Institutional Experience With Venous Aneurysms – Insights On The Natural History And Outcomes Of Surgical Treatment


  • Daniel Azevedo Mendes Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Oporto, Portugal
  • Rui Machado Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Oporto, Portugal
  • Carlos Veiga Department of Angiology and Vascular Surgery, Hospital de Braga, Braga, Portugal
  • Rui Almeida Department of Angiology and Vascular Surgery, Centro Hospitalar Universitário do Porto, Oporto, Portugal



aneurysm [MeSH], popliteal vein [MeSH], venous thrombosis [MeSH], pulmonary embolism [MeSH]


Introduction: Venous aneurysms are rare, so their natural history is not fully understood. Indications for treatment are often determined by the location and size of the aneurysm; however, considering the scarcity of data, there are no specific recommendations. Surgery is the mainstay for venous aneurysm treatment, but some authors reported successful endovascular treatment. We intend to describe our experience with this type of rare disorder.

Methods: A post hoc observational study of a prospectively maintained registry including consecutive patients admitted with the diagnosis of a venous aneurysm at different locations between January 2007 and September 2021. Demographic data, anatomic location, and medical history, including trauma or venous surgery, were analyzed. All vascular reconstructions and outcomes have been evaluated.

Results: We identified 30 venous aneurysms in 24 patients. Fifteen patients were male (63%). The most common anatomical location was the popliteal vein (n=19; 63%). Four patients had multiple venous aneurysms, and three patients had synchronous arterial aneurysms. Twelve (63%) of the popliteal vein aneurysms identified were surgically treated, most commonly by tangential aneurysmectomy and lateral venorrhaphy. The average diameter at the time of surgery was 22,8±3,6 mm. After discharge, all patients were anticoagulated for 6 to 12 months, in most cases with rivaroxaban. With a median follow-up time of 32 months (12 – 168 months), primary patency was 92%. Aneurysm recurrence was only observed in one case (1/12; 8%) with non-occlusive thrombosis of the aneurysm 14 years after surgery. One patient had a 21 mm gemelar vein aneurysm, having been proposed for surgery, with thrombosis before the intervention. Two patients had common femoral vein aneurysms treated with partial aneurysmectomy and lateral venorrhaphy without thromboembolic events during follow-up. Two patients presented with portal system aneurysms, one associated with portal hypertension. No treatment was performed, and an increase in aneurysm size was observed during follow-up. Another patient presented with acute deep vein thrombosis on chronically thrombosed bilateral iliac vein aneurysms. Three patients had aneurysms of the superficial venous system associated with previous trauma, which were treated with simple ligation and excision.

Conclusion: Venous aneurysms are rare and most commonly located in the popliteal vein, which seems to be associated with chronic venous disease. Treating these aneurysms, even without symptoms, can be important to avoid thromboembolic complications. However, close long-term follow-up with duplex ultrasound should be considered to detect late recurrence. Aneurysms from other locations are even rarer, and treatment decisions should be individualized, weighing the risks and benefits of the intervention.


Download data is not yet available.


Johnstone JK, Fleming MD, Gloviczki P, Stone W, Kalra M, Oderich GS, et al. Surgical treatment of popliteal venous aneurysms. Ann Vasc Surg. 2015;29:1084-9.

Teter KA, Maldonado TM, Adelman MA. A systematic review of venous aneurysms by anatomic location. J Vasc Surg Venous Lymphat Disord. 2018;6:408-13.

Cruddas L, Onida S, Davies AH. Venous aneurysms: When should we intervene? Phlebology. 2022;37:3-4.

Maldonado-Fernandez N, Lopez-Espada C, Martinez-Gamez FJ, Galan-Zafra M, Sanchez-Maestre ML, Herrero-Martinez E, et al. Popliteal venous aneurysms: results of surgical treatment. Ann Vasc Surg. 2013;27:501-9.

Beaulieu RJ, Boniakowski AM, Coleman DM, Vemuri C, Obi AT, Wakefield TW. Closed plication is a safe and effective method for treating popliteal vein aneurysm. J Vasc Surg Venous Lymphat Disord. 2021;9:187-92.

Perrotta I, Perrotta E, Guido C, Tripepi S, Donato G, Aquila S, et al. Ultrastructure of popliteal vein aneurysm. Ultrastruct Pathol. 2011;35:197-203.

Irwin C, Synn A, Kraiss L, Zhang Q, Griffen MM, Hunter GC. Metalloproteinase expression in venous aneurysms. J Vasc Surg. 2008;48:1278-85.

Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P, American Venous F, et al. Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus docu- ment. J Vasc Surg. 2009;49:498-501.

