Sadoul Charles, Settembre Nicla, Nabokov Victor, Alblowi Abdulrahman, Belkorissat Rabie Ali, Malikov Serguei
Department of Vascular Surgery, Nancy Regional University Hospital, and Université de Lorraine, Nancy, France.
Department of Vascular Surgery, Nancy Regional University Hospital, and Université de Lorraine, Nancy, France.
Ann Vasc Surg. 2025 Mar;112:148-156. doi: 10.1016/j.avsg.2024.10.028. Epub 2024 Dec 9.
Venous popliteal aneurysms are a rare but serious disease due to the risk of pulmonary embolism (PE). Aneurysms larger than 20 mm in diameter or with an embolic episode should be treated. The classic surgical technique is the tangential resection of the aneurysm with venorrhaphy, which may raise the risk of recurrence. We report a series of patients treated with a new technique consisting of aneurysmal resection and reconstruction using the axillary vein. The primary objective was to evaluate the patency of the transposed venous graft. The secondary objectives were to study the feasibility of the technique, the continence of the transplanted valve, the risk of aneurysmal recurrence, and the clinical consequences on the treated lower limb and at the donor site.
All the adult patients treated with this technique between October 2006 and May 2023 were included. Post-traumatic venous aneurysms, iatrogenic aneurysms, and those associated with vascular malformations were excluded. Ultrasound follow-up was obtained 3, 6, and 12 months after the operation, then annually and evaluated the patency and the diameter of the venous graft, and the continence of the valve. The clinical consequences at the donor and recipient site were collected.
Eleven patients were enrolled, including 7 men, with an average age of 55 (46-77) years. All the patients had symptoms: 10 had a history of PE and 1 suffered from deep venous insufficiency with dyspnea. The average diameter of the venous aneurysm was 29 mm (14-45 mm). The mean follow-up was 65 months (4-191) with only 1 patient lost to follow-up after 9 months. No bypass thrombosis was observed with ultrasound and venous-computed tomography follow-up, and the transposed valve remained continent in all the patients. There were no embolic recurrences after surgical treatment. The average diameter of the venous bypass was 10.5 mm (7-12), without aneurysmal recurrence. No complications were observed at the harvesting site.
Our study confirmed the feasibility of this alternative technique, with good long-term results with a 100% patency rate without any aneurysmal recurrence. It confirmed the continence of the transposed valve with a good tolerance at the donor site. The number of patients treated in this study was limited, but it highlights an interesting alternative to treat these venous lesions.
