title: A failure of preoperative duplex imaging to diagnose a lower extremity venous aneurysm in a patient with severe chronic venous insufficiency.
abstract: OBJECTIVE
  We present a case of recurrent bilateral lower extremity venous stasis ulcers in association with a superficial venous aneurysm at the right saphenofemoral junction that was misdiagnosed on preoperative duplex scanning.
  
  
  METHODS
  A 53-year-old female presented to our clinic with 6-year history of bilateral lower extremity venous stasis ulcers. Her past medical history was significant for refractory venous stasis ulcers of the bilateral lower extremities present for 6 years and morbid obesity.
  
  
  RESULTS
  Preoperative venous duplex demonstrated severe venous insufficiency of the superficial and deep systems, but a venous aneurysm was not appreciated. During the high ligation of the right saphenofemoral junction, a 3 × 4 × 5 cm aneurysm was encountered. Repair consisted of aneurysm resection, high ligation of the greater saphenous vein, dissociation of the great saphenous and anterior saphenous veins, and stab phlebectomy of large varicose veins of the thigh and lower leg. The patient recovered uneventfully and experienced complete healing of the venous stasis ulcer in several weeks.
  
  
  CONCLUSIONS
  Superficial venous aneurysms of the lower extremity are rare and can be often missed on preoperative duplex ultrasound imaging. Large diameter measurements of the proximal greater saphenous vein and obesity increase the risk of misdiagnosing venous aneurysms with duplex imaging; therefore, clinical suspicion must remain high. These aneurysms can be associated with significant symptoms for which repair is indicated.
authors.affiliation: Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Roy Wesley
authors.initials: RW
authors.lastname: Jones
authors.affiliation: Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Godfrey Ross
authors.initials: GR
authors.lastname: Parkerson
authors.affiliation: Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Ottinger
authors.affiliation: Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Rodriguez
authors.affiliation: Division of Vascular Surgery, USF Health Morsani College of Medicine, Tampa, FL, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Park
keywords: Superficial venous aneurysm; chronic venous insufficiency; duplex ultrasound; venous aneurysm; venous stasis ulcers