Great Saphenous Vein Aneurysm In Pediatric Patient
Mengdi Yao, Yasong Yu, Matthew St Fleur, Saqib Zia, Michael Curi.
Rutgers New Jersey Medical School, Newark, NJ, USA.
DEMOGRAPHICS:The patient is a 12-year-old female.
HISTORY:The patient has a history of swelling in the right groin since birth and is otherwise healthy and actively participates in sports. She initially presented to the office at age of 5, and venous duplex ultrasound showed a dilated great saphenous vein (GSV) at the saphenous-femoral junction (SFJ) measuring 1.5 cm without venous insufficiency or thrombosis. No other venous aneurysms were identified in the inferior vena cava, iliac veins, or deep and superficial veins in the lower extremities. Since then, she was followed with annual venous duplex ultrasounds. The size of the aneurysm remained stable from age 5 until 11, and was asymptomatic other than the swelling. After the patient turned 12 years of age, the aneurysm began causing pain during heavy exercises, as well as worsening discomfort in the groin when she sat or stood/walked for a long time. On physical examination, mild swelling was noted below the inguinal crease when patient was examined in the supine position. However, a prominent yet compressible bulge measuring 10.5 cm x 7 cm was seen in the medial right upper thigh in standing position. Two small areas of varicosities were noted in the right groin superior to the bulge. Venous duplex demonstrated GSV aneurysm measuring 6.6 cm x 6.1 cm, just beyond the SFJ. There was no mural thrombus. With patient in the upright position, venous reflux study demonstrated a jet of flow refluxing across the SFJ into the aneurysm, consistent with insufficiency of the saphenous-femoral junction.
PLAN:Giving the increasing limitations on the patientís quality of life, surgery was recommended. She underwent open aneurysm resection under general anesthesia. Intraoperatively, the aneurysm was a thin-walled, fusiform structure with multiple small venous tributaries (Figure 1). The GSV stump was oversewn, and the GSV was stripped to the distal thigh. Patient recovered well, with no limitations to activity.
DISCUSSION:Superficial venous aneurysms in pediatric populations are extremely rare. Pathophysiology, presentation, surgical options, and literature review are presented.
Figure 1. Intra-operative appearance of the GSV aneurysm.
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