Femoral Vein Ligation in an Elderly Patient with a Popliteal Venous Aneurysm: A Case Report

Abstract

We report the case of a 94-year-old woman who underwent right femoral vein ligation under local anesthesia for treatment of a popliteal venous aneurysm (PVA) and pulmonary embolism (PE). She presented with mild respiratory distress and was diagnosed with acute PE secondary to a right PVA. Contrast-enhanced computed tomography and ultrasonography revealed a saccular-shaped venous aneurysm (diameter 26 mm) filled with thrombus. We performed right femoral vein ligation under local anesthesia to prevent recurrent PE. She received edoxaban for 3 months, which led to resolution of the pulmonary emboli. Shrinkage of PVA was confirmed, and the patient is in good health without lower extremity edema and recurrent PE, 24 months postoperatively. Recurrent PE is common in patients with PVA, who are treated only with anticoagulation therapy. Therefore, surgical treatment is recommended for PVA to prevent recurrent PE in the previous reports. Aneurysm resection concomitant with venoplasty or popliteal vein reconstruction is usually performed under general anesthesia. However, general anesthesia is invariably physically burdensome for elderly patients. Therefore, we performed femoral vein ligation under local anesthesia in this patient. It is important to maintain collateral blood flow through the great saphenous vein and deep femoral vein during femoral vein ligation. Femoral vein ligation may be considered in elderly patients in poor general health, who present with PVA.