Congenital aneurysms of the deep veins of the lower extremities

A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency

OBJECTIVE

We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning.

METHODS

A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity.

RESULTS

Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks.

CONCLUSION

Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.

Popliteal venous aneurysm with deep venous thrombosis in the contralateral calf: report of a case

Although a popliteal venous aneurysm is a rare entity, it is an important cause of pulmonary embolism (PE), which is occasionally life-threatening. We herein report a case of a popliteal venous aneurysm with deep venous thrombosis (DVT) in the contralateral calf. A 65-year-old male, who presented with sudden onset palpitation and dyspnea, was transferred to our hospital. Enhanced computed tomography revealed PE and a venous aneurysm of the left popliteal vein. The popliteal venous aneurysm was saccular and had an intramural thrombus. Furthermore, duplex scanning detected DVT in the contralateral calf. The patient underwent a tangential aneurysmectomy with lateral venorraphy. The surgery and postoperative course were uneventful. The PE and calf DVT disappeared with perioperative anticoagulant therapy. It is recommended that, in the treatment of popliteal venous aneurysms, special attention should be given to the condition of the venous vessels of the contralateral leg, because this can influence the therapeutic strategy.

Popliteal vein aneurysm: an unusual source of pulmonary embolus

A 78 year old woman developed repeated major pulmonary emboli following nasal resection for recurrent basal cell carcinoma. Lower extremity venography performed prior to planned insertion of an inferior vena caval filter unexpectedly revealed a large thrombus-containing aneurysm of the proximal popliteal vein. The aneurysm was excised and the vein repaired by lateral suture. Anticoagulation was continued for 3 months postoperatively. There were no further episodes of pulmonary embolism and popliteal vein patency was confirmed by duplex ultrasound 3 months postoperatively. The literature pertaining to these rare popliteal venous aneurysms is reviewed.