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.