Successful ligation of posterior tibial vein aneurysm performed according to intraoperative venography results.

Masaaki Naganuma,Nobuaki Suzuki,Yasushi Kudo,Koichi Nagaya,Shinya Masuda

doi:10.1016/j.jvscit.2021.08.007

Masaaki Naganuma, Nobuaki Suzuki + Show 3 more

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https://doi.org/10.1016/j.jvscit.2021.08.007

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Abstract

A 23-year-old woman was diagnosed with a posterior tibial vein aneurysm that had resulted in deep vein thrombosis and a pulmonary embolism. The patient responded well to anticoagulation therapy, and surgical resection was planned to prevent recurrence. She was scheduled to undergo tangential aneurysmectomy and lateral venorrhaphy. However, the aneurysm could not be completely exposed because of adhesions. Therefore, venography was performed to identify the inflow and outflow vessels, which were ligated because an accessory venous communication was identified. Intraoperative venography can aid in the selection of simple ligation or reconstruction of a venous communication for the treatment of posterior tibial vein aneurysms.

Highlights

A 23-year-old woman was diagnosed with a posterior tibial vein aneurysm that had resulted in deep vein thrombosis and a pulmonary embolism
We report the case of a patient with a posterior tibial vein aneurysm that had caused deep vein thrombosis and a pulmonary embolism
We have described the case of a patient with a posterior tibial vein aneurysm in whom deep vein

Summary

CASE REPORT

A 23-year-old woman had presented with acute onset of shortness of breath. The chest radiograph findings were normal. Contrast-enhanced computed tomography revealed a pulmonary embolism and deep vein thrombosis caused by the right posterior tibial vein aneurysm. Anticoagulant therapy was started, which resulted in the dissolution of the pulmonary artery embolus and posterior tibial vein thrombus. She was discharged with direct oral anticoagulant therapy (edoxaban, 60 mg/day). Preoperative venography demonstrated a posterior tibial vein aneurysm that had another communication with the venous circulation (Fig 3). With the patient under general anesthesia, an incision was made along the medial side of the right lower extremity, and the posterior tibial vein was exposed. We identified a collateral pathway connecting the distal and proximal ends of the posterior tibial vein through which the blood was transported to the venous circulation, bypassing the aneurysm. Postoperative ultrasound demonstrated complete thrombosis of the posterior tibial vein aneurysm, and no thrombus was found in the other deep veins

DISCUSSION

CONCLUSIONS