Echo-Anatomy of Long Saphenous Vein in the Knee Region: Proposal for a Classification in Five Anatomical Patterns

2002 ◽  
Vol 16 (3) ◽  
pp. 111-116 ◽  
Author(s):  
S. Ricci ◽  
A. Cavezzi
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Medial Gastrocnemius ◽  
Long Saphenous Vein ◽  
Type D ◽  
Below The Knee ◽  
Duplex Imaging ◽  
Anatomical Classification ◽  
O 15

Objective: Ultrasonography of the anatomical course of the long saphenous vein (LSV) and its tributaries to produce and verify an anatomical classification (five types). Methods: Four hundred and ninety-three limbs (293 healthy; 200 with varicose veins, VV) were investigated by ultrasonic duplex imaging by the two authors independently, identifying the LSV as the vessel in the (ultrasonic) saphenous fascial ‘eye’ compartment (SFEC), in the thigh, and within two fascial layers between tibia and medial gastrocnemius muscle, below the knee. Results: Type A: LSV runs entirely in the SFEC without relevant tributaries: overall (O) 112 (23%), limbs with vv (V) 13, normal limbs (N) 99. Type B: LSV runs in the SFEC with one or more relevant tributaries below the knee: O 133 (27%), V 70, N 63. Type C: LSV runs in the SFEC with a relevant tributary above the knee: O 89 (18%), V 28, N 61. Type D: LSV runs in the SFEC from the foot upwards, continuing at the middle third of the leg in a large side vein with the calibre and role of the LSV but in a more superficial location. LSV stem is absent (or hypoplasic) in the para-tibial position. At the thigh level the tributary re-enters the true LSV: O 72 (14.5%), V 42, N 30. type E: similar to type D but the LSV is absent only at the knee level: O 72 (14.5%), V 38, N 34. Unclassified: O 15 (3%), V 9, N 6. Conclusions: We found a good reproducibility and clinical utility of the suggested classification. Remarks: (a) the absence (or hypoplasia) of LSV at the knee level with prevalence of a tributary in almost 30% of the limbs is of importance for arterial bypass and saphenous sparing management; (b) there is a low rate of LSV complete incompetence (6%); (c) there is a correlation between absent LSV (or presence of a relevant tributary) and the incidence of VV.

Recurrent varicose veins below the knee after varicose vein surgery

Phlebologie ◽  
2007 ◽  
Vol 36 (03) ◽  
pp. 132-136
Author(s):  
M. W. de Haan ◽  
J. C. J. M. Veraart ◽  
H. A. M. Neumann ◽  
P. A. F. A. van Neer
Keyword(s):  
Varicose Vein ◽  
Varicose Veins ◽  
Varicose Vein Surgery ◽  
Proximal Point ◽  
Perforating Veins ◽  
Recurrent Varicose Veins ◽  
Below The Knee ◽  
Duplex Imaging ◽  
Additional Value

SummaryThe objectives of this observational study were to investigate whether varicography has additional value to CFDI in clarifying the nature and source of recurrent varicose veins below the knee after varicose vein surgery and to investigate the possible role of incompetent perforating veins (IPV) in these recurrent varicose veins. Patients, material, methods: 24 limbs (21 patients) were included. All patients were assessed by a preoperative clinical examination and CFDI (colour flow duplex imaging). Re-evaluation (clinical and CFDI) was done two years after surgery and varicography was performed. Primary endpoint of the study was the varicographic pattern of these visible varicose veins. Secondary endpoint was the connection between these varicose veins and incompetent perforating veins. Results: In 18 limbs (75%) the varicose veins were part of a network, in six limbs (25%) the varicose vein appeared to be a solitary vein. In three limbs (12.5%) an incompetent sapheno-femoral junction was found on CFDI and on varicography in the same patients. In 10 limbs (41%) the varicose veins showed a connection with the persistent below knee GSV on varicography. In nine of these 10 limbs CFDI also showed reflux of this below knee GSV. In four limbs (16%) the varicose veins showed a connection with the small saphenous vein (SSV). In three limbs this reflux was dtected with CFDI after surgery. An IPV was found to be the proximal point of the varicose vein in six limbs (25%) and half of these IPV were detected with CFDI as well. Conclusion: Varicography has less value than CFDI in detecting the source of reflux in patients with recurrent varicose veins after surgery, except in a few cases where IPV are suspected to play a role and CFDI is unable to detect these IPV.

