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The Diagnosis and Management of Popliteal Vein Aneurysms
Grant T. Fankhauser, MD1, William M. Stone, MD1, Thomas C. Bower, MD2, Richard J. Fowl, MD1, Gloviczki Peter, MD2, Samuel R. Money, MD, MBA1.
1Mayo Clinic Arizona, Phoenix, AZ, USA, 2Mayo Clinic, Rochester, MN, USA.

Objectives: Popliteal vein aneurysms are rare and frequently diagnosed only after symptoms occur. The purpose of this study was to review a contemporary experience in surgical management.
Methods: A retrospective review was conducted at two geographically separate institutions between 1994 and June of 2011. Demographics, diagnostic work-up, treatment, and follow-up were reviewed.
Results: There were six patients with a mean age of 44 years (range 14 - 80), and an equal distribution of men and women. Mean aneurysm diameter was 2.5cm (range 1.6 - 3) and mean length was 4.9cm (range 2.6 - 10). Aneurysm size did not correlate with the presence of thrombus. Three patients (50%) were diagnosed after development of pulmonary embolism (PE). Pain (n=1), lower extremity edema (n=1), and knee injury (n=1) led to diagnosis in the other cases. Ultrasound was the initial diagnostic test in all cases. Computed tomography, magnetic resonance imaging, or venography were used to better delineate anatomy in 5 of the 6 cases. Five patients underwent surgical reconstruction. Three patients had an IVC filter placed prior to operation, two because of PE, and the other for thrombus in the aneurysm sac. Surgical procedures included aneurysmectomy with venorrhaphy in 3, and aneurysmectomy with interposition saphenous vein graft in 2. All operations were performed through a posterior approach. The remaining patient, age 80 years, is scheduled to undergo aneurysmectomy with venorrhaphy once her medical condition allows. Surgical complications included one hematoma requiring surgical evacuation. There has been no recurrence of aneurysm to date, and all vein reconstructions remain patent. The patients with PE were anticougulated for 6 months.
Conclusions: Popliteal vein aneurysms are rare but cause symptoms or complications including pulmonary embolism. Aneurysm size did not correspond to the risk of thrombus or its complications. Aneurysmectomy with venorrhaphy, or aneurysmectomy with vein interposition via a posterior approach works well, is safe, and durable.


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