Non-anastomotic aneurysmal degeneration of great saphenous vein graft A case report and review of the literature

Abstract

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.