Popliteal venous aneurysms: A two center experience with 21 cases and review of the literature

Abstract

Popliteal venous aneurysms (PVA) are an uncommon but potentially life-threatening disease as they can be a source for pulmonary emboli (PE). We reviewed 21 patients (5 males, 16 females aged 33–79 years, mean age 60 years) with popliteal venous aneurysms treated between 1985 and 1998 in two centers. Nine aneurysms were discovered in patients with varicose veins, and 12 aneurysms were symptomatic: 50% presented with PE and 50% had thrombotic symptoms. The diagnosis of PVA was achieved by venous duplex imaging and phlebography: 85% (18/21) of the aneurysms were saccular and 43% (9/21) had an intraluminal thrombus. Surgical repair was performed by aneurysmectomy with venorrhaphy in 16 patients. Five patients had various procedures, including vein transposition (n = 1), resection and end-to-end anastomosis (n = 2), resection with interposition vein grafting using the greater saphenous vein (n = 1) or superficial femoral vein (n = 1). Two patients had a concomitant inferior vena cava filter placement. Mean follow-up was 53 months (range: 2 to 136 months). No operative deaths occured, and no patient had evidence of a recurrent PE. Postoperative thrombosis of the surgical repair developed in 3 cases. Patency was restored with anticoagulation therapy. Four complications (19%) included transistory nerve injury (n = 2) and postoperative hematoma (n = 2). Despite its rarity PVA should be ruled out in patients with PE and no other obvious embolic source or thromboembolic risk factors. Based on our experience and a review of the literature: (1) Surgical treatment is indicated in all symptomatic patients and tangential aneurysmectomy with lateral venorraphy is the recommended procedure; (2) Asymptomatic patients with saccular or large fusiform PVA should also undergo surgery because of the unpredictable risk of thromboembolic complications; (3) Asymptomatic patients with small fusiform and thrombus-free PVA may remain under close surveillance and surgery should be performed if thrombus is detected in the aneurysm and if thromboembolic complications occur. Although this policy has been advocated by some authors, it will have to be supported by other long-term observations.