Venous aneurysms are rare lesions that have been described within the venous system and may be discovered at any age. The lower extremities are most frequently involved, with the popliteal vein being the most common location. Clinical presentations are often initially classified as subcutaneous masses or alternatively, as an incidental finding during imaging studies for pain or chronic venous disease of the lower limb. They may be asymptomatic and/or initially present as a pulmonary embolism (PE), thrombosis, or vessel rupture with bleeding. Although benign, venous aneurysms have the potential for complications depending on location, size, and type. Here, the author presents two cases of saccular popliteal vein aneurysm that did not receive surgical treatment. Case 1: A 66-year-old male presented with a venous aneurysm without any previously reported symptoms that suggested new onset of claudication. He had an episode of PE in the past. Upon outpatient follow-up for his arterial exam, duplex ultrasound was performed, and a popliteal vein outpouching was visualized. Results: The ultrasound demonstrated a patent arterial bypass graft, with an incidental finding of saccular popliteal vein aneurysm without evidence of thrombus. The patient received no further surgical treatment (considering his comorbidities) and began daily warfarin with close clinical monitoring. Case 2: A 49-year-old male presented with bilateral varicose veins (worse on the left side) with recurrent posterior calf pain. He was referred for a bilateral venous insufficiency ultrasound. The patient had no prior history of deep vein thrombosis or PE. Results: Deep and superficial venous insufficiency was identified bilaterally. In addition, a saccular vein aneurysm without thrombus measuring 3.3 × 2.7 × 2.1 cm was identified in the popliteal vein. The patient received surgical treatment for venous insufficiency and is doing well.
