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

lingua: Inglese

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


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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