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Alagha S, Ekim M. Comprehensive Management of Thrombosed Lower Extremity Venous Aneurysms: A Single-Center Retrospective Analysis and Insights Into Clinical Strategies. Vasc Endovascular Surg 2024; 58:854-861. [PMID: 39172954 DOI: 10.1177/15385744241276695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2024]
Abstract
OBJECTIVE Venous aneurysms are rare vascular abnormalities associated with venous thromboembolism. In this study, we presented our experience in managing thrombosed lower extremity venous aneurysms and evaluate the impact of vitamin D deficiency and genetic thrombophilic risk factors on patient management and outcomes. METHODS A single-center retrospective observational analysis was conducted on ten patients with thrombosed lower limb venous aneurysms who underwent surgical procedures at our hospital from July 2014 to February 2023. Collected data included venous duplex ultrasonographic imaging and laboratory tests including genetic thrombophilic risk factors and assessments of vitamin D levels. RESULTS There were 5 males and 5 females. The mean age was 46.6 ± 12.1 years. The aneurysms were located in the popliteal vein in three patients, the great saphenous vein in six, and the small saphenous vein in one. Venous duplex imaging revealed saccular aneurysms in eight patients and fusiform aneurysms in two, with a mean diameter of 37.2 ± 10.6 mm, ranging from 23 to 52 mm. Laboratory tests indicated vitamin D deficiency in all of the patients, and genetic thrombophilic risk factors were identified in two cases. Surgical interventions consisted of tangential excision with lateral venorrhaphy in three patients and total excision and ligation in seven patients. The postoperative period was favorable for all patients. CONCLUSIONS Surgical treatment of thrombosed venous aneurysms in the lower extremities is essential to prevent complications such as thromboembolism. A comprehensive approach, including knowledge of genetic risk factors and vitamin D levels, may improve patient outcomes.
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Affiliation(s)
- Sameh Alagha
- Cardiovascular Surgery Department, Bozok University Faculty of Medicine, Yozgat, Turkey
| | - Meral Ekim
- Emergency and Disaster Management Department, Bozok University Faculty of Health Sciences, Yozgat, Turkey
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Moreno O, Kumar K, Wakefield T, Obi A. Saphenous vein aneurysms characterization and treatment: A 36-year single center experience. Phlebology 2023:2683555231181858. [PMID: 37276249 DOI: 10.1177/02683555231181858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Superficial vein aneurysms (SVA) are rare vascular pathologies associated with trauma, chronic venous disease, and venous malformation. METHOD We retrospectively reviewed cases of SVA treated from 1986 to 2022. RESULTS Out of 2463 venous procedures, 16 patients were found with 19 GSV and 1 SSV aneurysms, with 88% presenting with a palpable mass. Varicose veins were noted in 94% of patients, 81% had concomitant reflux, 15% had thrombus within the aneurysm sac, and 19% demonstrated multiple aneurysms. All patients underwent ligation and excision. Post-procedure, 55% of patients received anticoagulants, and 85% received compression. Mean follow-up was 19.4 months, with no aneurysm recurrence. We propose a modification to the current SVA classification. CONCLUSION The prevalence of multiple aneurysms suggests the need for complete limb imaging in affected patients. Surgical management of SVA was effective in preventing SVA recurrence, while the proposed classification modification will aid in future SVA management.
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Affiliation(s)
- Oscar Moreno
- Department of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Kiran Kumar
- Department of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Thomas Wakefield
- Department of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Andrea Obi
- Department of Vascular Surgery, University of Michigan, Ann Arbor, MI, USA
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3
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Patel R, Woo K, Wakefield TW, Beaulieu RJ, Khashram M, De Caridi G, Benedetto F, Shalhub S, El-Ghazali A, Silpe JE, Rosca M, Cohnert TU, Siegl GK, Abularrage C, Sorber R, Wittgen CM, Bove PG, Long GW, Charlton-Ouw KM, Ray HM, Lawrence P, Baril D. Contemporary management and outcomes of peripheral venous aneurysms: A multi-institutional study. J Vasc Surg Venous Lymphat Disord 2022; 10:1352-1358. [PMID: 35940449 DOI: 10.1016/j.jvsv.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Extremity venous aneurysms result in the risk of pulmonary embolism (PE) and chronic venous insufficiency. At present, owing to the rarity of these aneurysms, no consensus for their treatment has been established. The purpose of the present study was to review the presentation, natural history, and contemporary management of extremity venous aneurysms. METHODS We performed a retrospective, multi-institutional review of all patients with extremity venous aneurysms treated from 2008 to 2018. A venous aneurysm was defined as saccular or fusiform with an aneurysm/vein ratio of >1.5. RESULTS A total of 66 extremity aneurysms from 11 institutions were analyzed, 40 of which were in a popliteal location, 14 iliofemoral, and 12 in an upper extremity or a jugular location. The median follow-up was 27 months (range, 0-120 months). Of the 40 popliteal venous aneurysms, 8 (20%) had presented with deep vein thrombosis (DVT) or PE, 13 (33%) had presented with pain, and 19 had been discovered incidentally. The mean size of the popliteal venous aneurysms presenting with DVT or PE was larger than that of those presenting without thromboembolism (3.8 cm vs 2.5 cm; P = .003). Saccular aneurysm morphology in the lower extremity was associated with thromboembolism (30% vs 9%; P = .046) and fusiform aneurysm morphology with a thrombus