THE MANAGEMENT OF VENOUS ANEURYSMS OF THE LOWER-EXTREMITIES

Vein aneurysms have been reported in both the deep and superficial vei n system of the lower extremities. In the iliofemoral area of the deep system the most common presentation is of an abdominal or iliac fossa mass while thromboembolism is not uncommon. The aneurysms are thought to result mainly from a congenital weakness of the vein wall,,vith an AV fistula present in over 50 % of cases. Existing AV fistulae must b e ligated; however, as the results of simple AV fistula or vein ligati on are poor, reconstruction should always be attempted. Aneurysm excis ion with an end-to-end anastomosis might be feasible in the proximal i liac segment while the use of PTFE grafts or the LSV seems appropriate in cases of attempted reconstruction. In the popliteal area there is agreement on the aetiology (congenital, traumatic, post operative and after an AV fistula formation), the symptomatology (mainly thromboembo lism) and the diagnosis (duplex scanning). Symptomatic cases should be treated surgically since the reported surgical results are excellent while the incidence of recurrent pulmonary embolism in patients treate d conservatively exceeds 80 %.Asymptomatic popliteal vein aneurysms co uld remain under close observation only but, if complicated with throm boembolism during the follow-up period, surgery should be performed im mediately. The crural and superficial veins represent a minor danger a nd can be easily treated with ligation and/or excision with excellent results.