución. MATERIAL Y MÉTODOS: Se identificaron los trayectos vasculares de los afluentes venosos posteriores extrapélvicos de las venas iliacas primitivas. RESULTADOS: En específico, describimos la presencia de una variante venosa que, hasta donde hemos revisado, es el primer reporte, pues esta vena posterior extrapélvica drena exactamente en la superficie anterior de la vena iliaca común. También describimos otras variantes encontradas. CONCLUSIONES: Conocer las variantes de los afluentes venosos posteriores extrapélvicos es de vital importancia para el cirujano que realiza cirugía pélvica.

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A Síndrome de May-Thurner é uma causa pouco comum de sinais e sintomas venosos relacionados ao membro inferior esquerdo. Esta síndrome é caracterizada pela compressão da veia ilíaca comum esquerda pela artéria ilíaca comum direita e, quando tal alteração anatômica causa sintomas que venham a prejudicar a qualidade de vida do paciente, existe a indicação de tratamento cirúrgico ou endovascular para correção desta alteração anatômica. Este artigo é o relato de um caso, no qual optou-se pelo tratamento endovascular com resultado satisfatório e as indicações, as nuances e os resultados esperados para esta técnica no tratamento da Síndrome de May-Thurner são discutidos. Foi concluído que, nesta síndrome, há eficácia do tratamento endovascular com melhora dos sintomas pela recanalização do sistema venoso, sem grandes riscos inerentes ao procedimento e com curto período de internação hospitalar.

May-Thurner Syndrome is an uncommon cause of venous symptoms and signs related to the left lower limb. It is characterized by compression of the left common iliac vein by the right common iliac artery and, when such anatomical change causes symptoms that may impair the patients' quality of life, surgical treatment is indicated. This article addresses a case of May-Thurner syndrome in which we opted for endovascular treatment with satisfactory outcome, as well as a discussion about indications, nuances, and expected results. We concluded that endovascular treatment is effective in treating this syndrome, for it resolves the symptoms by recanalization of the venous system with little risks during the procedure and with short hospital stay.

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During regular dissection of the retroperitoneal region, three uncommon anatomical variations of the internal iliac veins were found on dissected specimens: in the first case, the internal iliac veins converge forming a common trunk draining into the left external iliac vein. In the other two cases, the internal iliac vein crosses the median plane and flows into the contralateral common iliac vein. These anomalies result from a persistence of the embryonic inferior branch of the cardinal vein and are important to be known for they may be undetected or may not appear in imaging. These data have implications for both pelvic surgeons and anatomists who manipulated this anatomical area.

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Venous aneurysms are extremely rare. They may be congenital or acquired in origin and occasionally related to arteriovenous communications. A 58-year-old man complained of dull left lower quadrant pain and constipation. On physical examination a soft deep mass was palpated. Ultrasonogram and CT scan revealed a cystic formation in the pelvic cavity. Angiograms disclosed an arteriovenous malformation (AVM) at the pelvic floor draining into a large cavity. The patient was successfully managed by intraoperative selective embolization of the AVM and partial resection of a 10.6 x 8 x 6.7 cm venous aneurysm. The histopathologic studies of the wall confirmed a venous structure. Venous dilatation has been reported in high flow vein grafts, blood access V fistulas and rarely, proximal to traumatic AV fistulas of the lower extremities. The etiology of the present case is probably congenital, being to the best of our knowledge, the first case affecting the hypogastric territory, reported in the English literature.

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