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Image of Vascular Surgery

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Image of Vascular Surgery

Vasc Specialist Int 2021; 37(1): 60-61

Published online March 31, 2021 https://doi.org/10.5758/vsi.210018

Copyright © The Korean Society for Vascular Surgery.

Popliteal Venous Aneurysm: A Rare Cause of Recurrent Pulmonary Embolism

Suh Min Kim

Department of Surgery, Chung-Ang University College of Medicine, Seoul, Korea

Correspondence to:Suh Min Kim, Department of Surgery, Chung-Ang University College of Medicine, 102 Heukseok-ro, Dongjak-gu, Seoul 06973, Korea
Tel: 82-6299-1564, Fax: 82-2-6299-2017, E-mail: smkim819@hanmail.net, https://orcid.org/0000-0003-3221-2190

Received: March 11, 2021; Accepted: March 16, 2021

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Body

A 76-year-old woman visited our vascular clinic complaining of pain on the left popliteal fossa and a tingling sensation. Four years previously, she was admitted due to massive pulmonary embolism (PE). During the evaluation, a popliteal venous aneurysm of 25 mm in diameter was detected. She refused to undergo surgery and was treated with oral anticoagulation with warfarin. Six months ago, she had recurrent PE despite the regular medication of warfarin (Fig. 1). She still refused the operation, and oral rivaroxaban was prescribed. On this visit, computed tomography venography revealed a 49-mm popliteal vein aneurysm with mural thrombosis (Fig. 2). Due to the history of recurrent PE and compression symptoms of a partially thrombosed popliteal venous aneurysm, elective surgery was performed. Aneurysm resection and interposition graft with a great saphenous vein was performed (Fig. 3). Rivaroxaban was administered for 6 months and then changed to aspirin. She has been doing well without any symptoms for 4 years.

Figure 1. Computed tomography revealed multiple embolisms in the bilateral pulmonary lobar arteries (arrows).

Figure 2. Serial change of the left popliteal venous aneurysm (arrow).

Figure 3. The aneurysm was resected and replaced with a saphenous vein graft (arrow).

Although rare, the popliteal venous aneurysm can cause recurrent PE and should be corrected with an operation, including tangential aneurysmectomy with venorrhaphy or resection of the aneurysm with interposition graft [1,2].

Fig 1.

Figure 1.Computed tomography revealed multiple embolisms in the bilateral pulmonary lobar arteries (arrows).
Vascular Specialist International 2021; 37: 60-61https://doi.org/10.5758/vsi.210018

Fig 2.

Figure 2.Serial change of the left popliteal venous aneurysm (arrow).
Vascular Specialist International 2021; 37: 60-61https://doi.org/10.5758/vsi.210018

Fig 3.

Figure 3.The aneurysm was resected and replaced with a saphenous vein graft (arrow).
Vascular Specialist International 2021; 37: 60-61https://doi.org/10.5758/vsi.210018

References

  1. Li X, Wu H, Zhang L, Song H, Zeng C. Popliteal venous aneurysm with pulmonary embolism: a case report. Vasc Endovascular Surg 2020; doi: 10.1177/1538574420976237. [Epub ahead of print].
    Pubmed CrossRef
  2. Kawatani Y, Tajima A, Yamasaki M, Yamaguchi T, Oguri A. Popliteal venous aneurysm and pulmonary embolism initially presenting with recurrent pre-syncope: a case report. EJVES Vasc Forum 2020;48:19-22.
    Pubmed KoreaMed CrossRef