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Panminerva Medica 1998 June;40(2):89-93

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

The management of venous aneurysms of the lower extremities

Volteas S. K., Labropoulos N., Nicolaides A. N.

From the Academic Vascular Surgical Unit, St. Mary’s Hospital Medical School, London, UK


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Vein aneu­rysms ­have ­been report­ed in ­both the ­deep and super­fi­cial ­vein ­system of the low­er extrem­ities. In the ili­of­e­mo­ral ­area of the ­deep ­system the ­most com­mon pres­en­ta­tion is of an abdom­i­nal or ­iliac fos­sa ­mass ­while throm­boem­bo­lism is not uncom­mon. The aneu­rysms are ­thought to ­result main­ly ­from a con­gen­i­tal weak­ness of the ­vein ­wall, ­with an AV fis­tu­la ­present in ­over 50% of cas­es. Existing AV fis­tu­lae ­must be ligat­ed; how­ev­er, as the ­results of sim­ple AV fis­tu­la or ­vein liga­tion are ­poor, recon­struc­tion ­should ­always be attempt­ed. Aneurysm exci­sion ­with an end-to-end anas­tom­o­sis ­might be fea­sible in the prox­i­mal ­iliac seg­ment ­while the use of ­PTFE ­grafts or the LSV ­seems appro­pri­ate in cas­es of attempt­ed recon­struc­tion. In the pop­li­teal ­area ­there is agree­ment on the aetio­lo­gy (con­gen­i­tal, trau­mat­ic, ­post oper­a­tive and ­after an AV fis­tu­la for­ma­tion), the symp­tom­a­tol­o­gy (main­ly throm­boem­bo­lism) and the diag­no­sis (­duplex scan­ning). Symptomatic cas­es ­should be treat­ed sur­gi­cal­ly ­since the report­ed sur­gi­cal ­results are excel­lent ­while the inci­dence of recur­rent pul­mo­nary embo­lism in ­patients treat­ed con­ser­va­tive­ly ­exceeds 80%. Asymptomatic pop­li­teal ­vein aneu­rysms ­could ­remain ­under ­close obser­va­tion ­only but, if com­pli­cat­ed ­with throm­boem­bo­lism dur­ing the fol­low-up peri­od, sur­gery ­should be per­formed imme­di­ate­ly. The cru­ral and super­fi­cial ­veins rep­re­sent a ­minor dan­ger and can be eas­i­ly treat­ed ­with liga­tion and/or exci­sion ­with excel­lent ­results.

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