Anatomy of the lymph node venous networks of the groin and their investigation by ultrasonography

2015 ◽  
Vol 31 (5) ◽  
pp. 334-343 ◽  
Author(s):  
Jean Francois Uhl ◽  
Miguel Lo Vuolo ◽  
Nicos Labropoulos
Keyword(s):  
Lymph Node ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Normal Subjects ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Anatomical Dissection ◽  
Anatomical Finding

Objective To describe the anatomy of the lymph node venous networks of the groin and their assessment by ultrasonography. Material and methods Anatomical dissection of 400 limbs in 200 fresh cadavers following latex injection as well as analysis of 100 CT venograms. Routine ultrasound examinations were done in patients with chronic venous disease. Results Lymph node venous networks were found in either normal subjects or chronic venous disease patients with no history of operation. These networks have three main characteristics: they cross the nodes, are connected to the femoral vein by direct perforators, and join the great saphenous vein and/or anterior accessory great saphenous vein. After groin surgery, lymph node venous networks are commonly seen as a dilated and refluxing network with a dystrophic aspect. We found dilated lymph node venous networks in about 15% of the dissected cadavers. Conclusion It is likely that lymph node venous networks represent remodeling and dystrophic changes of a normal pre-existing network rather than neovessels related to angiogenic factors that occur as a result of an inflammatory response to surgery. The so-called neovascularization after surgery could, in a number of cases, actually be the onset of dystrophic lymph node venous networks. Lymph node venous networks are an ever-present anatomical finding in the groin area. Their dilatation as well as the presence of reflux should be ruled out by US examination of the venous system as they represent a contraindication to a groin approach, particularly in recurrent varicose veins after surgery patients. A refluxing lymph node venous network should be treated by echo-guided foam injection.

Anatomical and clinical factors favoring the performance of saphenous ablation and microphlebectomy or sclerotherapy as a single-stage procedure

2014 ◽  
Vol 30 (9) ◽  
pp. 627-631 ◽  
Author(s):  
AA Kokkosis ◽  
H Schanzer
Keyword(s):  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Class I ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Class Iii ◽  
Endovenous Ablation ◽  
Secondary Procedures ◽  
Extensive Class

Objective To identify the anatomical and clinical parameters that predict lack of regression of superficial varicosities after ablation of the great saphenous vein. Methods Symptomatic patients treated with endovenous ablation from August 2006 to July 2013, by a single surgeon, were included. Recorded parameters included age, sex, size, and extent of varicosities (class I–IV) (patient standing), and diameter and length (patient supine) of treated great saphenous vein. Varicose vein classification was defined as: class I ≤6 mm and localized to thigh or leg, class II ≤6 mm and present in the thigh and leg (extensive), class III >6 mm and localized to the thigh or leg, and class IV >6 mm and extensive. “Excellent” results were defined as complete resolution of varicosities, “good” results as incomplete resolution, and “poor” results as no improvement. Results A total of 267 patients and 302 consecutive limbs were included in the study. There were 175 females (65.5%), and the mean age was 54 years old (22–92). The CEAP classification was as follows: C2 (81.5%), C3 (6.3%), C4 (7.9%), C5 (2.0%), and C6 (2.3%). Great saphenous vein diameters was significantly larger in patients with C3–C6 (proximal 0.84 ± 0.25 versus 0.65 ± 0.21, p = < 0.0001, distal 0.58 ± 0.18 versus 0.44 ± 0.13, p < 0.0001) or class III–IV varicose veins (proximal 0.85 ± 0.25 versus 0.75 ± 0.27, p = 0.012, distal 0.62 ± 0.62 versus 0.50 ± 0.17, p < 0.0001). Class III–IV limbs had a “good/poor” result 69.8% of the time, as compared to 51.9% of the limbs class I–II varicose veins (p = 0.002). Conclusions Advanced chronic venous disease (C3–C6) patients have larger diameter great saphenous veins, reflecting the progressive nature of the disease. Patients with more severe varicosities regardless of CEAP class were more likely to require a secondary procedure. The severity of the varicosities may not correlate with the degree of venous disease, but it is an indication of which patients should undergo secondary procedures, possibly with a one-stage approach.

