Non-anastomotic aneurysmal degeneration of great saphenous vein graft


COD: 01_2019_13_2973 Categorie: ,

Paolo Tamellini, Andrea Recchia, Luca Garriboli, Tommaso Miccoli, Gianguido Pruner, Antonio Maria Jannello

Ann Ital Chir, 2019 90, 1: 83-87
Epub Ahead of Print – Jan. 16

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INTRODUCTION: True aneurysmal degeneration of autogenous vein grafts is unusual, despite their widespread use as arterial
substitutes. We report a case of acute lower leg ischemia due to thrombosis of a non-anastomotic venous aneurysm.
CASE REPORT: A 71-year old man presented at Emergency Unit at our Institution with left lower limb acute ischemia.
The patient had 9 years before undergone left below the knee femoro-popliteal bypass with in situ autologous great saphenous
vein (GSV) graft. Doppler ultrasound exam revealed patency of the entire conduit, and subtotal acute thrombosis
of a saccular aneurysm of the vein 2 cm before the distal anastomosis of the graft. Aneurysmectomy and distal thrombo-
embolectomy with Fogarty catheter of below the knee popliteal artery and tibio-peroneal trunk was performed. Vein
graft continuity was restored by a termino-terminal anastomosis.
DISCUSSION: Arterialized autologous veins are at risk of degenerative changes because of histological differences with arteries,
but the cause of true aneurysmal degeneration of these grafts is still unknown. The mean time from graft implantation
to clinical manifestation of the aneurysm is 7 years and the management of venous graft aneurysms should be
subjected to the same criteria as other aneurysms. The first choice in detecting vein graft aneurysms is Duplex ultrasonography
and the type of surgical intervention depends on the cause, type and extension of aneurysmal dilatation.
CONCLUSIONS: Aneurysmal degeneration of deep lower extremity vein conduits implanted for vascular reconstruction has
been rarely reported, but when detected they can lead to graft thrombosis, distal embolization, acute rupture, or skin
ulceration. Therefore, Doppler ultrasound guided surveillance of GSV grafts should be mandatory and long time from
vein graft creation to onset of aneurysms makes long-term graft surveillance even more imperative.