Chapter 166 - Venous aneurysms Flashcards
Gillespie definition of venous aneurysm
Solitary area of venous dilation communicating with main venous structure by single channel without AVF or pseudoaneurysm
Primary venous aneurysm
Congenital due to weakness in venous wall
e. g.
1) Klippel-Trenaunay
2) Neurofibromatosis NF-1
3) Parkes Weber Syndrome
Secondary venous aneurysm
Acquired
1) trauma
2) inflammation
3) mechanical stress
4) degenerative
5) hypertension
Histology of venous aneurysm
1) thick fibrosed intima
2) attenuated media
3) lack SMC
4) MMP over expression
Symptom of venous aneurysm
1) thrombosis
2) embolization
3) rupture
4) local mass effect: edema, tender, pain
Treatment of superficial venous aneurysm in LE and UE and jugular
1) exam with dependent position, valsalva
2) duplex to confirm
3) ligation and excision if deep system intact
4) indication if symptomatic or cosmetic
Popliteal venous aneurysm associated with PE
45-80% found after PE
Popliteal venous aneurysm symptoms
1) thrombosis
2) PE
3) pain and swelling
4) chronic venous insufficiency
Indication for treatment of popliteal venous aneurysm
1) thrombus
2) > 2cm
3) symptomatic
anticoagulation alone not good enough
Surgical options for deep venous aneurysms
1) Tangential aneurysmectomy with lateral venorrhaphy
2) aneurysm resection with primary anast, interpositional GSV or synthetic (prone to thrombosis)
+/- lysis
+/- IVC filter
anticoag 3-6 months post
Normal IVC size
1.5-3.7 cm
IVC aneurysm size
> 5cm
Iliocaval thrombosis rate in IVC aneurysm
19%
Gradman Steinberg classification of IVC aneurysm
Type 1: suprahepatic aneurysm without obstruction –> observation
Type 2: above or below hepatic vein with obstruction
Type 3: infrarenal without obstruction
Type 4: misc
Type 2-4 need treatment due to risk of thrombosis and embolism
Portal vein aneurysm size
> 15 mm in non-cirrhotic
> 19 in cirrhotic liver
