Abstract
Popliteal venous aneurysms (PVA) are an uncommon but potentially life-threatening
disease as they can be a source for pulmonary emboli (PE). We reviewed 21 patients
(5 males, 16 females aged 33–79 years, mean age 60 years) with popliteal venous aneurysms
treated between 1985 and 1998 in two centers. Nine aneurysms were discovered in patients
with varicose veins, and 12 aneurysms were symptomatic: 50% presented with PE and
50% had thrombotic symptoms. The diagnosis of PVA was achieved by venous duplex imaging
and phlebography: 85% (18/21) of the aneurysms were saccular and 43% (9/21) had an
intraluminal thrombus. Surgical repair was performed by aneurysmectomy with venorrhaphy
in 16 patients. Five patients had various procedures, including vein transposition
(n = 1), resection and end-to-end anastomosis (n = 2), resection with interposition
vein grafting using the greater saphenous vein (n = 1) or superficial femoral vein
(n = 1). Two patients had a concomitant inferior vena cava filter placement. Mean
follow-up was 53 months (range: 2 to 136 months). No operative deaths occured, and
no patient had evidence of a recurrent PE. Postoperative thrombosis of the surgical
repair developed in 3 cases. Patency was restored with anticoagulation therapy. Four
complications (19%) included transistory nerve injury (n = 2) and postoperative hematoma
(n = 2). Despite its rarity PVA should be ruled out in patients with PE and no other
obvious embolic source or thromboembolic risk factors. Based on our experience and
a review of the literature: (1) Surgical treatment is indicated in all symptomatic
patients and tangential aneurysmectomy with lateral venorraphy is the recommended
procedure; (2) Asymptomatic patients with saccular or large fusiform PVA should also
undergo surgery because of the unpredictable risk of thromboembolic complications;
(3) Asymptomatic patients with small fusiform and thrombus-free PVA may remain under
close surveillance and surgery should be performed if thrombus is detected in the
aneurysm and if thromboembolic complications occur. Although this policy has been
advocated by some authors, it will have to be supported by other long-term observations.