By Katherine Kozlowski, medical author and contributor to Vein News and Veinsveinsveins.com
Popliteal venous aneurysms are a rare, but important diagnosis as they can pose a risk for pulmonary embolism and deep vein thrombosis (DVT). Popliteal venous aneurysms can promote turbulent flow in which blood flows in multiple directions in the vein, which may result in DVT.
Researchers from Sweden and Switzerland performed retrospective reviews to determine the prevalence, symptoms, diagnostic tools, and prognosis regarding popliteal venous aneurysms.
RESULTS:
From the literature reviews, most of the patients were female and majority of aneurysms were on the left leg.
The most common symptoms are that of pulmonary embolism (i.e. chest pain, shortness of breath), the second most common symptoms being local discomfort and a palpable mass on the back of the leg.
Phlebography (x-ray of veins after dye is injected) and duplex ultrasound were the most commonly-used diagnostic tools.
There was a total of 4 deaths reported. In all 4 of the fatal cases, the aneurysm was not treated.
TREATMENT:
Treatment is recommended when the aneurysm showed turbulent flow on ultrasound and had a diameter greater than 20 mm/2 cm (Noppeney et al 2019).
Because popliteal venous aneurysms have potential to cause pulmonary embolism or deep vein thrombosis, there are several treatment options to address this and prevent further issues. The treatments used are listed below, from most to least common:
- Excision (removal of part of popliteal vein) and lateral suture
- Resection (removal of popliteal vein) and bypass
- Resection and end-to-end anastamosis (removing the popliteal vein, then tying off both ends)
- Ligation (tying the vein to close it off)
- Repair and graft of aneurysm
- Anticoagulation therapy (blood thinning medications to prevent pulmonary embolism)
A postoperative regimen of anticoagulation therapy for three months was followed to minimize risk of DVT.
CONCLUSION:
Popliteal venous aneurysms are rare, but due to the risk of pulmonary embolism and deep vein thrombosis, treatment should be considered even if the patient does not have a thrombophilic disorder. If surgical treatment is not an option, it is beneficial to consider anticoagulation therapy to prevent DVT or PE.
References:
Bergqvist D, Bjorck M, Ljungman C. Popliteal Venous Aneurysm—A Systematic Review. World J Surg 2006; 30(3):273-279.
Noppeney T, Kopp R, Pfister K et al. Treatment of Popliteal Vein Aneurysm. J Vasc Surg Venous Lymphat Disord; 7(4) 535-542.