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Point-Of-Care Ultrasound Screening for Proximal Lower Extremity Deep Venous Thrombosis
Published on: February 10, 2023
Primary tibial vein aneurysm with recurrent pulmonary emboli
Roberto Gabrielli1, Maria Sofia Rosati, Alessandro Costanzo
1Department of Vascular and Endovascular Surgery, Policlinico Casilino University of Rome, Rome, Italy. rogadoc@libero.it
Journal of Vascular Surgery
|June 24, 2010
Summary
A posterior tibial vein aneurysm thrombosis caused recurrent pulmonary emboli in a 42-year-old man. Surgical repair, alongside thrombolysis and an inferior vena cava filter, proved safe and effective for this rare condition.
Area of Science:
- Vascular Surgery
- Cardiology
- Radiology
Background:
- Recurrent pulmonary embolism (PE) can stem from unusual venous pathologies.
- Deep venous thrombosis (DVT) is the typical source of PE, but aneurysmal thrombosis is a rare differential diagnosis.
- Accurate diagnosis of the embolic source is crucial for effective treatment.
Observation:
- A 42-year-old male presented with symptoms suggestive of recurrent pulmonary embolism.
- Computed tomography confirmed multiple bilateral pulmonary emboli.
- Venous duplex examination identified a thrombosis within a posterior tibial vein aneurysm, despite no clinical signs of deep venous thrombosis.
Findings:
- The patient underwent thrombolysis, temporary inferior vena cava (IVC) filter placement, and surgical repair (tangential aneurysmectomy and lateral venorrhaphy) of the affected vein.
- The surgical intervention successfully addressed the source of the embolism.
- Accurate duplex scan evaluation of the lower limb venous system is crucial for identifying rare causes of PE.
Implications:
- Anticoagulation alone may be insufficient for managing PE originating from venous aneurysms.
- Surgical repair of venous aneurysms is a safe and effective treatment option for preventing recurrent pulmonary embolism.
- Comprehensive venous duplex imaging should be considered in all PE cases to uncover potential underlying vascular pathologies.
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