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Surgical Treatment of Popliteal Venous Aneurysm in a Young Patient
Tratamiento quirúrgico de un aneurisma venoso poplíteo en paciente joven
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class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Romina" "apellidos" => "Díaz-Serrano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Angiología y Cirugía Vascular, Hospital Universitario Morales Meseguer, Murcia, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Departamento de Cirugía, Facultad de Medicina, Universidad de Murcia, Murcia, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento quirúrgico de un aneurisma venoso poplíteo en paciente joven" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2043 "Ancho" => 2000 "Tamanyo" => 512940 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Popliteal venous aneurysm on magnetic resonance angiography; (B) intra-operative image of the venous aneurysm; (C) detail of open venous aneurysm; (D) result after tangential aneurysmectomy with lateral venorrhaphy.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Popliteal venous aneurysms are a rare disease of uncertain etiology that can present with serious complications, such as deep vein thrombosis and pulmonary embolism. We present the case of a 42-year-old man who worked on a truck trailer assembly line placing screws while in a squatting position, involving repeated flexion and extension of the knees (greater force and load on the right side as he was right-handed) for 8<span class="elsevierStyleHsp" style=""></span>h/day. The patient consulted with our department due to a painful tumor in the right popliteal fossa. On physical examination, a soft, non-pulsatile mass was observed; the remaining vascular examination was normal. Doppler ultrasound and venous MR angiography revealed a saccular popliteal venous aneurysm measuring 2.7×3.4<span class="elsevierStyleHsp" style=""></span>cm, with no signs of thrombosis (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A). No muscle, ligament or tendon anomalies were observed in the popliteal fossa or in the adductor canal. We indicated surgery, which was performed with the patient in prone decubitus, using a bayonet incision and under systemic heparinization, dissection of the aneurysm, tangential aneurysmectomy and lateral venorrhaphy of the popliteal vein (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>B–D). The patient was discharged 48<span class="elsevierStyleHsp" style=""></span>h later with no complications and prescribed treatment with low molecular weight heparin for 3 months and elastic compression, as well as a subsequent dose of 100<span class="elsevierStyleHsp" style=""></span>mg of ASA. The pathology study reported hypertrophy and generalized fibrosis of the vessel wall. After 18 months of follow-up, the patient presented no complications, with permeability of the vascular reconstruction and no recurrence of the venous dilatation on the ultrasound study.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Popliteal venous aneurysms are a rare disease of uncertain etiology, which can present with serious complications such as deep vein thrombosis and pulmonary embolism. A popliteal venous aneurysm is defined by a popliteal vein>20<span class="elsevierStyleHsp" style=""></span>mm in diameter. In the majority of published cases, the most frequent type is saccular. Most cases present with symptoms of pulmonary embolism or are discovered incidentally; very rarely is there a painful popliteal mass, as in the case of our patient. Since pulmonary embolisms and death have been reported even in patients without thrombi, surgical excision is also recommended in asymptomatic patients.<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">1–3</span></a> In addition, in patients with pulmonary embolism with no risk factors or a clear source of emboli, popliteal venous aneurysm should be ruled out.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The recommended and most frequently performed technique is tangential aneurysmectomy with lateral venorrhaphy because it has fewer associated complications.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">2</span></a> Currently, endovascular treatment is not recommended.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">3</span></a> The etiopathogenesis of popliteal venous aneurysms is uncertain, with the possible intervention of a combination of mechanical, trauma, inflammatory, hemodynamic or congenital disease factors.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">4</span></a> We cannot confirm that repeated trauma to the right popliteal vein due to the position and movements of our patient while at work were the cause of his popliteal venous aneurysm, but, along with genetic predisposition, this may have been a contributing factor.</p><p id="par0015" class="elsevierStylePara elsevierViewall">We have found no reports in the literature of popliteal venous aneurysms in patients performing repeated and continuous movements and positions in the workplace that may cause compressive trauma to the popliteal vein.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Cano-Trigueros E, Díaz-Serrano R. Tratamiento quirúrgico de aneurisma venoso poplíteo en paciente joven. Cir Esp. 2018;96:517–518.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2043 "Ancho" => 2000 "Tamanyo" => 512940 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Popliteal venous aneurysm on magnetic resonance angiography; (B) intra-operative image of the venous aneurysm; (C) detail of open venous aneurysm; (D) result after tangential aneurysmectomy with lateral venorrhaphy.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0025" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of symptomatic and asymptomatic popliteal venous aneurysms: a retrospective analysis of 25 patients and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "C. Sessa" 1 => "P. Nicolini" 2 => "M. Perrin" 3 => "I. Farah" 4 => "J.L. Magne" 5 => "H. Guidicelli" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1067/mva.2000.110353" "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "2000" "volumen" => "32" "paginaInicial" => "902" "paginaFinal" => "912" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11054222" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0030" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Surgical treatment of popliteal venous aneurysm" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J.K. Johnstone" 1 => "M.D. Fleming" 2 => "P. Gloviczki" 3 => "W. Stone" 4 => "M. Kalra" 5 => "G.S. Oderich" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.avsg.2015.02.009" "Revista" => array:6 [ "tituloSerie" => "Ann Vasc Surg" "fecha" => "2015" "volumen" => "29" "paginaInicial" => "1084" "paginaFinal" => "1089" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/26009475" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0035" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Popliteal vein aneurysm: a rare cause of pulmonary emboli" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "A. Sandstrom" 1 => "A. Reynolds" 2 => "P. Jha" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Ann Vasc Surg" "fecha" => "2017" "volumen" => "38" "paginaInicial" => "315e15" "paginaFinal" => "315e17" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0040" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Popliteal venous aneurysm: report of two cases and review of the world literature" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "S.C. Aldridge" 1 => "A.J. Comerota" 2 => "M.L. Katz" 3 => "J.H. Wolk" 4 => "B.I. Goldman" 5 => "J.V. White" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Vasc Surg" "fecha" => "1993" "volumen" => "18" "paginaInicial" => "708" "paginaFinal" => "715" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8411479" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009600000008/v1_201810270623/S2173507718301674/v1_201810270623/en/main.assets" "Apartado" => array:4 [ "identificador" => "15076" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009600000008/v1_201810270623/S2173507718301674/v1_201810270623/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507718301674?idApp=UINPBA00004N" ]
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