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Hamdan R, Precup CG, Falchero C, Baldassini AL, Castillo C. Acute Thrombosis of an Aneurysm of the Small Saphenous Vein: A Case Report. Vasc Endovascular Surg 2024; 58:350-356. [PMID: 37946330 DOI: 10.1177/15385744231215571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND A venous aneurysm (VA) is a focal dilatation of a nonvariceal vein (diameter increased by at least 1.5 times compared to the adjacent upstream or downstream venous segment), which carries a risk of venous thromboembolism (VTE) when located in the deep veins of the lower limbs but also when it affects the veins above the muscle fascia. CASE We report the case of a 40-year-old woman who presented with a painful and disabling mass-like lesion of the upper third of the right calf. A Doppler ultrasound (DUS) examination revealed a small saphenous vein (SSV) dilated at the saphenopopliteal junction (SPJ) and thrombosed along its entire length. Anticoagulant treatment was initiated but although the thrombosis regressed on DUS, the functional impotence and the persistence of pain prompted a stripping of the SSV. Histology allowed the diagnosis of SSV's primary aneurysm. DISCUSSION Dilated segments of the saphenous vein are not always varicose veins (VVs). True VAs can develop on veins located above the muscular fascia and, like deep VAs, may trigger VTE. Small saphenous vein aneurysms have seldom been reported, and only a few clinical observations have described the thrombosis of a SSV aneurysm. Any mass in the popliteal fossa or upper part of the calf should be examined by DUS to look for an SSV aneurysm. Excision of the saphenous vein with junctional ligation is advised if thrombosis is present at the time of diagnosis.
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Affiliation(s)
- Rémy Hamdan
- Department of Vascular Medicine, Mâcon Hospital, Mâcon, France
| | - Calin Gheorge Precup
- Department of Vascular Surgery, Hôpitaux Nord-Ouest de Villefranche-sur-Saône, Gleizé, France
| | - Catherine Falchero
- Department of Vascular Medicine, Hôpitaux Nord-Ouest de Villefranche-sur-Saône, Gleizé, France
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2
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Racman M, Kafol J, Jug B, Stankovic M, Piljic D, Ksela J. Rapidly Growing and Ruptured Great Saphenous Vein Aneurysm in a Liver Transplant Patient. Medicina (Kaunas) 2024; 60:290. [PMID: 38399577 PMCID: PMC10890480 DOI: 10.3390/medicina60020290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 01/31/2024] [Accepted: 02/06/2024] [Indexed: 02/25/2024]
Abstract
Venous aneurysms are rare vascular malformations that can lead to significant clinical complications, including thrombosis, pulmonary embolism, rupture, and even fatal outcomes when not promptly and adequately managed. This case report presents a liver transplant patient under immunosuppressive therapy who developed a rapidly progressing great saphenous vein aneurysm, ultimately requiring urgent surgical intervention due to acute bleeding from the ruptured aneurysm. Immunosuppression emerges as a potential key factor in the formation and rapid growth of the aneurysm, with the pathophysiological mechanism potentially involving increased expression of specific matrix metalloproteinases. Further research is warranted to gain a better understanding of the role of immunosuppression in the development of venous aneurysms.
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Affiliation(s)
- Mark Racman
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Jan Kafol
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
| | - Borut Jug
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
- Department of Vascular Diseases, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Milenko Stankovic
- Clinical Institute of Radiology, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Dragan Piljic
- Department of Cardiovascular Surgery, University Clinical Center Tuzla, 75000 Tuzla, Bosnia and Herzegovina
| | - Jus Ksela
- Department of Cardiovascular Surgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, 1000 Ljubljana, Slovenia
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3
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Nitesh P, Biju P, Kalayarasan R. Superior Mesenteric Vein Aneurysm With Arteriovenous Communication and Portal Vein Thrombosis: A Rare Presentation in Non-cirrhotic Portal Hypertension. Cureus 2023; 15:e42595. [PMID: 37641745 PMCID: PMC10460496 DOI: 10.7759/cureus.42595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/31/2023] Open
Abstract
Visceral venous aneurysms are exceedingly rare clinical entities reported in the literature. Venous aneurysms are usually acquired in origin, with most often portal hypertension as the underlying pathology. Most venous aneurysms are incidental findings on imaging. Complications of venous aneurysms like rupture with catastrophic outcomes had been reported. However, no clear guidelines exist regarding the management of portal venous aneurysms as most of the data is available only from case reports. Here, we report a rare finding of fusiform superior mesenteric vein (SMV) aneurysm with arteriovenous communication and portal vein thrombosis in the background of non-cirrhotic portal hypertension.
