PRESENTATION AND MANAGEMENT OF VENOUS ANEURYSMS

Purpose: Venous aneurysms have been reported to occur in most major ve ins. These aneurysms may be misdiagnosed as soft tissue masses or as i nguinal or femoral hernias. Venous aneurysms of the deep system have b een associated with deep venous thrombosis (DVT) and pulmonary embolis m (PE). To more precisely characterize these lesions, we reviewed our experience with the disease. Methods: A retrospective analysis of our experience over 22 years was performed. The presentation and managemen t of these lesions were reviewed and compared with the literature. Res ults: Thirty-nine venous aneurysms were reported in 30 patients. There were 14 men and 16 women. The patients' ages ranged from 3 to 75 year s. Thirty aneurysms were located in the lower extremities, four in the upper extremity, and five in the internal jugular vein. Fifty-seven p ercent of lower extremity aneurysms occurred in the deep system. Patie nts' symptoms were a mass (75%) associated with pain (67%) and swellin g (42%). Thromboembolism occurred in six patients, DVT in three, and P E in three. Eight of nine patients (89%) who had aneurysms of the supe rficial venous system had their condition misdiagnosed. Diagnosis was made by phlebography (60%), color now duplex scanning (27%), continuou s-wave Doppler scanning (10%), or magnetic resonance imaging (10%). Th e aneurysm size ranged from 1.7 to 6.0 cm. Management consisted of tan gential excision in five (17%), total excision in 23 (77%), and observ ation in seven (6%). Conclusions: Venous aneurysms are unusual vascula r malformations that occur equally between the sexes and are seen at a ny age. Most patients have a painful mass of the extremity, and diagno sis is achieved by radiologic examination. Superficial venous aneurysm s of the inguinal region are often misdiagnosed. Thromboembolism is mo re common in aneurysms involving the deep venous system. Because of th eir potential morbidity, management should be surgical in the majority of cases.