Tamellini Paolo, Recchia Andrea, Garriboli Luca, Miccoli Tommaso, Pruner Gianguido, Jannello Antonio Maria
Ann Ital Chir. 2019;90:83-87.
True aneurysmal degeneration of autogenous vein grafts is unusual, despite their widespread use as arterial substitutes. We report a case of acute lower leg ischemia due to thrombosis of a non-anastomotic venous aneurysm.
A 71-year old man presented at Emergency Unit at our Institution with left lower limb acute ischemia. The patient had 9 years before undergone left below the knee femoro-popliteal bypass with in situ autologous great saphenous vein (GSV) graft. Doppler ultrasound exam revealed patency of the entire conduit, and subtotal acute thrombosis of a saccular aneurysm of the vein 2 cm before the distal anastomosis of the graft. Aneurysmectomy and distal thrombo- embolectomy with Fogarty catheter of below the knee popliteal artery and tibio-peroneal trunk was performed. Vein graft continuity was restored by a termino-terminal anastomosis.
Arterialized autologous veins are at risk of degenerative changes because of histological differences with arteries, but the cause of true aneurysmal degeneration of these grafts is still unknown. The mean time from graft implantation to clinical manifestation of the aneurysm is 7 years and the management of venous graft aneurysms should be subjected to the same criteria as other aneurysms. The first choice in detecting vein graft aneurysms is Duplex ultrasonography and the type of surgical intervention depends on the cause, type and extension of aneurysmal dilatation.
Aneurysmal degeneration of deep lower extremity vein conduits implanted for vascular reconstruction has been rarely reported, but when detected they can lead to graft thrombosis, distal embolization, acute rupture, or skin ulceration. Therefore, Doppler ultrasound guided surveillance of GSV grafts should be mandatory and long time from vein graft creation to onset of aneurysms makes long-term graft surveillance even more imperative.
Acute Leg Ischemia, Great Saphenous Vein, Graft; Aneurysm, Thrombosis.
尽管自体静脉移植物作为动脉替代物被广泛使用，但其真正的动脉瘤样变性并不常见。我们报告一例因非吻合口静脉瘤血栓形成导致急性小腿缺血的病例。
一名71岁男性因左下肢急性缺血就诊于我院急诊科。该患者9年前接受了左膝下股腘动脉旁路移植术，使用的是原位自体大隐静脉（GSV）移植物。多普勒超声检查显示整个管道通畅，在移植物远端吻合口前2 cm处的静脉囊状动脉瘤存在亚急性血栓形成。进行了动脉瘤切除术以及使用Fogarty导管对膝下腘动脉和胫腓干进行远端血栓-栓子切除术。通过端端吻合恢复了静脉移植物的连续性。
由于与动脉在组织学上存在差异，动脉化的自体静脉有发生退行性改变的风险，但这些移植物真正的动脉瘤样变性的原因仍不清楚。从移植物植入到动脉瘤临床表现的平均时间为7年，静脉移植物动脉瘤的处理应遵循与其他动脉瘤相同的标准。检测静脉移植物动脉瘤的首选方法是双功超声检查，手术干预的类型取决于动脉瘤扩张的原因、类型和范围。
用于血管重建的下肢深静脉管道的动脉瘤样变性很少见报道，但一旦发现，可能导致移植物血栓形成、远端栓塞、急性破裂或皮肤溃疡。因此，对GSV移植物进行多普勒超声引导监测应成为常规操作，并且从静脉移植物建立到动脉瘤发生的时间间隔较长，这使得长期的移植物监测更加必要。
急性下肢缺血；大隐静脉；移植物；动脉瘤；血栓形成