Aldridge SC, Comerota AJ, Katz ML, Wolk JH, Goldman BI, White JV. Popliteal venous aneurysm: report of two cases and review of the world literature. J Vasc Surg. 1993;18:708-15.

Gabriel S, Eisenberg N, Kim D, Jaberi A, Roche-Nagle G. Primary venous aneurysms: A 20-year retrospective analysis. Vascular. 2020;28:577-82.

Sessa C, Nicolini P, Perrin M, Farah I, Magne JL, Guidicelli H. Management of symptomatic and asymptomatic popliteal venous aneurysms: a retrospective analysis of 25 patients and review of the literature. J Vasc Surg. 2000;32:902-12.

Bergqvist D, Bjorck M, Ljungman C. Popliteal venous aneurysm - a systematic review. World J Surg. 2006;30:273-9.

Noppeney T, Kopp R, Pfister K, Schierling W, Noppeney J, Cucuruz B. Treatment of popliteal vein aneurysms. J Vasc Surg Venous Lymphat Disord. 2019;7:535-42.

Donaldson CW, Oklu R, Watkins MT, Donaldson MC, Abtahian F, Schainfeld RM, et al. Popliteal venous aneurysms: characteristics, management strategies, and clinical outcomes - a modern single-center series. Ann Vasc Surg. 2014;28:1816-22.

Gillman LM, McGregor R, Guzman RP. Popliteal venous aneurysm and iliofemoral thrombosis. Can J Surg. 2008;51:E17-8.

Labropoulos N, Volteas SK, Giannoukas AD, Touloupakis E, Delis K, Nicolaides AN. Asymptomatic Popliteal Vein Aneurysms. Vascu- lar Surgery. 1996;30:453-7.

Gasparis AP, Awadallah M, Meisner RJ, Lo C, Labropoulos N. Recurrent popliteal vein aneurysm. J Vasc Surg. 2010;51:453-7.

Krishan A, Droste JC, Molloy K, Bharath A, Riggott C, Guarasci F. Popliteal Vein Aneurysm Masquerading as a Baker's Cyst Leading to Pulmonary Embolism. Am J Med. 2021;134:1495-8.

De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, et al. Editor's Choice - European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Manage- ment of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63:184-267.

Gabrielli R, Rosati MS, Siani A, Irace L. Management of symptomatic venous aneurysm. ScientificWorldJournal. 2012;2012:386478.

Patel R, Hanish S, Baril D, Woo K, Lawrence P. Contemporary management of lower extremity venous aneurysms. J Vasc Surg

Venous Lymphat Disord. 2019;7:860-4.

Gillespie DL, Villavicencio JL, Gallagher C, Chang A, Hamelink JK, Fiala LA, et al. Presentation and management of venous aneurysms. J Vasc Surg. 1997;26:845-52.

Laurenzi A, Ettorre GM, Lionetti R, Meniconi RL, Colasanti M, Vennarecci G. Portal vein aneurysm: What to know. Dig Liver Dis. 2015;47:918-23.

Tsauo J, Li X. Portal vein aneurysm associated with Budd-Chiari syndrome treated with transjugular intrahepatic portosystemic shunt: a case report. World J Gastroenterol. 2015;21:2858-61.

Rafiq SA, Sitrin MD. Portal vein aneurysm: case report and review of the literature. Gastroenterol Hepatol (N Y). 2007;3:296-8.

Dunlap R, Golden S, Lyons GR. Portal Vein Aneurysm Treated With Trans-Jugular Intrahepatic Porto-Systemic Shunt. Vasc Endovascular Surg. 2021;55:885-8.

Fanshawe AE, Hamilton HEC, Constantinou J. External iliac vein aneurysm: a case report and review of the literature. J Surg Case

Rep. 2018;2018:rjy115.

Keshelava G, Beselia K, Nachkepia M, Chedia S, Janashia G, Nuralidze K. Surgical treatment of the great saphenous vein aneurysm resulting in pulmonary embolization in two patients. Ann Vasc Surg. 2011;25:700 e13-5.

Ranero-Juarez GA, Sanchez-Gomez RH, Loza-Jalil SE, Cano-Valdez AM. Venous aneurysms of the extremities. Report of 4 cases and review of literature. Angiology. 2005;56:475-81.

Seo SH, Kim MB, Kwon KS, Kim CW, Oh CK. Primary venous aneurysms of the superficial venous system. Angiology. 2008;59:593-8.




How to Cite

Azevedo Mendes D, Machado R, Veiga C, Almeida R. Institutional Experience With Venous Aneurysms – Insights On The Natural History And Outcomes Of Surgical Treatment. Rev Port Cir Cardiotorac Vasc [Internet]. 2023 Jul. 7 [cited 2024 May 22];30(2):23-3. Available from:



Original Articles


Most read articles by the same author(s)