Venous aneurysms : surgical indications and review of the literature

Background . During the last 20 years we diagnosed five cases of venous aneurysm of the jugular (n=4) and basilic (n=1) veins. The purpose of this report was to determine the natural history and indications for surgery of venous aneurysms. Methods . Our five cases were included in an English-language literature review performed through August 1993. Results . In our series two aneurysms (one external jugular vein, one basilic vein) were excised for cosmetic reasons. Three internal jugular vein aneurysms were followed up for up to 4 years without complications with serial color duplex ultrasonography. Of 32 patients with abdominal venous aneurysms (18 portal, seven inferior vena cava, four superior mesenteric, two splenic, one internal iliac), 13 (41%) had major complications including five deaths. Of 31 patients with deep venous aneurysms of the extremity (29 popliteal, two common femoral), 22 (71%) had deep vein thrombosis or pulmonary embolism and in 17 recurrent deep vein thrombosis or pulmonry embolism developed when patients were treated with anticoagulation alone. Conclusions . Prophylactic surgery is cautiously recommended for low-risk patients with venous aneurysms of the abdomen and strongly recommended for most patients with lower extremity deep venous aneurysms. Other venous aneurysms should be excised only if they are symptomatic, enlarging, or disfiguring.