Symptoms, clinical disability scores and reflux in complicated and uncomplicated primary varicose veins

2003 ◽  
Vol 18 (2) ◽  
pp. 73-77 ◽  
Author(s):  
J Saarinen ◽  
M Heikkinen ◽  
V Suominen ◽  
J Virkkunen ◽  
R Zeitlin ◽  
...  
Keyword(s):  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Clinical Classification ◽  
Disability Score ◽  
Duplex Imaging ◽  
Primary Varicose Veins ◽  
Varicose Disease

Objective: To evaluate the role of subjective symptoms, grade of disability and axial reflux in superficial veins in different clinical stages of varicose veins (VVs). Methods: A total of 172 legs with primary venous insufficiency from 126 patients were studied. The examination involved evaluation of the CEAP clinical class and clinical disability score (CDS), recording of any symptoms of varicose disease, and a hand-held Doppler (HHD) examination of the superficial veins. Colour-flow duplex imaging (CFDI) was also performed in 22% of the legs. Results: The rate of insufficiency of the great saphenous vein (GSV) was 83% in complicated legs (C4-6), and 68% in uncomplicated legs (C2-3), ( P > 0.05). There was a difference between complicated and uncomplicated legs in the insufficiency of the whole GSV [C4-6: n = 18 (39%) versus C2-3: n = 12 (12%), P < 0.005]. Sensation of pain was noted in 68% of the legs in class C1, 60% of those in class C2-3 and 81% of those in class C4-6. Sensation of oedema was recorded in 70% of the legs in class C1, 65% of those in class C2-3 and 86% of those in class C4-6, respectively. CDS classes 2-3 were significantly more frequent among complicated legs (C4-6: 54% versus C2-3 12%, P < 0.005). Conclusions: Leg symptoms are frequent throughout classes C1-6. Their clinical usefulness is therefore limited. CDS parallels well with the clinical classification. In complicated disease the whole saphenous vein is more frequently insufficient.

scholarly journals A clinical study on varicose veins of lower limb, surgical management and functional outcome at a tertiary care hospital of South India

2020 ◽  
Vol 7 (4) ◽  
pp. 1051
Author(s):  
Bandaru Nageswara rao ◽  
Ramachandra Pushpalatha
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Tertiary Care ◽  
Duplex Ultrasound ◽  
Care Hospital ◽  
Medical College ◽  
Long Saphenous Vein ◽  
Below The Knee ◽  
Ethical Committee Approval ◽  
One Year

Background: Varicose veins defined as dilated, tortuous, subcutaneous veins ≥3 mm in diameter, measured in the upright position with demonstrable reflux. Though the history of varicose veins dates prehistorically, the advances in diagnosis and new management modalities gained attention recently. The aim of the present study was to study the clinical profile, risk factors and their association, different types of surgical procedures employed and complications associated with varicose veins.Methods: A one year observational after ethical committee approval was conducted by department of general surgery at ACSR Medical College. Cases fulfilling the inclusion criteria were clinically examined and duplex ultrasound colour Doppler was performed for diagnosing the varicose veins and findings of site of incompetence was noted. All the cases were operated and followed up for six months period. The results were tabulated and analyzed in Microsoft Excel for any corrections.Results: Eighty cases with 66.25% males and 33.75% females with mean age of 40.24 years and majority (40%) were in 41 to 50 years group. 60% of cases had varices in right limb and long saphenous vein was involved in 52.5% of cases.85% had dilated veins, perforator incompetence was noted below the knee in 30% of cases. 41.25% of cases saphenofemoral flush ligation with stripping of long saphenous vein. Wound infection was the common postoperative complication.Conclusions: Operative line of management should be the first line of treatment even though conservative management relieves the symptoms but always requires a definitive management.

Recurrent varicose veins assessed by colour-coded duplex scanning: own experience

Phlebologie ◽  
2000 ◽  
Vol 29 (03) ◽  
pp. 58-61 ◽  
Author(s):  
G. Madycki ◽  
P. Dabek ◽  
A. Gabrusiewicz ◽  
W. Staszkiewicz
Keyword(s):  
Saphenous Vein ◽  
Varicose Veins ◽  
Preoperative Assessment ◽  
Duplex Scanning ◽  
Group Iii ◽  
Recurrent Varicose Veins ◽  
Long Saphenous Vein ◽  
Group I ◽  
Short Saphenous Vein ◽  
Deep Vein

SummaryAim: Authors performed a retrospective analysis of causes of recurrent varicose veins following surgery. Methods: They evaluated 89 patients (65 women and 24 men, mean age 49.7 years). All patients previously underwent same surgical procedures (long saphenous vein stripping with/without local multiple avulsions). For the purpose of the study, colour/duplex examinations were applied (Siemens Sonoline Elegra unit). Results: Depending on the type and area of recurrent varicose veins, patients were classified into 4 groups. Group I – 22 patients (persistence of varicose tributaries of LSV in thigh or thigh perforator). Group II – 27 patients (recurrence along the LSV in the calf). Group III – 26 patients (recurrence due to left incompetent short saphenous vein). Group IV – 14 patients (isolated incompetent perforators). Authors conclude, that colour-coded duplex scanning is currently a method of choice in the diagnosis of recurrent varicose veins. High incidence of recurrence due to short saphenous vein incompetence should draw particular attention to this vein in the preoperative assessment of venous system. Recurrence of varicose veins at thigh level is not caused by deep vein insufficiency, but is related to inadequate vein surgery or might be linked to the problem of neovascularisation in this area.

