Novel management of a symptomatic femoral venous aneurysm with trans-popliteal endovenous stenting and coil embolization: A case report with 12 month follow-up

An 83 year old male experienced multiple episodes of pulmonary embolism over a 5 year period despite compliance with therapeutic anticoagulation. After a recent presentation with recurrent pulmonary embolism, a venous duplex was obtained that demonstrated a left distal superficial-popliteal venous aneurysm with rouleaux formation and non-occlusive thrombus. A retrievable inferior vena caval filter was initially placed. Subsequent ascending phlebography showed a true aneurysm of the left distal superfical femoral vein. The patient and his physicians were desirous of nonoperative management. Through percutaneous, trans-popliteal venous access, a 14mm X 60 mm bare metal, self-expanding stent was placed across the venous aneurysm. Coils were placed in the aneurysm sac. The IVC filter was removed three months following treatment. Follow-up phlebography and venous duplex ultrasonography have revealed exclusion of the aneurysm with minimal residual flow outside the stent interstices. Anticoagulation therapy has been continued. The patient has remained active and has experienced no limb swelling, no venous thrombotic complications and no episodes of recurrent pulmonary embolism.
This case represents the first report to our knowledge detailing percutaneous management of a femoral venous aneurysm. While surgical exposure and reconstruction, usually with tangential resection, represent standard therapy for femoral venous aneurysms, thrombosis of surgical repair is not uncommon. Exclusion of the venous aneurysm and prevention of recurrent pulmonary embolism was the goal of our therapy, and in early follow-up, has been achieved.