Surgical treatment of symptomatic popliteal vein aneurysm with autologous saphenous vein panel graft

Abstract

We report a vein surgery procedure for popliteal venous aneurysms (PVAs). A 73-year-old woman with a long, irregularly shaped, PVA and thrombus underwent graft replacement using a manually made triple vein panel graft. Simple bypass grafting with a saphenous vein was unsuitable because of long defects and a size mismatch. We harvested the great saphenous vein from the right thigh, divided it into three segments, anastomosed it side-by-side on the long side, and created a venous panel graft. Good graft patency was confirmed at 4 years postoperatively, and the clinical course was stable without pulmonary embolism recurrence.

Keywords: Aneurysm; Graft; Popliteal vein; Vascular surgical procedure; Venous thrombosis.

Fig 1

A, Preoperative echogram showing two consecutive saccular aneurysms with thrombosis (arrow). B, Preoperative computed tomography showing a complex popliteal venous aneurysm with a large thrombus (arrow).

Fig 2

A, The right great saphenous vein (length, 27 cm; ϕ = 3 mm) was harvested endoscopically with the patient in the supine position. It was divided into three segments, each 9-cm long, and opened longitudinally on a side table. B, The long sides of these three segments were sutured side by side with 7-0 Prolene continuous sutures (Ethicon, Johnson & Johnson, Raritan, NJ). C, The diameter of the manually created graft was adjusted to a Hegar-type dilator that had a diameter of 5.5 mm (1 mm larger than the native popliteal vein).

Fig 3

A, Intraoperative photograph showing complex-shaped and saccular, long-segment popliteal venous aneurysms (PVAs) with thrombosis. Dots on the paper were marked every centimeter. The proximal and distal sides of the PVAs were taped with rubber threads. B, The manually created vein graft was sutured with 6-0 Prolene using end-to-end continuous anastomosis (arrow). C, Many thromboses had adhered to the diseased aneurysmal intima (arrow).

Fig 4

A, Postoperative computed tomography scan 1 year postoperatively. The graft wall was smooth, and no thrombosis or aneurysm was present. The enhanced small points around the vein were clip devices. Arrows indicate an approximate substituted range. B, Postoperative echography 4 years postoperatively showing a smooth graft wall and good flow. Arrows indicate an approximate substituted range.