Lesser Saphenous Vein Aneurysm and Popliteal Vein Aneurysm: Report of Two Cases and Review of the Literature

Abstract

Background: During the last ten years we diagnosed two cases of venous aneurysm. The purpose of this report was to point out a certain risk of the thrombembolism of superficial venous aneurysms and to review our experience in the management of superficial and deep venous aneurysms.Methods: The presentation and management of these lesions were reviewed and discussed together with other cases from available literature.Results: In the first case an aneurysm of lesser saphenous vein with a possible threat of thrombembolism was revealed and surgically solved with saphena resection. Ten years after the surgery she is still symptom free. In the second case a small fusiforme popliteal vein aneurysm without any evidence of mural thrombus was diagnosed. The patient was treated conservatively with regular venous duplex imaging follow up. Two years later the disease has been stable.Conclusions: Superficial venous aneurysms can have a certain risk of the thrombembolism. Since surgical therapy is very simple, it can be recommended in all cases. Nevertheless, trombembolism is more common in deep venous aneurysms, especially popliteal ones, in which surgical repair can be based on their pathological features and presentation or can be indicated in all cases.

Popliteal Vein Aneurysm: A Case Report

“…It is not completely clear what causes venous aneurysms, but the running hypothesis is that they result from some type of congenital and/or acquired vessel-wall weakness. 2 Popliteal vein aneurysms are usually discovered in one of three ways: (1) incidentally or as the cause of either (2) lower-extremity symptoms or (3) a pulmonary embolus, with the latter being the most common presentation. 2 Because of the high risk for pulmonary embolism, popliteal venous aneurysms, except under special circumstances, are treated with surgery, the most common of which is tangential aneurysmectomy and lateral venorrhaphy.…”

“…We discussed with the patient that the associated risk for pulmonary embolism has been reported to be as high as 70-80% and that it is a potentially fatal event. 2,4 We also explained that much of the literature points to vascular surgery as the mainstay of treatment for popliteal vein aneurysms, even in asymptomatic cases. [5][6][7] Some have reported the size cutoff above which surgery is indicated to be a diameter of 2.0-2.5 cm.…”

“…[5][6][7] Some have reported the size cutoff above which surgery is indicated to be a diameter of 2.0-2.5 cm. 2,8 With her aneurysmal diameter of 2.7 cm and current symptoms, the patient opted for surgery initially but then later reconsidered and wanted solely observational management, which consists of regular duplex imaging per the literature. 2 The role of long-term anticoagulation in patients with popliteal vein aneurysms but no provable history of thrombus and in whom surgery is indicated but declined has not been well-defi ned in the literature.…”

“…1 They are usually discovered in the ensuing workup after a patient presents with pulmonary embolism, but they can also be discovered incidentally or in a patient with lower-extremity symptoms, as in our case. 2 Because popliteal vein aneurysms present a large risk for pulmonary embolism (estimates have been as high as 70–80%), which is a potentially fatal event, they are usually treated aggressively via surgery. 2–4…”

“…2 Because popliteal vein aneurysms present a large risk for pulmonary embolism (estimates have been as high as 70–80%), which is a potentially fatal event, they are usually treated aggressively via surgery. 2–4…”