Surgical Repair for Popliteal Venous Aneurysm Causing Severe or Recurrent Pulmonary Thromboembolism: Three Case Reports

Norimatsu, Togo; Aramoto, Haruo

doi:10.3400/avd.cr.14-00111

Cited by 21 publications

(15 citation statements)

References 9 publications

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“…Many patients with PVA are asymptomatic. Only 20% have been reported to present with palpable masses in the popliteal fossa 7 . The most common presenting symptoms are those associated with PE given the signi cant VTE risk that PVA pose, as was the case for our patient [2][3][4][5][6] .…”

Section: Discussionmentioning

confidence: 99%

Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: A case report

McBride

Rannelli

Cantle

2023

Preprint

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Background Popliteal vein aneurysms (PVA) are a rare clinical entity with unknown etiology that pose a significant risk for venous thromboembolic events (VTE). The current literature supports anticoagulation and operative management. There are few case reports of PVA in pregnancy. We present a unique case of a pregnant patient with recurrent pulmonary embolism (PE) in the setting of PVA with intra-aneurysmal thrombosis who ultimately underwent surgical excision. Case presentation A previously healthy 34-year-old G2P1 at 30 weeks gestational age presented to the emergency department with shortness of breath and chest pain. She was diagnosed with PE and subsequently required intensive care unit (ICU) admission and thrombolysis for a massive PE. While on a therapeutic dose of tinzaparin she had recurrence of PE in the post-partum period. She was treated with supratherapeutic tinzaparin and subsequently transitioned to warfarin. She was found to have a PVA and ultimately underwent successful aneurysmorrhaphy. She remains on anticoagulation for secondary prevention of VTE. Conclusions PVA are a rare but potentially fatal source of VTE. Patients most commonly present with symptoms of PE. The risk of VTE is elevated in the pro-thrombotic states of pregnancy and the post-partum period due to both physiologic and anatomical changes. The recommended management of PVA with PE is anticoagulation and surgical resection of the aneurysm, however this can be complicated in the setting of pregnancy. We demonstrated that pregnant patients with PVA can be temporized with medical management to avoid surgical intervention during pregnancy, but require close symptom monitoring and serial imaging to reassess the PVA, with high index of suspicion for recurrent VTE. Ultimately, patients with PVA and PE should undergo surgical resection to reduce the risk of recurrence and long-term complications. The ideal duration of post-operative anticoagulation remains unclear, and should likely be decided on based on risks, benefits, values, and shared decision making with the patient and their care provider.

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Section: Discussionmentioning

confidence: 99%

Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: A case report

McBride

Rannelli

Cantle

2023

Preprint

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“…Furthermore, Norimatsu et al reported that thromboembolic complications are more frequent in large fusiform- and saccular-type VAs. 3 ) Furthermore, they pointed out that approximately 70% of PVAs contained thrombosis within the aneurysmal sac. They also noted that treatment and management, including anticoagulant therapy, for asymptomatic PVAs remained unclear.…”

Section: Discussionmentioning

confidence: 99%

“… 1 ) VAs are normally located in the popliteal vein (PV), 2 ) and 24–51% of patients with popliteal VA (PVA) have shown symptomatic pulmonary embolism (PE). 3 ) Even though VAs can be located in other parts of the body, including the head, neck, and upper extremities, they are rarely related to PE. Thus, VAs in parts other than the lower extremities have been treated non-operatively.…”

Section: Introductionmentioning

confidence: 99%

A Case of Total Excision of a Thrombosed-Venous Aneurysm in the Sural Vein

Nishizawa

Igari

Hirokawa³

et al. 2020

Annals of Vascular Diseases

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Venous aneurysm (VA) is an uncommon vascular disease; however, VA, especially in the lower extremities, can lead to critical complications, such as pulmonary embolism (PE). We report a case with a VA located in the sural vein (SV), which did not lead to PE; however, it had the potential to cause PE. Therefore, we treated this VA by total excision. The popliteal vein (PV) is the most common VA location in the lower extremities, but SV is extremely rare. We should always be aware that, in addition to the PV, VAs may also occur in the SV.

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“…Periodic echography examination can be performed for fusiform aneurysms with diameters of <20 mm. According to the available literature, 3,12 -16 the main surgical methods adopted by clinicians include tangential aneurysmectomy with lateral venorrhaphy (more preferred), vascular bypass or venoplasty, and end-to-end anastomosis or simple ligation. In the present case, the first method was planned preoperatively.…”

Section: Discussionmentioning

confidence: 99%

Popliteal Venous Aneurysm With Pulmonary Embolism: A Case Report

Zhang

et al. 2020

Vasc Endovascular Surg

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Popliteal venous aneurysm (PVA) is defined as an increase in the diameter of the popliteal vein, twice its normal dimension. Herein, we report a case of right PVA with severe pulmonary embolism in a 75-year-old woman who presented with sudden chest tightness and dyspnea. Clinical examination revealed hypotension and hypoxemia. Radiographic investigations revealed extensive pulmonary embolism and right fusiform PVA. Following thrombolysis, her blood pressure and oxygen saturation normalized. However, she developed right calf swelling, and angiography revealed a thrombus in the right PVA, which was managed by catheter-directed thrombolysis. Thereafter, a vascular bypass was performed using the left great saphenous vein as a conduit to treat recurrent thrombosis. Subsequent venography indicated a patent vein graft, acceptable blood flow velocity, no thrombosis residue, and no significant thrombosis. Follow-ups at 3, 6, and 12 months revealed satisfactory outcomes. In conclusion, if the systemic condition is conducive, a surgical resection and reconstruction of the popliteal vein is recommended for the treatment of PVAs.

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Surgical Repair for Popliteal Venous Aneurysm Causing Severe or Recurrent Pulmonary Thromboembolism: Three Case Reports

Cited by 21 publications

References 9 publications

Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: A case report

Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: A case report

A Case of Total Excision of a Thrombosed-Venous Aneurysm in the Sural Vein

Popliteal Venous Aneurysm With Pulmonary Embolism: A Case Report

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