1. Popliteal Vein Aneurysm
Reviewed by Harry H. Holdorf

2. Case Study
51 Year old woman with a medical history of hypertension and hepatitis C.
Presented to the ER with pain and swelling of her right lower extremity.
A venous duplex ultrasound of the bilateral right lower extremities was performed.
After ultrasound, extremities were found to be negative for thrombosis but revealed a 2.7 cm by 2.1 cm fusiform aneurysmal dilation of her right popliteal vein.

4. Overview
Aneurysm: is an abnormal widening or ballooning of a portion of an artery due to weakness in the wall of the blood vessel.
Popliteal Vein aneurysms are the most common of all venous aneurysms, but extremely rare.
Approximately only 150 cases were reported to date.
Usually discovered in the ensuing workup after a patient presents with pulmonary embolism ( is a blockage of an artery in the lungs by fat, air, blood clot, or tumor cells), incidentally, or when lower extremity symptoms are present.
Because popliteal aneurysm present a large risk for pulmonary embolism (70-80%), which is a potentially fatal event, they are usually treated aggressively via surgery.
It is not completely clear what causes this type of aneurysm, but the running theory is that they may result from congenital and/or acquired vessel wall weakness.

5. Discussion
Patient was referred to vascular surgery service to repeat ultrasound and confirm both presence and size of popliteal vein aneurysm.
Risks were thoroughly explained, and surgery was indicated as the mainstay treatment, which is indicated in cases that the diameter is greater than cm.
Patient refused surgery and opt solely for observational management.
However, because patient is hypertensive, a long term anti-coagulation treatment was discussed, but also refused.
All popliteal vein aneurysm are at high risk for pulmonary embolism, and are treated with surgery unless contraindicated.

6. Most common surgery performed is tangential aneurysmectomy and lateral venorrhaphy.
Or, if first is not possible aneurysmal resection with popliteal vein reconstruction.
Surgery may not be first line of treatment when patient refuses it, contraindicated, aneurysm is too small, or asymptomatic without thrombus.
However, many advocate surgery in all cases.
In patients with popliteal vein aneurysm who have already had at least one pulmonary embolism, surgery is obligatory because recurrence rates are as high as 80%.
Long term anticoagulation treatment is indicated, however literature has yet to define its role.