Popliteal venous aneurysms: results of surgical treatment

Abstract

Background: Popliteal venous aneurysms are an uncommon clinical entity although they have been the subject of a number of published clinical cases. Herein we have conducted an updated review of reports of these aneurysms while also describing our own experience with 4 such cases over the last 10 years.

Methods: A systematic search was conducted on MEDLINE and Embase concerning popliteal venous aneurysms. We collected all information mentioned associated with their clinical morphology, diagnosis, treatment, and follow-up. The patients included consisted of all those from the literature reports for whom the presence of an aneurysm in the popliteal region was described, plus the 4 cases in our own series.

Results: The most significant contribution was made by Sessa et al. in 2000, who recommended that this disorder be actively searched for in conventional echo-Doppler studies and, once detected, surgical repair should be undertaken by tangential aneurysmectomy with lateral venorrhaphy to prevent repeat pulmonary embolisms. In conjunction with their series, we reviewed other publications over the last 10 years to determine whether these recommendations have undergone any changes based on the new findings. We found 91 cases in addition to the 117 cases described by Sessa and colleagues as well as the 4 contributed by our group. Most of these cases do not present any specific symptomatology and are discovered by chance via echo Doppler. They are sometimes detected as a palpable mass in the popliteal fossa, with a tendency toward growth, venous thrombosis, and repeat pulmonary embolisms. Phlebography is usually left to preoperative study, and NMR and CAT are rarely used. The objective of surgical treatment is to eliminate the aneurysm while maintaining venous drainage to the limb, with the technique employed most often being tangential aneurysmectomy with lateral venorrhaphy. There are very few postoperative complications and relapses are rare.

Conclusions: The most recent publications confirm the recommendations made by Sessa et al. more than 10 years ago. Thus, no further changes should be made to the current approach to treatment of venous aneurysms.