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Affiliation(s)
- Pagadala Nitesh
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Pottakkat Biju
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
| | - Raja Kalayarasan
- Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, IND
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4
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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5
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Gong TS, Li TS. Resectable fusiform internal jugular vein aneurysm with vascular excision and bypass with an 8 mm Maquet graft: A case report. Medicine (Baltimore) 2023; 102:e33582. [PMID: 37083804 PMCID: PMC10118334 DOI: 10.1097/md.0000000000033582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 03/31/2023] [Indexed: 04/22/2023] Open
Abstract
RATIONALE Venous aneurysm is a rare vascular disease. Studies reveal that patients with fusiform internal jugular vein aneurysms are not suitable for embolization. PATIENT CONCERNS Two treatment options are considered, either bypass the aneurysm via stenting or excision of the lesion site and anastomosis using an artificial graft. The advantages of excision bypass include the absence of endoleak and stent migration; however, a larger wound and longer operation time are required for it. DIAGNOSES Physical examination revealed a swelling in the right neck area. Head and neck computed tomography was performed for the survey. It revealed a 27.22 × 25.07 × 58.17 mm internal jugular fusiform aneurysm. INTERVENTIONS Vein excision was performed while using hemoclamps to control inflow and outflow, and a graft was anastomosed for bypass using an 8 mm Maquet graft. OUTCOMES The wound recovery was favorable, with no signs of infection, and the pain was under control. LESSONS The patient had a contrast-enhanced head and neck computed tomography, and the images efficiently diagnosed a venous aneurysm. This patient had refractory pain, which was a significant indication of the operation. We decided by ourselves on the duration of the interval of following up. We used excision and bypassing with graft, and the result was beneficial.
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Affiliation(s)
- Ting-Sheng Gong
- College of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, Changhua, Taiwan
| | - Tzong-Shiun Li
- Division of Cardiovascular Surgery, Department of Surgery, Changhua Christian Hospital, Changhua County, Changhua, Taiwan
- College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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6
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Chalhoub W, Romani M, Slika H. Thoracic venous aneurysm underlying a lipoma. JAAD Case Rep 2023; 33:42-44. [PMID: 36852338 PMCID: PMC9958385 DOI: 10.1016/j.jdcr.2022.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Affiliation(s)
- Wissam Chalhoub
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon,Faculty of Medicine, American University of Beirut, Lebanon,Correspondence to: Wissam Chalhoub, MD, MPH, American University of Beirut Medical Center, PO Box: 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon.
| | - Maya Romani
- Department of Family Medicine, American University of Beirut Medical Center, Beirut, Lebanon,Faculty of Medicine, American University of Beirut, Lebanon
| | - Hasan Slika
- Faculty of Medicine, American University of Beirut, Lebanon
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7
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Gómez-Galán S, Velandia-Sánchez A, Sanabria-Arévalo LM, Polania-Sandoval CA, Gallo-Bernal S, Cabrales-Arévalo J, Camacho-Mackenzie J, Barrera-Carvajal JG. Endovascular Repair of a Spontaneous Popliteal Arteriovenous Fistula Associated With a Venous Aneurysm. Vasc Endovascular Surg 2022; 56:501-504. [PMID: 35651321 DOI: 10.1177/15385744221077557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Popliteal arteriovenous fistulae (PAF) are anomalous communications between the arterial and venous systems of the lower extremity. They are usually secondary to trauma and are rarely associated with additional vascular defects. The coexistence of a PAF and a venous aneurysm is rare and usually occurs in patients with connective tissue disorders. Evidence regarding the management of this type of anomaly is scarce. However, both open and endovascular approaches seem feasible alternatives for treating this condition. Here, we describe a spontaneous popliteal arteriovenous fistula associated with a venous aneurysm in a 42-year-old male patient who presented with a popliteal mass. Satisfactory endovascular closure of the fistula and exclusion of the venous aneurysm were achieved using an Amplatzer™ Vascular Plug II.
