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Shinoda D, Yuri K, Miyagawa A, Yokoyama N. A Case of Popliteal Venous Aneurysm Diagnosed after Sudden Cardiac Arrest. Ann Vasc Dis 2024; 17:188-191. [PMID: 38919330 PMCID: PMC11196170 DOI: 10.3400/avd.cr.23-00097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/17/2024] [Indexed: 06/27/2024] Open
Abstract
A popliteal venous aneurysm (PVA) is a rare vascular disorder. We report a case of PVA discovered through further evaluation of sudden cardiac arrest (CA) caused by a pulmonary embolism (PE). It is well-known that PVA causes PE; however, there are few reports of PVA causing CA. A tangential aneurysmectomy and lateral venorrhaphy were performed. The patient's postoperative course was uneventful. When contrast-enhanced computed tomography is performed to search for the cause of CA, PVA should be considered and thus, screening below the knee is recommended. At 1-year follow-up, there were no complications.
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Affiliation(s)
- Daigo Shinoda
- Department of Cardiovascular Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Koichi Yuri
- Department of Cardiovascular Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Atsushi Miyagawa
- Department of Cardiovascular Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Nobu Yokoyama
- Department of Cardiovascular Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
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Goel P, Bhatnagar V, Chennur VS. Makeshift Shunts in Extrahepatic Portal Vein Obstruction in Pediatric Population. J Indian Assoc Pediatr Surg 2024; 29:152-158. [PMID: 38616824 PMCID: PMC11014182 DOI: 10.4103/jiaps.jiaps_21_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/23/2021] [Accepted: 10/25/2021] [Indexed: 04/16/2024] Open
Abstract
Background and Objectives More than 20% of patients with extrahepatic portal vein obstruction (EHPVO) may be deemed as nonshuntable due to lack of a suitable vein. The role of "makeshift shunts" or "lesser shunts" assumes importance in such cases. In this report, the authors have shared their experience with the makeshift shunts in the management of portal hypertension in children with emphasis upon anatomic considerations, resolution of symptoms, outcomes after surgery, and shunt patency. Materials and Methods During the period 1983-2018, 138 children with portal hypertension were managed under the care of a single surgeon (VB). Of them, 134 were EHPVO. Children with EHPVO were treated with splenectomy and proximal lienorenal shunt (n = 107), splenectomy and devascularization (n = 21), and makeshift shunts (n = 6). Makeshift shunts comprised (i) side-to-side right gastroepiploic vein (Rt-GEV) to left renal vein (LRV) shunt (n = 1), (ii) superior mesenteric vein (SMV) to inferior vena cava (IVC) shunt using a spiral saphenous venous graft (n = 1), (iii) side-to-side inferior mesenteric vein (IMV) to LRV shunt (n = 2), (iv) side-to-side IMV to IVC shunt (n = 1), (v) end-to-side IMV to IVC shunt (n = 1), and (vi) side-to-side IMV to LRV shunt (n = 1) in a case of crossed fused renal ectopia. Results Following the creation of portosystemic shunt, a decline in portal pressure was demonstrated in all six patients. There was resolution of symptoms including hematemesis, melena, and anorectal variceal bleed. None of the patients demonstrated the features of hepatic encephalopathy. The associated portal cavernoma cholangiopathy (n = 1) also resolved following Rt-GEV to LRV shunt. Shunt patency was documented for the entire duration of follow-up (1.5-4 years) in five of six patients; the sixth patient demonstrated shunt block at 6-month follow-up but without recurrence of symptoms. Conclusions Makeshift shunts offer a viable alternative to standard portosystemic shunting in pediatric patients with a nonshuntable vein. The selection of such shunts is, however, subject to surgeon's preferences and has to be individualized to local anatomy.
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Affiliation(s)
- Prabudh Goel
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Veereshwar Bhatnagar
- Department of Paediatric Surgery, All India Institute of Medical Sciences, New Delhi, India
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McBride SA, Rannelli LA, Cantle PM. Recurrent, life-threatening PE in the setting of popliteal vein aneurysm in pregnancy: a case report. Thromb J 2023; 21:53. [PMID: 37147712 PMCID: PMC10161411 DOI: 10.1186/s12959-023-00495-2] [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: 02/22/2023] [Accepted: 04/24/2023] [Indexed: 05/07/2023] Open
Abstract
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 gestation 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 PVA ligation. 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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Affiliation(s)
- S Ainslie McBride
- Department of Medicine, University of Calgary, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Rd SW, Calgary, AB, T2T 5C7, Canada.