Haemodynamic Correction of Varicose Veins (CHIVA): An Effective Treatment?

1996 ◽  
Vol 11 (3) ◽  
pp. 98-101 ◽  
Author(s):  
P. Zamboni ◽  
C.V. Feo ◽  
M. G. Marcellino ◽  
G. Vasquez ◽  
C. Mari
Keyword(s):  
Saphenous Vein ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Venous Pressure ◽  
Vein Thrombosis ◽  
Long Saphenous Vein ◽  
Group A ◽  
Primary Varicose Veins ◽  
Short Saphenous Vein ◽  
Group B

Objective: Evaluation of the feasibility and utility of haemodynamic correction of primary varicose veins (French acronym: CHIVA). Design: Prospective, single patient group study. Setting: Department of Surgery, University of Ferrara, Italy (teaching hospital). Patients: Fifty-five patients with primary varicose veins and a normal deep venous system (ultrasonographic criteria) were studied. Interventions: Fifty-five haemodynamic corrections by the CHIVA method described by Franceschi were undertaken. Seven patients were treated for short saphenous vein varices (group A) while 48 patients were treated for long saphenous vein varices (group B). Main outcome measures: Clinical: presence of varices and reduction in symptoms. Duplex and continuous-wave Doppler detection of re-entry through the perforators and identification of recurrences or new sites of reflux. Postoperative ambulatory venous pressure and refilling time measurements. Patients were studied for 3 years following surgery. Results: In group A, 57% short saphenous vein occlusions with no re-entry through the gastrocnemius and soleal veins were recorded. In group B the long saphenous vein thrombosis rate was 10%. In this group 15% of the patients showed persistence of reflux instead of re-entry at the perforators. Early recurrences were also observed. Overall CHIVA gave excellent results in 78% of the patients. Statistically significant ambulatory venous pressure and refilling time changes were recorded ( p<0.001). Conclusions: CHIVA treatment is inadvisable for short saphenous vein varices. Long saphenous vein postoperative thrombosis is related to development of recurrences

Results after Re-Operation in the Groin for Recurrent Varices of the Long Saphenous Vein

2002 ◽  
Vol 16 (3) ◽  
pp. 98-100 ◽  
Author(s):  
N. Jessen ◽  
N. Bækgaard
Keyword(s):  
Recurrence Rate ◽  
Saphenous Vein ◽  
Varicose Veins ◽  
Standard Procedure ◽  
University Hospital ◽  
Groin Dissection ◽  
Perforating Veins ◽  
Long Saphenous Vein ◽  
Perforating Vein

Objective: To evaluate the outcome of re-operation in the groin for recurrent varicose veins. Design: Retropective follow-up study Setting: Department of Vascular Surgery, Gentofte University Hospital, Copenhagen, Denmark. Methods and materials: Thirty-two patients with 43 operated legs. Operations were performed between January 1996 and the end of April 1997 and solely as a groin dissection; no stripping was done. Follow-up consisted of a clinical examination and duplex scanning with an ATL HDI 5000 scanner. Results: Sixteen cured legs, 17 with reflux beginning at mid-thigh, mainly a Hunter's perforating vein, and 10 with remaining reflux at the sapheno-femoral junction. Conclusion: Recurrence rate in the groin is acceptable. Stripping of the long saphenous vein is mandatory to bring down the recurrence rate from mid-thigh perforating veins. This is now standard procedure in our department.

Morphological Study of the Valvular Distribution in the Long Saphenous Vein

1994 ◽  
Vol 9 (2) ◽  
pp. 59-62 ◽  
Author(s):  
F. Ortega ◽  
L. Sarmiento ◽  
B. Mompeo ◽  
A. Centol ◽  
A. Nicolaides ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Saphenous Vein ◽  
Lower Limb ◽  
Morphological Study ◽  
Venous Disease ◽  
Gran Canaria ◽  
Anatomical Dissection ◽  
Long Saphenous Vein ◽  
Below The Knee ◽  
Academic Vascular Surgery

Objective: To measure the distribution of valves in the long saphenous vein. Design: Morphological study of the intervalvular distance of the long saphenous vein. Setting: Department of Morfología, Facultad de Ciencias de la Salud (Universidad de Las Palmas de Gran Canaria, Spain) and Academic Vascular Surgery Unit, St Mary's Hospital, London, UK. Material: Twenty lower extremities from adult cadavers with no evidence of lower limb venous disease. Methods: Anatomical dissection of the long saphenous vein, with accurate measurement of valve distribution. Results: There were on average 8.7 valves in the long saphenous vein, with 6.3 above the knee and 2.4 below the knee. Conclusion: Contrary to classical anatomical texts on this subject there are more valves in the long saphenous vein in the thigh than in the calf.

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