POPLITEAL VENOUS ANEURYSM - REPORT OF 2 CASES AND REVIEW OF THE WORLDLITERATURE

Two new cases of popliteal venous aneurysm are reported and added to t he 22 other cases of popliteal venous aneurysm available for review. B oth patients were first seen with acute pulmonary embolism and were tr eated with thrombolytic therapy followed by anticoagulation. Each had recurrent venous thromboembolism before discovery of the popliteal ven ous aneurysm. One popliteal venous aneurysm was diagnosed with phlebog raphy and the second with venous duplex imaging, confirmed with phlebo graphy. Both were surgically corrected with tangential aneurysmectomy and lateral venorrhaphy. Twenty-four cases of popliteal venous aneurys m are now available for review. Seventy-one percent (17 of 24) present ed with pulmonary embolism, 88% (21 of 24) were saccular, and 96% (23 of 24) were located in the proximal popliteal vein. All but two were d iagnosed by ascending phlebography. Three patients received no treatme nt: in two of these the outcome was not documented and the third had o ccasional pain. Two patients received anticoagulation without subseque nt operative repair and both died of recurrent pulmonary emboli. Opera tive correction resulted in a 75% patency rate with 21% complications, most of which were related to postoperative anticoagulation. No patie nt who was operated on had subsequent pulmonary embolism, and there we re no operative deaths. We suggest that all patients who have pulmonar y embolism have lower-extremity venous duplex imaging. All popliteal v enous aneurysms should be surgically repaired, inasmuch as nonoperativ e therapy results in recurrent thromboembolism and an unacceptably hig h mortality rate. Tangential aneurysmectomy with lateral venorrhaphy i s the recommended procedure.