Department of Surgery, Division of Vascular and Endovascular Surgery, UCLA Medical Center, Los Angeles, Calif.
College of Letters and Science, University of California, Los Angeles, Calif.
J Vasc Surg Venous Lymphat Disord. 2019 Nov;7(6):860-864. doi: 10.1016/j.jvsv.2019.06.017. Epub 2019 Sep 5.
Lower extremity venous aneurysms may lead to serious morbidity in patients, including pulmonary embolism (PE) and chronic venous insufficiency. Presently, because of the low incidence of these aneurysms, no consensus for their treatment exists. The purpose of this study was to review the presentation and management of lower extremity venous aneurysms at our institution.
A retrospective review of all patients with isolated lower extremity venous aneurysms treated at a single tertiary care medical center from 2005 to 2017 was conducted.
Five male and six female patients with lower extremity venous aneurysms were identified, with a mean age of 50.4 years. Three patients presented with deep venous thrombosis or PE, three presented with pain, and five venous aneurysms were found incidentally. Nine of 11 patients had aneurysms involving the popliteal vein; one was in the iliac vein, and one was in the common femoral vein. Diagnosis was made by duplex ultrasound in five patients, magnetic resonance imaging in five patients, and computed tomography venography in one patient. Mean aneurysm to adjacent vein ratio was 2.62. No patients who had venous aneurysms discovered incidentally suffered thromboembolic complications. Three patients who were initially treated conservatively went on to eventual surgical intervention. Six patients underwent surgical intervention. The indication for operation was deep venous thrombosis or PE in three patients and lower extremity swelling in three patients; all were symptomatic at presentation. Three patients had simple venorrhaphy, two patients had aneurysmectomy and ligation of the vein, and one patient underwent aneurysmectomy with placement of an interposition vein graft. Mean follow-up was 26 months, with no recurrent thromboembolism. Perioperative complications included postoperative hematoma (one) and superficial thrombophlebitis (one).
Lower extremity venous aneurysms continue to represent a rare yet potentially morbid vascular disease. Symptomatic patients demonstrated a clear benefit from surgery vs conservative management. Larger, multicenter studies are required to properly characterize the natural history and management of this disease.
下肢静脉动脉瘤可导致患者出现严重的并发症，包括肺栓塞（PE）和慢性静脉功能不全。目前，由于这些动脉瘤的发病率较低，因此针对其治疗尚未达成共识。本研究旨在回顾我院下肢静脉动脉瘤的临床表现和治疗方法。
对 2005 年至 2017 年在一家三级保健医疗中心接受治疗的孤立性下肢静脉动脉瘤患者进行回顾性分析。
共发现 5 例男性和 6 例女性下肢静脉动脉瘤患者，平均年龄为 50.4 岁。3 例患者出现深静脉血栓形成或 PE，3 例出现疼痛，5 例静脉动脉瘤为偶然发现。11 例患者中有 9 例动脉瘤累及腘静脉，1 例位于髂静脉，1 例位于股总静脉。5 例患者通过双功能超声、5 例患者通过磁共振成像、1 例患者通过计算机断层静脉造影诊断出动脉瘤。平均动脉瘤与相邻静脉的比值为 2.62。未发现有偶然发现的静脉动脉瘤患者发生血栓栓塞并发症。3 例最初接受保守治疗的患者最终进行了手术干预。6 例患者接受了手术干预。手术指征为 3 例患者深静脉血栓形成或 PE，3 例患者下肢肿胀；所有患者均有症状。3 例患者接受单纯静脉吻合术，2 例患者接受动脉瘤切除术和静脉结扎术，1 例患者接受动脉瘤切除术和静脉间置移植术。平均随访时间为 26 个月，无复发性血栓栓塞。围手术期并发症包括术后血肿（1 例）和浅表血栓性静脉炎（1 例）。
下肢静脉动脉瘤仍然是一种罕见但潜在致命的血管疾病。与保守治疗相比，有症状的患者从手术中获益更明显。需要更大规模、多中心的研究来正确描述这种疾病的自然史和治疗方法。
