International Vein CongressInternational Vein CongressMay 12-14, 2011May 12-14, 2011

DISCLOSUREDISCLOSURE

David L. Walrath, M.D., F.A.C.S., A.B.Ph., David L. Walrath, M.D., F.A.C.S., A.B.Ph., R.P.V.IR.P.V.I

I have no financial relationships to disclose.I have no financial relationships to disclose.

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

David L. Walrath, M.D., F.A.C.S., A.B.Ph., David L. Walrath, M.D., F.A.C.S., A.B.Ph., R.P.V.IR.P.V.I

Vein Center of Lake NormanVein Center of Lake Norman

Huntersville, NCHuntersville, NC

Venous Aneurysms at the SFJVenous Aneurysms at the SFJ

RGSVRGSV

Pre-operativePre-operative

2-2-20112-2-2011

66 year old 66 year old femalefemale

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

RGSVRGSV

2 weeks post 2 weeks post operativeoperative

2-16-20112-16-2011

66 year old female66 year old female

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

RGSVRGSV

2 months post 2 months post operativeoperative

4-11-20114-11-2011

66 year old female66 year old female

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

Definition: A vein aneurysm is Definition: A vein aneurysm is defined as an isolated zone of defined as an isolated zone of venous dilatation that venous dilatation that communicates with a normal sized communicates with a normal sized venous segment not associated venous segment not associated with trauma or varicose with trauma or varicose

veins. (1.5 x nl)veins. (1.5 x nl)

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

Histology: Histology:

The walls are thinner, all three The walls are thinner, all three layers are present, but there is layers are present, but there is loss of small muscle and elastic loss of small muscle and elastic fibers with an increase in fibrous fibers with an increase in fibrous connective tissue.connective tissue.

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

Superficial venous aneurysms Superficial venous aneurysms can cause DVT and rarely can cause DVT and rarely pulmonary emboli especially if pulmonary emboli especially if near the SFJ.near the SFJ.

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

However, we also know that a However, we also know that a groin incision is responsible for groin incision is responsible for neovascularization and that neovascularization and that neovascularization significantly neovascularization significantly increase the rate of recurrence.increase the rate of recurrence.

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

In a recent phlebology article Dr. In a recent phlebology article Dr. Ferreira stated that the Ferreira stated that the International Endovenous laser International Endovenous laser working group (I.E.W.G.) does not working group (I.E.W.G.) does not recommend simultaneous recommend simultaneous crossectomy (ligation) in patients crossectomy (ligation) in patients treated with EVLT treated with EVLT exceptexcept in cases in cases of associated pathologies such as of associated pathologies such as venous aneurysms.venous aneurysms.

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

I welcome your advice!I welcome your advice!

Venous Aneurysms at the Venous Aneurysms at the SFJSFJ

Thank you!Thank you!