Venous Aneurysms

Popliteal Venous Aneurysms

Patients with popliteal aneurysms come to the hospital 44% of the time with symptoms suggestive of a pulmonary embolism (PE) followed by 36% having local symptoms in the popliteal space ( Figure 1 A). The presence of bilateral popliteal aneurysms is uncommon, and rupture has never been reported. Associated symptoms of venous insufficiency are often present.

Duplex ultrasonography is the modality of choice for initial diagnosis, although most surgeons rely on venography for preoperative planning ( Figure 1 B). Ascending phlebography is rarely performed today owing to the sophistication of magnetic resonance venography and computed tomography venography. All popliteal venous aneurysms should be repaired given the high risk for PE. The risk of embolism does not correlate with the size of the aneurysm. Anticoagulation alone has been observed to be ineffective in preventing embolism from venous aneurysms in the popliteal space. The posterior approach to the popliteal fossa is the preferred surgical route for most cases ( Figure 1 C). Surgical options include resection of the aneurysm with end-to-end anastomosis or with an interposition bypass using nonreversed great saphenous vein, internal jugular vein, saphenous panel composite, or spiral vein ( Figure 1 D). Alternatively, aneurysmectomy with lateral venorraphy or patch angioplasty repair are options when the entire aneurysm is not completely removed. All surgical options appear to have similar results, although longterm patency rates are not available from the literature. Perioperative intravenous anticoagulation is recommended, followed by oral anticoagulation for 1 to 3 months postoperatively.

Aneurysms of the Superficial Veins of the Extremities

Superficial venous aneurysms of the extremities manifest as a soft blue compressible mass with engorgement caused by expansion during inspiration (lower extremities) or expiration (upper extremities). Venous aneurysms of the saphenous vein are often associated with varicosities, and those located in the upper thigh are often misdiagnosed as reducible inguinal or femoral hernias. Because the risk of pulmonary embolism caused by superficial venous aneurysms in lower extremities is low and very likely nonexistent for those in the upper extremities, treatment is reserved for patients with symptoms (e.g., pain, thrombosis, cosmesis). Excision without reconstruction suffices in most cases. Reconstruction is needed if the deep venous system is thrombosed or occluded.