Surgical Strategy for Primary Venous Aneurysms
2000 Volume 11 Issue 1 Pages 71-79
Details
2000 Volume 11 Issue 1 Pages 71-79
Venous aneurysms (VAs) are rare and known to cause pulmonary embolism, leading to sudden death. Seven patients with VAs were surgically treated in our institution between 1991 and 1998.
Patients included 5 female and 2 male, with mean age of 53.3 years (range 11 to 77 years).
There were two patients with external jugular VAs, two patients with dorsal pedic VAs, two patients with lesser saphenous VAs, and one patient with cephalic VA.
Each patient initially noticed a painless mass of the lesion, and was diagnosed as VAs by angiography, ultrasonography, and/or CT scan. Four VAs were saccular type aneurysms and three were fusiform type aneurysms.
In all cases, surgical treatment was performed. Although in our two cases the VAs were located in the peripheral vein (lesser saphenous vein, cephalic vein), we successfully performed an aneurysmal excision with venous reconstruction using by end-to-end anastomosis. In four patients, the operations were performed by day surgery using local anesthesia.
In all cases, histologic examination of the venous wall of the aneurysms revealed a flattended layer of endothelial cells, and the other side of the vein wall was composed primarily of fibrous connective tissues, fragmented elastic fibers, and few smooth muscle cells, however, no infiltrations of inflammatory cells were seen. Partial intimal hyperplasia was observed in 3 cases, and intraaneurysmal thrombus was observed in 3 cases. All patients were doing well after a longest 7-year follow-up.
Early surgical treatment is required for VAs of the popliteal vein, the iliac vein, the superior vena cava and the portal vein, because of the risks such as pulmonary emboli and rupture. However, the natural history of the peripheral VA may run the gamut from stable, painless subcutaneous masses to painful lesions producing distal embolization, no serious complications have resulted from them. Nevertheless, early surgical treatment for the peripheral VA may be done, because of the progressive symptoms such as pain and/or discomfort and of the tendency to form the intraaneurysmal thrombus.
