Twenty-Five Years of Popliteal Venous Aneurysm Management

Popliteal venous aneurysms (PVAs) are a rare vascular disease that can lead to deep vein thrombosis (DVT) and pulmonary embolism (PE). There are limited data on optimal management. This retrospective, single centre cohort study, conducted over a 25 year period (1998 - 2022), evaluated the clinical features, treatment strategies, and outcomes in patients with PVAs.

Demographics, intra-operative details, and outcomes of all consecutive patients with PVA treated surgically or conservatively were analysed. Primary endpoints were 30 day mortality rate, long term graft patency, and re-intervention rates.

Fifty-four patients (mean age 52.5 ± 18 years; range 15 - 90) were included. Thirty-four of the 54 (63%) patients had symptoms, including PE in eight (15%), DVT in nine (17%), pain in 24 (44%), and palpable mass in seven (13%). Thirty-one (57%) of the PVAs were saccular. Twenty-four (44%) patients underwent surgical repair, 19 of 24 (79%) were symptomatic and five of 24 (21%) were asymptomatic. The remaining 30 patients (56%) were managed conservatively, including 15 symptomatic and 15 asymptomatic. Tangential aneurysmectomy with lateral venorrhaphy was the most common procedure (19 of 24, 79%), followed by saphenous vein interposition graft in five of 24 (21%). Four (16%) patients experienced early complications, including wound dehiscence (4%), graft thrombosis (4%), and haematoma (8%). During a median follow up of 31 months (range 1 - 134), two patients had recurrent symptomatic PVA, only one requiring surgery. Among symptomatic patients managed conservatively, symptoms resolved in 13, were unchanged in one, and one developed new DVT. Among asymptomatic patients initially treated conservatively (15 of 30), one (3%) developed pain and swelling, which was managed conservatively. The 3 year primary and assisted patency rates were 95 ± 3% and 100%, respectively. Freedom from re-intervention was 97 ± 2%. Five year survival was 94 ± 4%, with no PVA related deaths.

The results support selective operative intervention based on size, symptoms, and thrombus presence, while validating conservative management in low risk patients.