The iliolumbar vein accompanies the iliolumbar artery, draining the iliac fossa, iliacus, and lower lumbar muscles into the common iliac vein or the internal iliac vein. It forms the primary venous drainage from the iliolumbar territory and crosses the L5 transverse process.
The iliolumbar vein is a consistent but variable structure encountered during anterior lumbar approaches at the L4-L5 level. It must be identified and ligated before L5 vertebral body mobilisation to prevent avulsion haemorrhage. In retroperitoneal lymph node dissection, the iliolumbar vein is divided to expose the L4-L5 disc. Its injury produces significant bleeding difficult to control in the deep retroperitoneum.
Avulsion or laceration of the iliolumbar vein during L4-L5 anterior approach producing significant retroperitoneal haemorrhage requiring immediate vascular control and ligation.
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