Treatment of Large External Iliac Vein Aneurysm and Venous Obstruction Using Off-label Aortic Endograft in a Multidisciplinary Approach

A 34-year-old man with history of Protein S Deficiency on lifelong Eliquis, numerous deep vein thromboses (DVTs), and intracranial venous malformations presented with worsening right lower leg pain and venous wounds. Previous interventions include DVT thrombolysis, venous reconstruction with two left common iliac stents, and IVC stent placement. CT imaging demonstrated the presence of a large right external iliac vein (EIV) aneurysm measuring 7.7 cm with concurrent narrowing of the right common iliac vein (CIV).