Society For Clinical Vascular Surgery

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Contemporary Management of Lower Extremity Venous Aneurysms
Rhusheet Patel, MD, Stefan Hanish, Karen Woo, MD, Peter Lawrence, MD, Donald Baril, MD.
UCLA, Los Angeles, CA, USA.

Contemporary management of lower extremity venous aneurysms
Rhusheet Patel, Stefan Hanish, Donald Baril, Karen Woo, Peter Lawrence
Objective: Lower extremity venous aneurysms may lead to serious morbidity in patients, including pulmonary embolism and chronic venous insufficiency. Presently, due to the low incidence of these aneurysms, no consensus for their treatment exists. The purpose of this study was to review the presentation and management of lower extremity venous aneurysms at our institution.
Methods: Retrospective review of all patients with isolated lower extremity venous aneurysms treated at a single tertiary care medical center from 2005 to 2017.
Results: Five male and six female patients with lower extremity venous aneurysms were identified, with a mean age of 50.4 years. Three patients had recent trauma associated with presentation and two patients had concomitant arterial aneurysmal disease. Three patients presented with deep vein thrombosis (DVT) and/or pulmonary embolism (PE), two presented with pain, and five venous aneurysms were found incidentally. Nine of 11 patients had aneurysms involving the popliteal vein, 1 was in the iliac vein and 1 was in the common femoral vein. Nine of 11 venous aneurysms were left sided. Diagnosis was made by duplex ultrasound in 5 patients, magnetic resonance imaging in 5 patients, and CT venogram in 1 patient. Mean aneurysm size was 2.6cm. Six patients underwent surgical intervention. The indication for operation was DVT/PE in three patients and lower extremity swelling in three patients. Aneurysm size in surgically treated patients was 3.6cm, versus 2.3cm in those managed non-operatively. Three patients had simple venorrhaphy, two had aneurysmectomy and ligation of the vein, and one patient underwent aneurysmectomy with placement of an interposition vein graft. Mean follow-up was 26.4 months, with no recurrent thromboembolism. Perioperative complications included post op hematoma (1) and superficial thrombophlebitis (1). One patient had aneurysm recurrence.
Lower extremity venous aneurysms continue to represent a rare yet potentially morbid vascular pathology. Conservative management may be preferred in patients without history of PE, but larger, multicenter studies are required to properly characterize the natural history and management of this disease.

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