Popliteal Venous Aneurysm Associated with Duplicated Popliteal Veins: Report of a Case

Abstract

Popliteal venous aneurysms are an uncommon but potentially life-threatening disease because they can be a source for pulmonary emboli. However, most of the reported cases are saccular or fusiform. We describe here a very rare case of popliteal venous aneurysm associated with duplicated popliteal veins. To our knowledge, this kind of case has never been previously reported. A 69-year-old female consulted our hospital because of varicose veins of her left lower limb. About 9 years ago, she presented to another hospital with acute shortness of breath. She had been prescribed warfarin for one year under the diagnosis of pulmonary embolism. However, we could get no further information. Duplex ultrasound scan revealed reflux of the left great saphenous vein and a saccular aneurysm of the popliteal vein with a diameter of 2.2 cm. There was no sign of thrombosis. Computed tomography scan showed a segmental duplication of the popliteal vein, beginning in the popliteal fossa and joining in a single vessel again before the adductor canal. The distal joining portion of the duplicated veins was enlarged. The patient underwent an operation under spinal anesthesia via a posterior approach to the popliteal fossa. There was no thrombus in the aneurysm. The aneurysm was excised and the veins were repaired by lateral suture. The postoperative course was uneventful and duplex studies at 3 months after the procedure confirmed patency. Elastic compression was maintained, but anticoagulation was not prescribed. The inner wall of the true venous aneurysm exhibit fragmented elastic fibers replaced by fibrous tissue. The venous anatomy of the lower limb is highly variable and these variations have immense clinical significance particularly in cases of deep vein thrombosis and pulmonary embolism. We would recommend to all who perform venous duplex scanning for the diagnosis of deep vein thrombosis to look for two vessels in the popliteal fossa and for a duplicated femoral vein. Computed tomographic scanning is also considered to be important non-invasive diagnostic method. Because of the unpredictable risk of thromboembolic complications, surgical treatment is indicated in popliteal venous aneurysms.