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Affiliation(s)
- Sebastián Gómez-Galán
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Alejandro Velandia-Sánchez
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Lina María Sanabria-Arévalo
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Camilo Andrés Polania-Sandoval
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Division of Radiology, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Sebastian Gallo-Bernal
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,Division of Radiology, 2348Massachusetts General Hospital, Boston, MA, USA
| | - Jaime Cabrales-Arévalo
- Interventional Cardiology, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
| | - Jaime Camacho-Mackenzie
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Juan Guillermo Barrera-Carvajal
- Vascular and Endovascular Surgery Research Group, 42705Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.,School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
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8
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Chang H, Bae J, Chung TN. A Unique Case of Inferior Vena Cava Aneurysm Complicated with Pulmonary Embolism and Cerebral Infarction. J Cardiovasc Dev Dis 2021; 8:jcdd8110147. [PMID: 34821700 PMCID: PMC8621951 DOI: 10.3390/jcdd8110147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 10/27/2021] [Accepted: 11/03/2021] [Indexed: 11/16/2022] Open
Abstract
Inferior vena cava (IVC) aneurysms rarely occur. They are commonly detected incidentally since they present with mild or no symptoms. This was the first study to report a fatal case of a saccular IVC aneurysm with pulmonary embolism and cerebral infarction. The patient developed cardiac arrest five minutes after arriving at the emergency department, and spontaneous circulation was restored after two minutes of cardiopulmonary resuscitation. Computed tomography scans of the brain, chest, and abdomen–pelvis were obtained. The patient was diagnosed with a saccular aneurysm of the IVC measuring 8 × 11 cm, massive embolism of both pulmonary arteries, and cerebral infarction. An electroencephalogram, taken on the third day of hospitalization, suggested brain death, and the patient died on the eleventh day of hospitalization. This case report highlights that an IVC aneurysm with pulmonary embolism can be associated with paradoxical emboli-induced cerebral infarction, which is fatal.
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9
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Abstract
OBJECTIVE We sought to assess the diagnostic yield of advanced noninvasive imaging in the evaluation of patients with pulsatile tinnitus. BACKGROUND Pulsatile tinnitus can be caused by high-risk cerebrovascular pathologies such as arteriovenous fistulae. The role of advanced noninvasive imaging, including magnetic resonance angiography and magnetic resonance venography, in the diagnostic evaluation of pulsatile tinnitus is not well defined. DESIGN AND METHODS We performed a retrospective cohort study of patients presenting for outpatient diagnostic evaluation of pulsatile tinnitus from January 2018 to March 2020 at Weill Cornell Medicine. Patients with non-pulsatile tinnitus and established etiologic diagnoses were excluded. Systematic chart abstraction was summarized using standard descriptive statistics. Univariate logistic regression was used to identify factors associated with nondiagnostic noninvasive imaging. RESULTS A total of 187 patients (139 (74.3%) women) took part in this study, with a mean age of 48.6 years (standard deviation (SD) = 15.5 years) and a mean body mass index (BMI) of 26.9 kg/m2 (SD = 6.1 kg/m2). Of the 187 patients, 121 (64.7%) underwent exclusively noninvasive imaging, and 66 (35.3%) patients also had digital subtraction angiography (DSA). In patients who had exclusively noninvasive imaging, 62 (51.2%) patients received a diagnosis. In patients who underwent noninvasive and DSA imaging, 14 (21.2%) patients received a diagnosis based on DSA. Patients who were older at symptom onset (odds ratio (OR) = 1.05; 95% confidence interval (CI) 1.01-1.09) and those with a lower BMI (OR = 0.88, 95% CI 0.77-0.98) were more likely to have nondiagnostic noninvasive imaging. CONCLUSION Noninvasive cerebrovascular imaging often uncovers the etiology of pulsatile tinnitus. DSA remains useful for additional evaluation for patients with specific associated features.