| | - Luke A Rannelli
- Department of Medicine, University of Calgary, Rockyview General Hospital, 7007 14 St SW, Calgary, AB, T2V 1P9, Canada
| | - Paul M Cantle
- Department of Surgery, University of Calgary, Peter Lougheed Centre 5Th East Wing, 5940 - 3500 26th Ave NE, Calgary, AB, T1Y 6J4, Canada
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Li X, Wu H, Zhang L, Song H, Zeng C. Popliteal Venous Aneurysm With Pulmonary Embolism: A Case Report. Vasc Endovascular Surg 2020; 55:491-494. [PMID: 33353495 DOI: 10.1177/1538574420976237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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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Affiliation(s)
- Xiang Li
- Department of Vascular Surgery, Dazhou Central Hospital, Sichuan, China
| | - Huaping Wu
- Department of Vascular Surgery, Dazhou Central Hospital, Sichuan, China
| | - Li Zhang
- Department of Vascular Surgery, Dazhou Central Hospital, Sichuan, China
| | - Huanhuan Song
- Department of Vascular Surgery, Dazhou Central Hospital, Sichuan, China
| | - Cunliang Zeng
- Department of Vascular Surgery, Dazhou Central Hospital, Sichuan, China
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Nishizawa M, Igari K, Hirokawa M, Kurihara N, Katsui S, Kudo T, Uetake H. A Case of Total Excision of a Thrombosed-Venous Aneurysm in the Sural Vein. Ann Vasc Dis 2020; 13:322-325. [PMID: 33384739 PMCID: PMC7751067 DOI: 10.3400/avd.cr.20-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
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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Affiliation(s)
- Masato Nishizawa
- Department of Specialized Surgery, Tokyo Medical and Dental University
| | - Kimihiro Igari
- Department of Specialized Surgery, Tokyo Medical and Dental University
| | | | | | - Sotaro Katsui
- Department of Specialized Surgery, Tokyo Medical and Dental University
| | - Toshifumi Kudo
- Department of Specialized Surgery, Tokyo Medical and Dental University
| | - Hiroyuki Uetake
- Department of Specialized Surgery, Tokyo Medical and Dental University
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Yamamoto Y, Kimura K, Takago S, Kato H, Iino K, Takemura H. Aneurysm resection interposed with a spiral saphenous vein graft in a patient with a popliteal venous aneurysm with thrombosis. J Vasc Surg Venous Lymphat Disord 2019; 7:898-901. [DOI: 10.1016/j.jvsv.2019.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 06/19/2019] [Indexed: 11/17/2022]
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Overview of venous pathology related to repetitive vascular trauma in athletes. J Vasc Surg Venous Lymphat Disord 2019; 7:756-762. [PMID: 31231058 DOI: 10.1016/j.jvsv.2019.03.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 03/29/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND Athletes are generally young, high-functioning individuals. Pathology in this cohort is associated with a decrease in function and consequently has major implications on quality of life. Venous disorders can be attributed to a combination of vascular compression with a high burden of activity. OBJECTIVE This article promotes increased awareness of these uncommon conditions specific to the athlete by summarizing pathophysiology, clinical features, investigation, and treatment protocols for use in clinical practice. Prognostic outcomes of these management regimens are also discussed, allowing for clinicians to counsel these high-functioning individuals appropriately. With the aim of providing an overview of sport-related venous pathology, a literature review was undertaken identifying articles that were independently reviewed by the authors. RESULTS Lower limb venous thrombosis has been identified in young, high-functioning athletes attributed to both compression-related venous trauma, associated with repetitive movements resulting in intimal damage, and blunt trauma. The diagnosis and treatment follow the same protocols as for the general population. Of note, early ambulation is advocated, with an aim to return to premorbid (noncontact) function within 6 weeks. Athletes performing high-intensity repetitive upper limb movement, such as baseball players, are predisposed to upper limb deep venous thrombosis (DVT). Diagnosis follows the same protocols as for lower extremity DVT; however, the optimal treatment strategy remains debated. Current guidelines advocate the use of anticoagulation alone. A specific subset of primary upper limb DVT is effort thrombosis, where there is compression at the level of the thoracic outlet. Thrombolysis with first rib resection is indicated in the acute setting within 14 days. In cases of complete occlusion, surgical decompression with venous reconstruction may be required. Popliteal vein entrapment syndrome is also discussed. This entity has been identified as an overuse injury associated with popliteal vein compression. Duplex ultrasound examination is indicated as a first-line investigation, with conservative noninvasive options considered as an initial management strategy. Chronic venous insufficiency or persistent symptoms may require subsequent surgical decompression. CONCLUSIONS Key conditions including upper extremity and lower extremity venous thrombosis, venous aneurysms, Paget-Schroetter syndrome (effort thrombosis), and popliteal vein entrapment syndrome are discussed. Further studies evaluating long-term outcomes on morbidity for current treatment regimens in upper extremity DVT, effort thrombosis, venous thoracic outlet syndrome, and popliteal venous entrapment syndrome are required.
