Popliteal venous aneurysm

Article Outline

• Supplementary data
• Reference
• Copyright

• 
  • View Large Image
  • Download to PowerPoint

A 37-year-old previously healthy man presented with sudden onset of acute shortness of breath. While he was being assessed, he went into cardiac arrest with one episode of seizure. He was resuscitated and was subsequently found to have a large pulmonary embolus. Duplex scanning of his lower limbs revealed a globular swelling arising from the left popliteal vein with thrombus in the lumen. The remainder of the venous system was normal. Ascending venography confirmed the presence of a saccular popliteal venous aneurysm. The vein above and below was normal (A). There was no history of trauma (he had had previous surgery for recurrent patellar subluxation) or previous venous thrombosis.

The patient received anticoagulation therapy, and a temporary inferior vena cava filter was inserted. The popliteal fossa was explored through a posterior approach. The aneurysm of the popliteal vein was exposed (Cover).When opened, it was seen to be filled with friable thrombus (B). It was tangentially excised, and the resulting defect was closed with a superficial vein patch derived from a local vein (C).

The patient had an uneventful recovery. He continued to receive anticoagulation therapy and was treated with compression stockings. The popliteal vein was patent at 6 weeks after surgery by duplex scan.

Venous aneurysms are rare. They are more common in the neck and lower limbs. Most of them are asymptomatic. They are sometimes associated with congenital venous malformations.

Just over 100 cases of popliteal aneurysms have been reported.¹ The diameter to define a venous fusiform dilatation as an aneurysm must be at least three times (>20 mm) that of the normal popliteal vein. Congenital and various acquired factors, including trauma, may be their cause. They are more common in females. At least 50% of them are symptomatic with pulmonary embolism. Some may cause local venous hypertension.

Duplex scan is diagnostic and useful for follow-up. Ascending venography is useful in planning surgery. Computed tomographic venography and magnetic resonance venography are alternative imaging modalities. Treatment is recommended for all symptomatic aneurysms and aneurysms with thrombus in appropriate patients.¹ Tangential excision of a saccular aneurysm with a patch venoplasty or resection of the involved segment and interposition vein graft are the two treatment options. Compression stockings and anticoagulation for 3 to 6 months are generally recommended.

Back to Article Outline

Supplementary data 

Back to Article Outline

Reference 

1. Sessa C, Nicolini P, Perrin M, Farah I, Magne J, Guidicelli H. Management of symptomatic and asymptomatic popliteal venous aneurysms: a retrospective analysis of 25 patients and review of the literature. J Vasc Surg. 2000;32:902–912
   • View In Article
   • Abstract
   • Full Text
   • Full-Text PDF (217 KB)
   • CrossRef