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Affiliation(s)
- Alice J Tao
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, USA
| | - Neal S Parikh
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute and Department of Neurology, Weill Cornell Medicine, USA
| | - Athos Patsalides
- Department of Neurological Surgery, 24945North Shore University Hospital, North Shore University Hospital, Manhasset, NY
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10
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Patsalides A, Santillan A, Sundararajan SH, Michael M, Suurna M, Alexiades G. Venous sinus stenting for the treatment of isolated pulsatile tinnitus: Results of a prospective trial. Interv Neuroradiol 2020; 27:266-274. [PMID: 33243042 DOI: 10.1177/1591019920974185] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES This prospective study evaluates the effectiveness and safety of venous sinus stenting for patients with isolated pulsatile tinnitus and lateral sinus stenosis. METHODS Patients with isolated pulsatile tinnitus and lateral sinus stenosis with a minimum trans stenotic gradient of 4 mm Hg were treated with stenting. Pulsatile tinnitus before and after treatment was assessed with the Tinnitus Handicap Inventory (THI). Periprocedural adverse events, neurological complications, clinical and radiographic follow-up were also recorded. RESULTS A total of 42 patients (41 females and 1 male) were included in the study (median age of 37.5 years). Thirty patients had post-stenotic fusiform and 12 had post-stenotic saccular venous sinus aneurysm. In addition to stenting, coils were used to treat the patients with saccular venous aneurysms. The median follow-up was 5 months (range 1 to 34 months). Most patients had complete (39/42) or near-complete (2/42) resolution of their pulsatile tinnitus post-procedure. There were no serious adverse events. CONCLUSION Stenting of the lateral venous sinus is a safe and effective treatment for patients with isolated pulsatile tinnitus due to venous sinus stenosis.
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Affiliation(s)
- Athos Patsalides
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Alejandro Santillan
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Sri Hari Sundararajan
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Marissa Michael
- Division of Interventional Neuroradiology, Department of Neurosurgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - Maria Suurna
- Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
| | - George Alexiades
- Department of Otolaryngology - Head and Neck Surgery, New York Presbyterian Hospital/Weill Cornell Medical Center, New York, NY, USA
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11
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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12
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Khodarahmi I, Alizai H, Adler R. Partially thrombosed aneurysm of the medial marginal vein. J Clin Ultrasound 2019; 47:436-438. [PMID: 30896046 DOI: 10.1002/jcu.22723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/23/2019] [Accepted: 03/03/2019] [Indexed: 06/09/2023]
Abstract
Lower extremity superficial venous aneurysms are occasionally encountered by clinicians and are almost always located above the knee. Very few cases of aneurysm of the medial marginal vein in the most distal part, near the origin of the great saphenous vein, have been reported. We present a case of partially thrombosed aneurysm of the medial marginal vein, and briefly review the imaging characteristics and treatment options of this entity. Being aware of the existence of superficial venous aneurysms may help clinicians in their differential diagnosis of foot masses and choice of appropriate treatment.
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Affiliation(s)
- Iman Khodarahmi
- Department of Radiology, Section of Musculoskeletal Radiology, New York University School of Medicine, New York, New York
| | - Hamza Alizai
- Department of Radiology, Section of Musculoskeletal Radiology, New York University School of Medicine, New York, New York
| | - Ronald Adler
- Department of Radiology, Section of Musculoskeletal Radiology, New York University School of Medicine, New York, New York
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13
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Affiliation(s)
- Kenta Kumagai
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Japan
| | - Masato Yoshioka
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Japan
| | - Naohiko Otsuka
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Japan
| | - Yuzo Yamamoto
- Department of Gastroenterological Surgery, Akita University Graduate School of Medicine, Japan
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14
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Rajadurai A, Aziz AA, Daud NAM, Wahab AFA, Muda AS. Embolisation of External Jugular Vein Aneurysm: A Case Report. Malays J Med Sci 2017; 24:107-112. [PMID: 29379394 DOI: 10.21315/mjms2017.24.6.14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 08/02/2016] [Indexed: 10/18/2022] Open
Abstract
Introduction Venous aneurysms are not as common as their arterial counterpart. The choice of management is debatable. Case Report: We present the case of a teenage boy with left external jugular vein aneurysm treated by endovascular technique. Embolisation was done using pushable microcoils with access via the femoral vein and direct puncture. Conclusion This form of treatment provides a less-invasive option with a more concrete evaluation of the venous abnormality and its drainage during venous aneurysm occlusion.
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Affiliation(s)
- Arvin Rajadurai
- Department of Radiology, Hospital Sungai Buloh, Selangor, Malaysia
| | - Aida Abdul Aziz
- Department of Radiology, Hospital Sungai Buloh, Selangor, Malaysia
| | | | | | - Ahmad Sobri Muda
- Department of Radiology, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia
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15
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Jones RW, Parkerson GR, Ottinger M, Rodriguez E, Park B. A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency. SAGE Open Med Case Rep 2017; 5:2050313X17692937. [PMID: 28255445 PMCID: PMC5315365 DOI: 10.1177/2050313x17692937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 01/10/2017] [Indexed: 12/03/2022] Open
Abstract
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.
