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Aneurysms of the Saphenous Vein Multi-Center Study ~ Dr. Mueller needs clarification & Dr. Bush responds
Last Updated: 4/2/2012Responses
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The definition of a venous aneurysm is too vague based on the
commonly proposed 1-1.5 ratio. Some normal veins with valvular dilation could
be classified as aneurysmal according to this criteria. While only a true
histological examination can determine if a true aneurysm is present, rather
than dilatation alone, this is somewhat impractical. Hence, I would like to use as
the criteria the methodology stated in the article by Gabrielli, 2012, which is
listed below.
The Scientific World Journal Management of Symptomatic Venous Aneurysm1Department of Vascular Surgery, Policlinico Umberto I, Sapienza University of Rome, 00161 Rome, Italy Received 17 October 2011; Accepted 13 December 2011 Academic Editors: E. Ishimura and P. Quax Copyright © 2012 Roberto Gabrielli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Linked References
Submitted by Ron Bush, MD, FACS - 4/2/2012
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| Thanks Ron I thought aneurysm was defined as 1.5x normal diameter, not 3x, by convention and per your original list on this topic Without an absolute cutoff size it’s more confusing than defining a AAA where we have not only the 1.5x rule but an absolute. Utiff of 3.0 cm for clarity... Submitted by Rich mueller - 4/1/2012
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| Thanks Terry, What we are really trying to prove is the exact incidence of saphenous vein aneurysms. According to Bergan’s report in 2006, Annals of Vas. Surgery, the incidence was 12% in his practice. This to me seems quite high. There has been no multi-center study on the frequency of aneurysms in the general population. While there have been case reports of pulmonary emboli from these saphenous vein aneurysms, the real problem is that by conventional treatments of the saphenous vein i.e. laser or RF, we may make a harmless condition, for the most part, now dangerous. Also, there has been no mention of AAGSV aneurysms, which do occur and are frequently prone to thrombosis. Also, in Bergan’s report, he was totally wrong in the exact anatomical location of the aneurysm at the junction. So I think it is important to address many issues including creating a new category for aneurysm dilatation of the AAGSV. In brief, this is a very significant paper. Sorry you can’t help, but please keep track of any future aneurysms. Ron Submitted by Ron Bush, MD, FACS - 4/1/2012
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| Rich, I realize that there is no documented exact cutoff of what constitutes an aneurysm. I think we should assume that an aneurysm is at least 3x the normal size of the saphenous vein. While the adjacent contiguous vein is < 2/3 the size of the dilated vein, which we are labeling an aneurysm. Thus an aneurysm of the saphenous vein should be at least 18-20 mm in size. However Rich, if you have a saphenous vein that is 4mm in size with the dilatation of the valve at HC that is 10=-12 mm in size, this would constitute aneurysm. Thus you have to consider the size of the dilatation in relation to the surrounding vein. A marked discrepancy in size would constitute an aneurysm compared to the overall vein diameter. I hope this helps. Submitted by Ron Bush, MD, FACS - 4/1/2012
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| Peggy and Ron While I would greatly enjoy participating in this review, I don’t believe it is possible to retrieve data to provide for the study. I usually don’t measure much less document which patients have VA’s. I could start now going forward but that will not help you now. I never really considered these of significance as I don’t recall having a complication, failure to close, rupture, etc in a VA so I guess I never really paid too much attention to them by documenting or measuring. Just found them interesting. What are you trying to show or prove with this study? Will it significantly impact the way we treat venous disease? If you wish to gather data going forward, I can certainly gather data from Leanna’s and my DUS over the next 6 months or so. Please let me know if there is another way we can participate or if/when you will review another topic of interest. Thank you and I wish you both a very Blessed Easter! Terry Terry L. Gueldner, MD, FACS, RPhS Registered Phlebology Sonographer Member, American Venous Forum Member, American College of Phlebology Wisconsin Vein Center a division of Premier Surgical of WI, SC 940 Maritime Drive Manitowoc, WI 54220 920-686-7900 Submitted by Terry Gueldner, MD, FACS, RPhS - 4/1/2012
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| ron, get ready to coin ’type V’: micro aneurysms every day we see segments > 1.5x the adjacent diameter but absolute size is often 3-5 mm i see this particularly for the ssv unless you set an absolute minimum size Submitted by rich mueller - 4/1/2012
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4/1/12
Dr. Bush would like study participants to read this article:
Nomenclature of the veins of the lower limb:
Draft of tool emailed to each participant for review.
Submitted by Peggy Bush, APN - 4/1/2012
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| John, Thats an excellent idea! Not restricted to specific dates and time, but the overall number of aneurysms that you have discovered is important. Submitted by Ron Bush, MD, FACS - 3/11/2012
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| Peggy I have seen several but will need to pull charts, some may have been prior to the dates given. Would be good to look at some of these issues with a prospective study. Possibly we can start the prospective study while reviewing the past data. With the prospective look we will have better controlled data collection and a large group volume give much better information. I’ll start looking at last years charts. Thanks JJF
Submitted by John Flanagan, MD - 3/11/2012
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Submitted by Peggy Bush, APN - 3/4/2012
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Submitted by Peggy Bush, APN - 2/22/2012
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Submitted by Peggy Bush, APN - 2/16/2012
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I have had several, but i will have to review to pull out the charts/emr to see if I measured above and below. Several patients come to mind. I am interested
Submitted by Phil Seaver, MD - 2/16/2012
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2) How many of these patients had superficial venous aneurysms?
In the region of the SFJ junction
Distal third of the saphenous vein
Contains both type I & II
SSV aneurysm
Lower extremity superficial venous aneurysms.
Source
Department of Surgery, University of California-San Diego State University, San Diego, CA, USA.
Abstract
Venous aneurysms are not rare. But most attention has been paid to deep venous aneurysms. Because of their propensity to thrombose and cause pulmonary embolization. Increased availability of duplex Doppler ultrasound has allowed total evaluation of all venous segments in patients undergoing surgery for chronic venous insufficiency. In this study, patients were recorded consecutively and the venous reflux examination was carried out with the patient standing. The superficial venous system was studied with special interrogation of the great and small saphenous veins and their tributaries. Reflux >0.5 sec was recorded as positive. Data were analyzed using the Spearman's correlation index and the student's t-test. A strong correlation was considered for values of rho > 0.6. A total of 65 superficial venous aneurysms of the saphenous vein systems were found in 43 patients (33 women and 10 men) with an average age of 53 years (range, 34-70). The mean body mass index (BMI) overall was 25 +/- 4.6. The BMI in men was 29.5 +/- 2.5. The BMI in women was 23.6 +/- 4 (p < 0.05). Aneurysms of the saphenous systems were classified into four types. Type I aneurysms (52%) were located in the proximal third of the saphenous vein, not at the saphenofemoral junction but instead just distal to the subterminal valve. Type II aneurysms were located in the shaft of the saphenous vein in the distal third of the thigh (35%). The third classification (type III) of superficial saphenous vein aneurysms was an occurrence of types I and II in the same lower extremity (3 patients/43 patients). Superficial venous aneurysms of the short saphenous system were found and were classified as type IV (6%.) Strong correlations were found with female gender and a very strong correlation of larger aneurysms was found with an elevated BMI in men. There was a so a strong correlation between type III aneurysms of the proximal and distal thigh greater saphenous vein and greater saphenous vein reflux. Aneurysms of the saphenous veins are common and this may have an impact on choice of surgical treatment.
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