A Case of Popliteal Venous Aneurysm Treated with a Direct Oral Anticoagulant as Perioperative Anticoagulation Therapy

Abstract

Popliteal venous aneurysm (PVA) is often associated with pulmonary embolism and can be fatal, so early surgery and postoperative anticoagulation therapy are the current standard therapies. The patient was a 75-year-old woman who was examined by a local physician after experiencing a sudden chest discomfort and dyspnea. She was diagnosed as having an acute pulmonary embolism and admitted to our hospital. Contrast computed tomography (CT) revealed a 23×37 mm left PVA with internal thrombus, and anticoagulation therapy using rivaroxaban was initiated. Dyspnea gradually disappeared, and contrast CT revealed that the thrombi in the pulmonary arteries and the PVA have disappeared. In the perioperative period, an inferior vena cava filter was placed and tangential aneurysmectomy with lateral venorrhaphy was performed. Rivaroxaban was administered for 1 year as postoperative anticoagulant therapy, which yielded positive short-term results. Only a few cases have been reported on the efficacy and duration of postoperative anticoagulant therapy using direct oral Xa inhibitors because of its short history. Hence, we believe further examination is necessary.