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Affiliation(s)
- Roy Wesley Jones
- Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | | | - Mary Ottinger
- Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Eduardo Rodriguez
- Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
| | - Brian Park
- Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA
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16
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Gomez DF, Mejia JA, Murcia DJ, Useche N. Isolated giant cerebral varix - A diagnostic and therapeutic challenge: A case report. Surg Neurol Int 2016; 7:S156-9. [PMID: 27069749 PMCID: PMC4802985 DOI: 10.4103/2152-7806.177894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 12/16/2015] [Indexed: 11/22/2022] Open
Abstract
Background: Isolated giant cerebral varix (IGV) is an uncommon vascular lesion that represents a diagnostic challenge and requires dynamic vascular studies for its characterization. The IGV is considered a benign, low-flow venous lesion with very low risk of bleeding that might cause secondary symptoms mainly due to compression of the adjacent parenchyma. Case Description: A 12-year-old female patient with non-contributory medical history presented with headache for the last 2 months. Upon admission, her neurological examination was unremarkable. Magnetic resonance imaging (MRI) and computed tomography angiography (CTA) images demonstrated a large varicose dilation of the superficial Sylvian vein, located anterior to the left temporal pole, with no evidence of abnormal arteriovenous connections or tumoral lesions. This finding was considered incidental and unrelated to her symptoms. In this case, we considered that the combination of CTA and MRIs was enough to establish an accurate diagnosis, excluding the need to perform invasive imaging studies. Taking into account these considerations, the patient was managed with conservative treatment and has been followed up for 1 year, remaining asymptomatic. Conclusion: Cerebral IGVs are rare vascular lesions that are treated conservatively when asymptomatic and surgically in the case of rupture or compression of adjacent structures. Given our observation of a high unlikelihood of vascular connections to arteries, and the information obtained with non-invasive imaging techniques such as CTA and MRI was enough to make a clinical decision and avoid the evaluation with invasive procedures.
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Affiliation(s)
- Diego Fernando Gomez
- Department of Neurosurgery, Fundación Santafe de Bogota University Hospital, Bogotá, Colombia
| | - Juan A Mejia
- Department of Neurosurgery, Fundación Santafe de Bogota University Hospital, Bogotá, Colombia
| | - Diana J Murcia
- Department of Neurosurgery, Fundación Santafe de Bogota University Hospital, Bogotá, Colombia
| | - Nicolas Useche
- Department of Radiology, Division of Neuroradiology, Fundación Santafe de Bogota University Hospital, Bogotá, Colombia
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Aggarwal A, Salunke P, Futane S, Mathuriya SN, Kumar A, Mukherjee KK, Radotra BD. Ruptured venous aneurysm of cervicomedullary junction. Surg Neurol Int 2014; 5:2. [PMID: 24575317 PMCID: PMC3927081 DOI: 10.4103/2152-7806.124977] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 12/11/2013] [Indexed: 11/30/2022] Open
Abstract
Background: Ruptured venous aneurysm is often seen with arterio-venous malformation (AVM) or developmental venous anomaly (DVA). However, isolated venous aneurysm is unusual. Case Description: We present a case of ruptured venous aneurysm that presented with subarachnoid hemorrhage (SAH) and intraventricular hemorrhage (IVH). Digital substraction angiography (DSA) revealed a saccular contrast filling pouch in the left lateral aspect of cervicomedullary junction (CMJ). Endovascular intervention was not a viable option. During surgery, a saccular pliable structure approx. 1.5 × 1 cm was found in the subarachnoid space that was clipped and excised. There were no arterial feeders, no evidence of surrounding AVM, and no dilated perimedullary vein. Conclusion: This is perhaps the first reported case of ruptured venous aneurysm (without associated AVM) of CMJ, which was successfully managed surgically. The possible etiologies remain an unnoticed head trauma or a congenital vessel wall abnormality. Surgically clipping and excision remains the treatment of choice for such lesion.
