J Gynecol Oncol.  2014 Jan;25(1):64-69. 10.3802/jgo.2014.25.1.64.

Surgical anatomy of the common iliac veins during para-aortic and pelvic lymphadenectomy for gynecologic cancer

• Kato K
• Tate S
• Nishikimi
• Shozu M

• KMID: 1811190
• DOI: http://doi.org/10.3802/jgo.2014.25.1.64

Abstract

OBJECTIVE
Compression of the left common iliac vein between the right common iliac artery and the vertebrae is known to be associated with the occurrence of left iliofemoral deep vein thrombosis (DVT). In this study, we described the variability in vascular anatomy of the common iliac veins and evaluated the relationship between the degree of iliac vein compression and the presence of DVT using the data from surgeries for gynecologic cancer.
METHODS
The anatomical variations and the degrees of iliac vein compression were determined in 119 patients who underwent systematic para-aortic and pelvic lymphadenectomy during surgery for primary gynecologic cancer. Their medical records were reviewed with respect to patient-, disease-, and surgery-related data.
RESULTS
The degrees of common iliac vein compression were classified into three grades: grade A (n=28, 23.5%), with a calculated percentage of 0%-25% compression; grade B (n=47, 39.5%), with a calculated percentage of 26%-50% compression; and grade C (n=44, 37%), with a calculated percentage of more than 50% compression. Seven patients (5.9%) had common iliac veins with anomalous anatomies; three were divided into small caliber vessels, two with a flattened structure, and two had double inferior vena cavae. The presence of DVT was associated with the elevated D-dimer levels but not with the degree of iliac vein compression in this series.
CONCLUSION
Although severe compression of the common iliac veins was frequently observed, the degree of compression might not be associated with DVT in surgical patients with gynecologic cancer. Anomalous anatomies of common iliac veins should be considered during systematic para-aortic and pelvic lymphadenectomy in the gynecologic cancer patients.

Keyword

Anatomy; Deep vein thrombosis; Gynecologic cancer; Iliac veins; Lymphadenectomy

MeSH Terms

Humans
Iliac Artery
Iliac Vein*
Lymph Node Excision*
Medical Records
Spine
Vena Cava, Inferior
Venous Thrombosis

Figure

• 

  Fig. 1 (A) Intraoperative photograph of a patient during presacral lymphadenectomy. Upper side of the photograph is the cranial side of the patient. Length of the compressed common iliac vein (a) and the diameter of the common iliac artery (b) at the point where the common iliac artery crosses over the common iliac vein were measured. (B) Schematic representation of the surgical anatomy of the iliac veins and arteries in this patient. (C) Schematic representation of the calculation of the degree of iliac vein compression. CIA, common iliac artery.

• 

  Fig. 2 (A) Intraoperative photograph of a patient during presacral lymphadenectomy. Left side of the photograph is the cranial side of the patient. The left common iliac vein appeared to be small caliber vessels. One of them was ruptured and repaired with sutures (arrow heads). (B) Schematic representation of the surgical anatomy of the iliac veins and arteries in this patient. The ruptured vein is indicated by arrow heads. CIA, common iliac artery; CIV, common iliac vein; IVC, inferior vena cava.

• 

  Fig. 3 (A) Intraoperative photograph of a patient during presacral lymphadenectomy. Left side of the photograph is the cranial side of the patient. In this case, the left common iliac vein was severely compressed and appeared to be a flattened structure (arrow heads). (B) Schematic representation of the surgical anatomy of the iliac veins and arteries in this patient. CIA, common iliac artery; CIV, common iliac vein.

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