Primary popliteal venous aneurysm with recurrent pulmonary emboli

Abstract

Primary venous aneurysms are infrequently noted and rarely have clinical significance. An important exception, however, is an aneurysm of the popliteal vein that is known to be a source for pulmonary emboli. We present the case of a previously healthy 57-year-old man with recurrent episodes of occult pulmonary embolism. Initial diagnostic investigations were compatible with multiple pulmonary emboli, but no source was identified. Subsequently, an indium 111-labeled platelet scan confirmed a site of active thrombus formation in the right lower extremity above the knee. Magnetic resonance imaging defined a saccular aneurysm of the popliteal vein, which was confirmed by contrast venography. Thereafter, the patient had resection of the venous aneurysm and tangential venorrhaphy. After operation duplex scanning confirmed patency of the venous repair. This is the eleventh report in the English-language literature of pulmonary emboli suspected of having originated from a popliteal venous aneurysm.

A Rare Case of Popliteal Venous Aneurysm

“…However they can lead to severe complications including deep-vein thrombosis, pulmonary embolism, and death [7, 8]. …”

Popliteal venous aneurysms: A two center experience with 21 cases and review of the literature

“…In the symptomatic group (n = 65), 44 patients presented with PE (67%) and 21 patients had postthrom-botic symptoms (35%). Only a few aneurysms were identified by physical examination [11,48] or presented with leg pain and swelling. Most of the aneurysms were located in the proximal popliteal vein, and only five cases were bilateral [28,32,43], including one case of our series.…”

“…Currently venous duplex imaging is considered, by most authors, to be the best noninvasive diagnostic method for the diagnosis of PVA [1,10,11,34,36,[59][60][61][62][63][64]. Duplex imaging is reliable in defining the true size of the aneurysm and the extent of thrombus within the aneurysmal sac (Figure 1).…”

“…Experience with two fatal cases in the literature showed that despite therapeutic levels of an anticoagulant, thrombus may continue to form and embolize [7,18]. Moreover six of the 10 patients who were initially treated with anticoagulation presented a recurrent thrombosis in the popliteal fossa or PE before having surgical correction of the aneurysm [5,11,12,18,19,59]. Since recurrence of PE after surgery has never been reported and given the high risk of recurrence of thromboembotic events with anticoagulation alone surgical treatment is indicated in all symptomatic patients.…”

“…Primary venous aneurysms are uncommon and in most cases of little clinical significance [1][2][3][4] whereas popliteal venous aneurysms (PVA) are a potentially life-threatening diseases as they have been recognized to be a source of recun'ent pulmonary emboli (PE) [5][6][7][8][9][10][11][12][13]. Nearly all the cases reported in the literature are symptomatic with the most common symptoms being PE and postthrombotic syndrome [5][6][7][8][9][10][11][12][13][14][15][16][17][18]. May and Nissel [49] were the first to describe in 1968 a PVA associated with foot and ankle swelling.…”