Contemporary management and outcomes of peripheral venous aneurysms: A multi-institutional study.

Autor: Patel R; Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA. Electronic address: rhusheetpatel@mednet.ucla.edu., Woo K; Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA., Wakefield TW; Division of Vascular Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI., Beaulieu RJ; Division of Vascular Surgery and Disease, Department of Surgery, Ohio State University, Columbus, OH., Khashram M; Department of Vascular Surgery, University of Auckland Waikato Hospital, Hamilton, New Zealand., De Caridi G; Division of Vascular Surgery, University of Messina, Messina, Italy., Benedetto F; Division of Vascular Surgery, University of Messina, Messina, Italy., Shalhub S; Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA., El-Ghazali A; Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, WA., Silpe JE; Division of Vascular Surgery, Department of Surgery, Northwell Health at Hofstra, Zucker School of Medicine, New Hyde Park, NY., Rosca M; Division of Vascular Surgery, Department of Surgery, Northwell Health at Hofstra, Zucker School of Medicine, New Hyde Park, NY., Cohnert TU; Department of Vascular Surgery, Graz Medical University, Graz, Austria., Siegl GK; Department of Vascular Surgery, Graz Medical University, Graz, Austria., Abularrage C; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, MD., Sorber R; Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, the Johns Hopkins Medical Institutions, Baltimore, MD., Wittgen CM; Division of Vascular Surgery, Department of Surgery, Saint Louis University, St Louis, MO., Bove PG; Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Gross Pointe Farms, MI., Long GW; Division of Vascular Surgery, Department of Surgery, Oakland University William Beaumont School of Medicine, Gross Pointe Farms, MI., Charlton-Ouw KM; Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX., Ray HM; Department of Clinical Sciences, University of Houston College of Medicine, Houston, TX., Lawrence P; Division of Vascular and Endovascular Surgery, Department of Surgery, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA., Baril D; Division of Vascular Surgery, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA.
Jazyk: angličtina
Zdroj: Journal of vascular surgery. Venous and lymphatic disorders [J Vasc Surg Venous Lymphat Disord] 2022 Nov; Vol. 10 (6), pp. 1352-1358. Date of Electronic Publication: 2022 Aug 05.
DOI: 10.1016/j.jvsv.2022.06.011
Abstrakt: Objective: Extremity venous aneurysms result in the risk of pulmonary embolism (PE) and chronic venous insufficiency. At present, owing to the rarity of these aneurysms, no consensus for their treatment has been established. The purpose of the present study was to review the presentation, natural history, and contemporary management of extremity venous aneurysms.
Methods: We performed a retrospective, multi-institutional review of all patients with extremity venous aneurysms treated from 2008 to 2018. A venous aneurysm was defined as saccular or fusiform with an aneurysm/vein ratio of >1.5.
Results: A total of 66 extremity aneurysms from 11 institutions were analyzed, 40 of which were in a popliteal location, 14 iliofemoral, and 12 in an upper extremity or a jugular location. The median follow-up was 27 months (range, 0-120 months). Of the 40 popliteal venous aneurysms, 8 (20%) had presented with deep vein thrombosis (DVT) or PE, 13 (33%) had presented with pain, and 19 had been discovered incidentally. The mean size of the popliteal venous aneurysms presenting with DVT or PE was larger than that of those presenting without thromboembolism (3.8 cm vs 2.5 cm; P = .003). Saccular aneurysm morphology in the lower extremity was associated with thromboembolism (30% vs 9%; P = .046) and fusiform aneurysm morphology with a thrombus burden >25% (45% vs 3%). Patients presenting with thromboembolism were more likely to have had a thrombus burden >25% in their lower extremity venous aneurysm compared with those who had presented without thromboembolism (70% vs 9%). Approximately half of all the patients underwent immediate intervention, and half were managed with observation or antithrombotic regimen. In the non-operative cohort, three patients subsequently developed a DVT. Eight patients in the medically managed cohort went on to require surgical intervention. Of the 12 upper extremity venous aneurysms, none had presented with DVT or PE, and only 2 (17%) had presented with pain. Of the 66 patients in the entire cohort, 41 underwent surgical intervention. The most common indication was the absolute aneurysm size. Nine patients had undergone surgery because of a DVT or PE, and 11 for pain or extremity swelling. The most common surgery was aneurysmorrhaphy in 21 patients (53%), followed by excision and ligation in 14 patients (35%). Five patients (12%) had undergone interposition bypass grafting. A postoperative hematoma requiring reintervention was the most common complication, occurring in three popliteal vein repairs and one iliofemoral vein repair. None of the patients, treated either surgically or medically, had reported post-thrombotic complications during the follow-up period.
Conclusions: Large lower extremity venous aneurysms and saccular aneurysms with thrombus >25% of the lumen are more likely to present with thromboembolic complications. Surgical intervention for lower extremity venous aneurysms is indicated to reduce the risk of venous thromboembolism (VTE) and the need for continued anticoagulation. Popliteal aneurysms >2.5 cm and all iliofemoral aneurysms should be considered for repair. Upper extremity aneurysms do not have a significant risk of VTE and warrant treatment primarily for symptoms other than VTE.
(Copyright © 2022 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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