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Affiliation(s)
| | | | - Sameer Futane
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | - S N Mathuriya
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | - Ajay Kumar
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
| | - K K Mukherjee
- Department of Neurosurgery, PGIMER, Chandigarh, India
| | - B D Radotra
- Department of Pathology, PGIMER, Chandigarh, India
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Abstract
Thoracic venous aneurysms are very rare. They may be asymptomatic and can be found incidentally during imaging. They are associated with few complications including pulmonary embolism, rupture, and venous obstruction. Accurate diagnosis of a mediastinal aneurysm is essential to avoid complications secondary to biopsy or surgical intervention. This is a rare case of left innominate vein aneurysm, its imaging, as well as associated imaging shortfalls.
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Affiliation(s)
- Mark A Buehler
- Department of Radiology, University of Toledo, Toledo, Ohio
| | - Farhad S Ebrahim
- Department of Radiology, University of Toledo, Toledo, Ohio ; Department of Radiology, St. Luke's Hospital, Maumee, Ohio
| | - Theodore O Popa
- Department of Radiology, University of Toledo, Toledo, Ohio ; Department of Medicine, University of Toledo, Toledo, Ohio
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19
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Abstract
Popliteal venous aneurysms have always been linked to death from pulmonary embolism. Incidental finding of an asymptomatic popliteal venous aneurysm during duplex scan performed for patients with chronic venous disease is increasingly diagnosed but the relation between popliteal venous aneurysms and chronic venous disease remains unknown. We report the incidental finding of three asymptomatic popliteal venous aneurysms associated with iliac vein compression in patients with chronic venous disease who had undergone computed tomography venography with direct pedal contrast injection. An association between popliteal venous aneurysms and iliac vein compression is postulated.
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Affiliation(s)
- Ahmed S Gaweesh
- Department of Vascular Surgery, Alexandria Faculty of Medicine, University of Alexandria, Egypt
| | - Mohamed H Kayed
- Department of Diagnostic Radiology, Alexandria Faculty of Medicine, University of Alexandria, Egypt
| | - Tamer Y Gaweesh
- Department of Diagnostic Radiology, Alexandria Faculty of Medicine, University of Alexandria, Egypt
| | - Aly Shata
- Department of Diagnostic Radiology, Alexandria Faculty of Medicine, University of Alexandria, Egypt
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20
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Abstract
Venous aneurysm of neck is a rare anomaly, usually presenting as a painless mass which increases in size on valsalva maneuver. A child with multiple aneurysms of the right common facial and external jugular veins diagnosed on Doppler ultrasonography and magnetic resonance venography is reported.
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Affiliation(s)
- Sweta Swaika
- Department of Radiology, Nil Ratan Sircar Medical College, Kolkata, West Bengal, India
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21
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Abstract
OBJECTIVES Primary aneurysms of superficial venous system are rare and frequently misdiagnosed as varicose veins. Clinical presentation is variable depending on the presence of compression to surrounding structures. We report a rare case of primary cephalic vein aneurysm presented with wrist pain due to radial nerve compression. METHOD/CASE A 61-year-old woman was admitted with right wrist pain and localized mass. Physical and imaging examinations showed a localized cephalic vein aneurysm compressing radial nerve. Simple excision was performed successfully. RESULTS Cosmetic and clinical results at the first month follow-up were successful. DISCUSSION Although primary superficial venous aneurysms of upper extremities are very rare, the treatment of choice is most commonly same as the ones in lower limbs. Simple excision is the best approach in the most of the cases, while sclerotherapy could be preferred in order to obtain better cosmesis or to avoid injuries to surrounding structures.
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Affiliation(s)
- M Cakıcı
- Department of Cardiovascular Surgery, Diskapi Yildirim Beyazit E.A. Hospital, Ankara, Turkey
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22
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Dallatana R, Barbetta I, Settembrini A, Casazza F, Boeri R, Carmo M, Mazzaccaro D, Settembrini PG. Recurrent pulmonary embolism secondary to popliteal vein aneurysm with intraluminal wall ulcer. Phlebology 2012; 28:219-22. [PMID: 22528693 DOI: 10.1258/phleb.2012.011120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The popliteal vein is the most frequent site of venous aneurysm. Surgical treatment is indicated above a 2.5 cm diameter to prevent complications, notably deep venous thrombosis and pulmonary embolism (PE). Here we report a case of recurrent episodes of severe PE, leading to cardio-circulatory shock caused by a popliteal vein aneurysm (PVA) despite oral anticoagulant therapy. When surgical correction of the aneurysm was performed, we found an ulcerative lesion in the inner aspect of the vein that was acting as a 'thrombogenic focus' inside the aneurysm. An accurate inspection of the intimal wall is always important during surgery of PVA, particularly when tangential resection is performed.
