Complicated Superficial Venous Disease Ron Bush, MD, FACS Midwest Vein & Laser Center Dayton, OH
Complicated Superficial Venous Disease
Ron Bush, MD, FACSMidwest Vein & Laser Center
Dayton, OH
Disclosures
Dornier, VeinGogh, VeinExperts.org, BushVenousLectures.com
My Experience• In my 17 years of a purely venous practice, the
most complicated aspect of superficial disease are the aneurysms of the GSV, AAGSV, & SSV
• Most are benign in presentation• Potentially lethal• Inappropriate treatment may make a benign
condition be malignant
Definition of Aneurysm Conflicting• Pascarella, 2005, define an aneurysm as 1.5x
contiguous vein diameter• (Gabrielli, 2012) – 2.0x contiguous diameter or
3x normal vein size• Only histologic evaluation can differentiate
aneurysm from dilatation• But dilatation may mimic same presentation
and clinical outcome as an aneurysm
Histoslide of Aneurysm
High Ligation Aneurysm Photo
GSV Aneurysm
GSV Aneurysm with Small Neck
Type II aneurysm
• Treated with thermal ablation, stripping, or phelbectomy
SSV Aneurysm• At SPJ junction, excision is the only option• Mimics popliteal aneurysm• Distal aneurysm can be excised, ablated, or
foam and depends on the size
SSV Aneurysm
Treatment of GSV Aneurysm• Conventional treatment – high ligation• But treatment can be individualized
depending on anatomic location• Post-terminal vs. post-subterminal valve• Contradicts Pacarella and Bergan’s report
AAGSV Aneurysm
AAGSV Aneurysm
• This should be classified as a Type V aneurysm, since it is a distinct aneurysm
• True incidence not known• May be associated with GSV aneurysm• Treatment depends on diameter of
connection to GSV connection- ligation• Small connection – thermal ablation of distal
trunk or foam
Etiology
• Long standing venous hypertension• Turbulent flow at valve• Increased BMI
Final Considerations
• Consider unloading GSV circuit before definitive treatment (Personal communication – Allesandro Frullini, MD)
• 4-6 months later, there may be substantial reduction in aneurysm size
• Treatment can be individualized, but any persistent aneurysmal dilatation post terminal valve including junctional branches should be resected
Final Considerations
• All SSV aneurysms involving SPJ are excised• Inappropriate treatment may lead to clot
propagation and possible pulmonary embolus
References
• Pascarella L, Al-Tuwaijri, Bergan J, & Mekenas L. Lower extremity superficial venous aneurysms. Ann Vasc Surg 2005;19:69-73.