Duplex Ultrasound Imaging of the Iliac Veins with Penile Prosthesis Implant

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Introduction/Patient Description

Iliac vein compression is characterized by unilateral leg swelling, with discomfort or pain, often resulting in deep vein thrombosis. Vein compression results from physiologic as well as mechanical factors. Described is a 63-year-old man who underwent surgery for an Inflatable Penile Prosthesis (IPP), which was placed in the right retro-pubic space. The patient presented with right lower extremity edema over a course of four months following the procedure. Color duplex imaging (CDI) and spectral Doppler was used to diagnose iliac vein compression, secondary to the inflated IPP.

Methods

The patient was referred to the vascular laboratory for evaluation of lower extremity edema. CDI and spectral Doppler were performed, utilizing a Philips IU22 ultrasound machine, using a linear 9-3 MHz and curved 5-1 MHz transducer. The IPP, right external iliac vein (EIV), and femoral veins were imaged for patency.

Results

CDI and spectral Doppler demonstrated, compression of the EIV when the IPP was inflated, resulting in continuous flow in the femoral veins. At the level of the filled reservoir, the EIV exhibited an increase in flow. Upon reservoir deflation, flow in the EIV at the level of the emptied reservoir decreased and phasicity was reestablished, distally to the deflated reservoir. Post analysis, it was determined the IPP placement location was compressing the EIV, when full. Due to the patient’s symptoms and observed diminished flow, a revision was completed. A new IPP was placed in a sub-rectus space.

Conclusion/Discussion

The patient returned for a two week post–operative visit, which concluded discomfort minimized and edema resolved. Duplex aided in the diagnosis of external iliac vein compression from this rare mechanical factor and provided a functional assessment of hemodynamics in real-time; inflation vs deflation.

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Presented by

Melissa Craft, RVT, Emory Saint Joseph's Hospital Atlanta, GA