burden >25% (45% vs 3%). Patients presenting with thromboembolism were more likely to have had a thrombus burden >25% in their lower extremity venous aneurysm compared with those who had presented without thromboembolism (70% vs 9%). Approximately half of all the patients underwent immediate intervention, and half were managed with observation or antithrombotic regimen. In the non-operative cohort, three patients subsequently developed a DVT. Eight patients in the medically managed cohort went on to require surgical intervention. Of the 12 upper extremity venous aneurysms, none had presented with DVT or PE, and only 2 (17%) had presented with pain. Of the 66 patients in the entire cohort, 41 underwent surgical intervention. The most common indication was the absolute aneurysm size. Nine patients had undergone surgery because of a DVT or PE, and 11 for pain or extremity swelling. The most common surgery was aneurysmorrhaphy in 21 patients (53%), followed by excision and ligation in 14 patients (35%). Five patients (12%) had undergone interposition bypass grafting. A postoperative hematoma requiring reintervention was the most common complication, occurring in three popliteal vein repairs and one iliofemoral vein repair. None of the patients, treated either surgically or medically, had reported post-thrombotic complications during the follow-up period. CONCLUSIONS Large lower extremity venous aneurysms and saccular aneurysms with thrombus >25% of the lumen are more likely to present with thromboembolic complications. Surgical intervention for lower extremity venous aneurysms is indicated to reduce the risk of venous thromboembolism (VTE) and the need for continued anticoagulation. Popliteal aneurysms >2.5 cm and all iliofemoral aneurysms should be considered for repair. Upper extremity aneurysms do not have a significant risk of VTE and warrant treatment primarily for symptoms other than VTE.
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Affiliation(s)
- Rhusheet Patel
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
| | - Karen Woo
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Thomas W Wakefield
- Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI
| | - Robert J Beaulieu
- Division of Vascular Surgery and Disease, Department of Surgery, Ohio State University, Columbus, OH
| | - Manar Khashram
- Department of Vascular Surgery, University of Auckland Waikato Hospital, Hamilton, New Zealand
| | | | | | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Asmaa El-Ghazali
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA
| | - Jeffrey E Silpe
- Division of Vascular Surgery, Department of Surgery, Northwell Health at Hofstra, Zucker School of Medicine, New Hyde Park, NY
| | - Mihai Rosca
- Division of Vascular Surgery, Department of Surgery, Northwell Health at Hofstra, Zucker School of Medicine, New Hyde Park, NY
| | - Tina U Cohnert
- Department of Vascular Surgery, Graz Medical University, Graz, Austria
| | - Gregor K Siegl
- Department of Vascular Surgery, Graz Medical University, Graz, Austria
| | - Christopher Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, MD
| | - Rebecca Sorber
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, MD
| | - Catherine M Wittgen
- Division of Vascular Surgery, Department of Surgery, Saint Louis University, St Louis, MO
| | - Paul G Bove
- Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Gross Pointe Farms, MI
| | - Graham W Long
- Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Gross Pointe Farms, MI
| | | | - Hunter M Ray
- Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX
| | - Peter Lawrence
- Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA
| | - Donald Baril
- Division of Vascular Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA
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Gaudry M, al-Osail EM, Barral PA, Piquet P. Pulmonary embolism secondary to popliteal vein aneurysm: case report and literature review. Future Cardiol 2022; 18:309-314. [DOI: 10.2217/fca-2021-0071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: Aneurysms are rarely detected in the popliteal vein as only a few cases have been reported in the literature so far. However, such aneurysms can be fatal due to thromboembolic complications or rupture. Case presentation: A 47-year-old male who had multiple bilateral pulmonary embolisms secondary to saccular right popliteal vein aneurysm discovered by lower limb duplex ultrasound and successfully treated with tangential aneurysmectomy with venorrhaphy. Conclusion: Popliteal vein aneurysm should be ruled out as a cause of pulmonary embolism, and medical treatment should be started rapidly, but surgical management remains the gold standard.
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Affiliation(s)
- Marine Gaudry
- Department of Vascular Surgery, Aortic Centre, Hôpital de la Timone, Marseille, France
| | - Emad M al-Osail
- Department of Vascular Surgery, Aortic Centre, Hôpital de la Timone, Marseille, France
| | | | - Philippe Piquet
- Department of Vascular Surgery, Aortic Centre, Hôpital de la Timone, Marseille, France
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Krishan A, Droste JC, Molloy K, Bharath A, Riggott C, Guarasci F. Popliteal Vein Aneurysm Masquerading as a Baker's Cyst Leading to Pulmonary Embolism. Am J Med 2021; 134:1495-1498. [PMID: 34297976 DOI: 10.1016/j.amjmed.2021.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 06/13/2021] [Accepted: 06/14/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Anjli Krishan
- Department of Acute Medicine, Airedale NHS Foundation Trust, Keighley, UK
| | | | - Kevin Molloy
- Department of Vascular Surgery, Bradford Royal Infirmary, UK
| | - Amit Bharath
- Department of Radiology, Airedale NHS Foundation Trust, UK
| | - Christy Riggott
- Department of Acute Medicine, Airedale NHS Foundation Trust, Keighley, UK
| | - Franco Guarasci
- Department of Acute Medicine, Airedale NHS Foundation Trust, Keighley, UK
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