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A systematic review of venous aneurysms by anatomic location. J Vasc Surg Venous Lymphat Disord 2018; 6:408-413. [PMID: 29661366 DOI: 10.1016/j.jvsv.2017.11.014] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 11/13/2017] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Venous aneurysms are uncommon vascular abnormalities that may be identified anywhere in the body. Historically, they were often misdiagnosed as soft tissue lesions, but with the advent of readily available noninvasive imaging (such as duplex ultrasound), they can now be easily identified. Our aim was to review the presentation of venous aneurysms, available imaging modalities for defining them, and management. METHODS The English-language literature before March 2017 was reviewed, and only reports of primary venous aneurysms of the deep veins were included. Reports were subdivided on the basis of the location of the venous aneurysm, and reports containing sample imaging studies were referenced from Elsevier publications. RESULTS In total, our review identified reports of 35 head and neck venous aneurysms, 42 thoracic venous aneurysms, 152 intra-abdominal venous aneurysms, and 279 venous aneurysms of the extremities. Venous aneurysms of the lower extremity deep veins were most likely to be manifested by venous thromboembolic events, with approximately 25% to 50% of popliteal vein aneurysms presenting with pulmonary embolism. Diagnosis can be made by duplex ultrasound, computed tomography venography, magnetic resonance venography, or invasive venography. Management varies by location; most thoracic and head and neck aneurysms are observed, whereas venous aneurysms of the extremities are treated with surgical intervention, given the potential for venous thromboembolism. Few reports describe endovascular management of these lesions, so open surgical intervention remains the standard of care. CONCLUSIONS Venous aneurysms are rare vascular malformations that occur throughout the body. Many are identified on routine imaging ordered for other indications, whereas venous aneurysms of the deep veins of the extremities are often manifested with venous thromboembolism. Management of these lesions is determined largely by location and the potential morbidity and mortality of the untreated aneurysms vs surgery; aneurysms of the head and neck and thorax are managed with observation and serial imaging over time, whereas those of the abdomen and extremities are treated with surgical intervention. Endovascular techniques continue to lack a defined role in their management, and the standard of care remains open repair, when indicated.
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Ghali MGZ, Taylor JA, Mallon M, Gerety P, Shea P, Weinberger S, Urbine J, Raybagkar D. Popliteal Venous Aneurysm Presenting With Bilateral Pulmonary Thromboembolism. Vasc Endovascular Surg 2018; 52:287-290. [PMID: 29486675 DOI: 10.1177/1538574417754031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A 12-year-old boy presenting with chest pain and dyspnea was found to have bilateral pulmonary thromboembolism (PTE) secondary to left popliteal venous aneurysm (PVA) with thrombus. He improved with thrombolytics, developed recurrent PTE, then underwent surgical repair of his PVA. The pathophysiology, diagnosis, and management of PVA are discussed.
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Affiliation(s)
- Michael George Zaki Ghali
- 1 Department of Neurobiology & Anatomy, St. Christopher's Hospital for Children, Philadelphia, PA, USA.,2 Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, PA, USA.,3 Department of Pediatrics Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jesse A Taylor
- 4 Department of Plastic Surgery Children's Hospital of Philadelphia, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Mary Mallon
- 2 Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Patrick Gerety
- 5 Department of Plastic Surgery, Indiana University, Indianapolis, Indiana
| | - Paul Shea
- 6 Department of Critical Care Medicine, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Sharon Weinberger
- 7 Department of Cardiology, Drexel University College of Medicine, Philadelphia, PA, USA
| | - Jacqueline Urbine
- 2 Department of Radiology, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Deepti Raybagkar
- 3 Department of Pediatrics Drexel University College of Medicine, Philadelphia, PA, USA
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Life-threatening pulmonary embolism associated with multiple venous aneurysms. J Vasc Surg Venous Lymphat Disord 2017; 5:413-416. [DOI: 10.1016/j.jvsv.2016.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 07/18/2016] [Indexed: 11/22/2022]
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Sandstrom A, Reynolds A, Jha P. Popliteal Vein Aneurysm: A Rare Cause of Pulmonary Emboli. Ann Vasc Surg 2017; 38:315.e15-315.e17. [DOI: 10.1016/j.avsg.2016.05.093] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/26/2016] [Accepted: 05/01/2016] [Indexed: 11/29/2022]
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