TÍTULO

ANEURYSM OF THE FIBULAR VEIN: A CASE REPORT

INTRODUÇÃO

Aneurysms of the deep veins of the lower limbs are rare and often asymptomatic. Although natural history is unclear, these aneurysms have been associated with deep venous thrombosis and fatal pulmonary embolism events. To our knowledge, this case represents the
fifth patient with isolated aneurysm of a calf vein described in the literature and the second one affecting the fibular vein.

RELATO DE CASO

A 20-year-old Caucasian male presented with progressive and debilitating pain and heaviness in left calf, accompanied by painful swelling of the left ankle. Symptoms have been present for the last year, increasing during the day with reversion after bed rest or elevation of the leg. Clinical examination showed no abnormality of the superficial venous system, and a Doppler ultrasound depicted a large venous dilatation corresponding to the fibular vein topography. The patient was then submitted to ascending phlebography and magnetic resonance of the left calf and diagnosis of aneurysm of the fibular vein was established. The patient was operated through a medial approach of the leg and a bilobated aneurysm was resected with ligature of the proximal and distal vein and tributaries. Recovery was uneventful and, during a 3-year follow-up period, the patient remained asymptomatic.

DISCUSSÃO

Aneurysms are a rare condition affecting the venous system but have been reported to occur in many major veins throughout the body. Venous aneurysms occur more often in the lower limbs, mostly in the superficial vein system with an estimated prevalence of 0.1%. Head and neck and abdominal and thoracic veins can also be affected. In the lower limb, femoral and popliteal veins account
for the majority of venous aneurysms of the deep system. Histopathologic findings reveal reduction of smooth muscle cells and changes in fibrous connective tissue. It is not clear whether these findings represent the primary etiology of the venous dilatation or whether they are a consequence of the aneurysm itself. At least for the popliteal and femoral vein, mechanical factors could be implied as a possible additional explanation. These veins are located in areas of flexion and surrounded by a significant content of loose fat tissue, whereas other veins of the deep venous system of the leg are surrounded by fascia and skeletal muscle, which could represent a more resistant counterforce against dilatation of these veins. In addition, both popliteal and femoral veins receive major superficial tributaries, the lesser and great saphenous veins, respectively, which could also account for both localized weakness of the vessel wall as well as represent an area of hemodynamic overload. These factors might explain the rarity of reports concerning calf vein aneurysms in the literature as compared with the femoral and popliteal vein reports. Unlike proximal veins, where reconstruction
is advisable, calf vein aneurysms can be safely managed by simple excision and ligature.

PALAVRAS CHAVE

ANEURYSM; VASCULAR SURGERY; DEEP VEIN SYSTEM

Área

CIRURGIA VASCULAR