The management of venous aneurysms of the lower extremities

Vein aneurysms have been reported in both the deep and superficial vein system of the lower extremities. In the iliofemoral area of the deep system the most common presentation is of an abdominal or iliac fossa mass while thromboembolism is not uncommon. The aneurysms are thought to result mainly from a congenital weakness of the vein wall, with an AV fistula present in over 50% of cases. Existing AV fistulae must be ligated; however, as the results of simple AV fistula or vein ligation are poor, reconstruction should always be attempted. Aneurysm excision with an end-to-end anastomosis might be feasible in the proximal iliac segment while the use of PTFE grafts or the LSV seems appropriate in cases of attempted reconstruction. In the popliteal area there is agreement on the aetiology (congenital, traumatic, post operative and after an AV fistula formation), the symptomatology (mainly thromboembolism) and the diagnosis (duplex scanning). Symptomatic cases should be treated surgically since the reported surgical results are excellent while the incidence of recurrent pulmonary embolism in patients treated conservatively exceeds 80%. Asymptomatic popliteal vein aneurysms could remain under close observation only but, if complicated with thromboembolism during the follow-up period, surgery should be performed immediately. The crural and superficial veins represent a minor danger and can be easily treated with ligation and/or excision with excellent results.