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Affiliation(s)
- R Dallatana
- Division of Vascular Surgery, Università degli Studi di Milano-Ospedale San Carlo Borromeo, Milano, Italy
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23
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Abstract
OBJECTIVE To describe a case of a rare type of venous aneurysm (posterior tibial) with associated pulmonary embolus. We will discuss options and considerations germane to the diagnostic evaluation and possible interventions for this challenging clinical scenario. METHODS Case presentation and literature review. RESULTS A 36-year-old man presented to an outside hospital with a three-day history of left calf pain, acute shortness of breath and syncope elicited by exercise. Work-up demonstrated a pulmonary embolus and a posterior tibial venous aneurysm with mural thrombus. The patient presented to us 18 months later with persistent calf pain seeking an alternative to recommendations of lifelong anticoagulation. The patient was treated with surgical resection of the venous aneurysm with subsequent discontinuation of his anticoagulation. There were no surgical or thrombotic complications of this treatment course and the patient's discomfort improved. CONCLUSION Primary aneurysms of the tibial veins as a cause of pulmonary emboli are rare. A review of the literature suggests that anticoagulation alone does not provide effective amelioration of thromboembolic risk from lower extremity venous aneurysms. We have reported a case of successful surgical treatment of a posterior tibial venous aneurysm and recommend that surgical correction be strongly considered for accessible venous aneurysms.
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Affiliation(s)
- O P Haqqani
- Department of Vascular Surgery, Cardiovascular Center, Tufts Medical Center, Boston, MA 02111, USA.
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24
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Abstract
Pediatric neck masses should trigger a high index of suspicion for certain genetic disorders of connective tissue. To highlight this, we report on three infants with Menkes disease, an inherited disorder of copper transport, who developed large, unilateral neck masses at between 7 and 17 months of age. All were identified in imaging studies as internal jugular phlebectasia. The masses, which enlarged on crying or exertion, have remained clinically benign in these patients for 20, 17, and 2 months, respectively. While arterial tortuosity and aneurysms have been reported often in Menkes disease, venous phlebectasia has rarely been described. We speculate that low activity of the copper-dependent enzyme, lysyl oxidase, leading to reduced tensile strength in the deep cervical fascia comprising the carotid sheath may predispose to internal jugular phlebectasia in these individuals. Improved survival and neurological outcomes in infants with Menkes disease due to advances in early diagnosis and treatment may be associated with recognition of novel clinical stigmata of this condition such as internal jugular phlebectasia.
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Affiliation(s)
| | - Thyyar Ravindranath
- Division of Critical Care Medicine, Department of Pediatrics, Columbia University Medical Center, New York, NY
| | - Stephen G. Kaler
- Unit on Pediatric Genetics, Laboratory of Clinical Genomics, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD
- Corresponding Author: Stephen G. Kaler, MD, National Institutes of Health, Building 10; Room 5-2571, 10 Center Drive MSC 1832, Bethesda, Maryland 20892-1832, Phone: 301 496-8368; FAX: 301 402-1073, E-mail:
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Burnley HM, McCormick D, Hurren J, Gallagher PJ. Primary venous dissecting aneurysm arising during pregnancy: a case report and review of the literature. J Clin Pathol 2003; 56:634-5. [PMID: 12890822 PMCID: PMC1770022 DOI: 10.1136/jcp.56.8.634] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This report describes a case of venous dissecting aneurysm presenting as a popliteal mass, in a 33 year old woman. A 1 x 1 x 0.5 cm lump developed early in the course of a second pregnancy. Primary venous aneurysms are rare vascular abnormalities that can affect either the superficial or deep veins, and have been described throughout the venous system. Most commonly found in the neck and central thoracic veins, they have also been found in visceral veins and extremities. There is a tendency for vascular disturbances to occur during pregnancy. The haemodynamic changes and hormonal milieu may be the cause of vascular alterations, which can lead to new aneurysm formation, or weakening of pre-existing aneurysms. This is the first reported case of a dissecting venous aneurysm, and has the added interest that it occurred during pregnancy.
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