Manual lymphatic drainage in chronic venous disease: A duplex ultrasound study

2013 ◽  
Vol 29 (10) ◽  
pp. 667-676 ◽  
Author(s):  
Rute Sofia dos Santos Crisóstomo ◽  
Miguel Sandu Candeias ◽  
Ana Margarida Martins Ribeiro ◽  
Catarina da Luz Belo Martins ◽  
Paulo AS Armada-da-Silva
Keyword(s):  
Blood Flow ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Femoral Vein ◽  
Lymphatic Drainage ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Flow Volume ◽  
Manual Lymphatic Drainage ◽  
Venous Flow

Objectives To compare the effect of call-up and reabsorption maneuvers of manual lymphatic drainage on blood flow in femoral vein and great saphenous vein in patients with chronic venous disease and healthy controls. Methods Forty-one subjects participated in this study (mean age: 42.68(15.23)), 23 with chronic venous disease (chronic venous disease group) with clinical classification C1–5 of clinical-etiological-anatomical-pathological (CEAP) and 18 healthy subjects (control group). Call-up and reabsorption maneuvers were randomly applied in the medial aspect of the thigh. The cross-sectional areas, as well as the peak and the mean blood flow velocity at femoral vein and great saphenous vein, were assessed by Duplex ultrasound at the baseline and during maneuvers. The venous flow volume changes were calculated. Results The venous flow volume in femoral vein and great saphenous vein increased during both manual lymphatic drainage maneuvers and in both groups ( P < 0.05). The two maneuvers had a similar effect on femoral vein and great saphenous vein hemodynamics, and in both the chronic venous disease and control groups. As a result of the call-up maneuver, the flow volume augmentations, as a result of call-up maneuver, decreased with the severity of chronic venous disease in those patients measured by the clinical classification of CEAP ( r = −0.64; P = 0.03). Conclusions Manual lymphatic drainage increases the venous blood flow in the lower extremity with a magnitude that is independent from the specific maneuver employed or the presence of chronic venous disease. Therefore, manual lymphatic drainage may be an alternative strategy for the treatment and prevention of venous stasis complications in chronic venous disease.

Endovenous laser ablation is an effective treatment for great saphenous vein incompetence in teenagers

2015 ◽  
Vol 31 (3) ◽  
pp. 198-202
Author(s):  
Piotr Terlecki ◽  
Stanislaw Przywara ◽  
Marek Iłżecki ◽  
Karol Terlecki ◽  
Piotr Kawecki ◽  
...  
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Current Knowledge ◽  
Varicose Veins ◽  
Signs And Symptoms ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Invasive Treatment ◽  
Endovenous Laser Ablation

Objectives The current knowledge of chronic venous disease in teenagers and its treatment is very limited. The aim of the study is to present our experience and the available literature data on the treatment of varicose veins in teenagers with endovenous laser ablation of the great saphenous vein. Methods Five patients, aged 15–17 years, were qualified for surgery, based on typical signs and symptoms of chronic venous disease. Minimally invasive treatment with endovenous laser ablation of the great saphenous vein was applied. Results The technical success of surgery was achieved in all patients. Over a 2-year follow-up we did not observe any case of recanalisation of the great saphenous vein, recurrence of varicose veins, or serious complications, such as deep vein thrombosis or pulmonary embolism. One patient presented with resolving of post-operative bruising, and two cases of local numbness were transient. Conclusions Endovenous laser ablation of the great saphenous vein in the treatment of chronic venous disease in teenagers is effective and safe. The method provides excellent cosmetic effects, very short recovery time and high levels of patient satisfaction.

Short-term results of isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) in primary varicose veins disease

2016 ◽  
Vol 32 (9) ◽  
pp. 601-607 ◽  
Author(s):  
Igor A Zolotukhin ◽  
Evgeny I Seliverstov ◽  
Elena A Zakharova ◽  
Alexander I Kirienko
Keyword(s):  
Recurrence Rate ◽  
Local Anesthesia ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Primary Varicose Veins ◽  
One Year

Objective To establish an effect of isolated phlebectomy in patients with incompetent great saphenous vein (Ambulatory Selective Varices Ablation under Local anesthesia (ASVAL) procedure) on the reflux and diameter of the trunk and to assess recurrence rate of varicose veins at one year. Material and methods We conducted a prospective study on patients with primary varicose veins and with C2 or C2,3 or C2,3,4 or C2,4 classes of chronic venous disease and great saphenous vein incompetence. The study included 67 patients (51 women and 16 men; 75 limbs in total). Age varied from 17 to 71 years; mean age was 46.8 years (SD 13.9). We recorded the presence or absence of reflux in the great saphenous vein with duplex ultrasound before and after surgery. The recurrence of varicose veins was evaluated at 12 months. All the patients underwent isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) under local anesthesia. Results At one year after removing of tributaries of the incompetent trunk, 66% of them were competent. Reflux persisted in 17% of great saphenous veins with reflux above mid-thigh and in 61% of trunks with reflux extended below the mid-thigh (p = 0.0004). The diameter of all the veins decreased significantly no matter reflux disappeared or not. Varicose veins reoccurred in 13.5% cases. In 6.5% of limbs with a reflux above the mid-thigh, the recurrence was registered at one year, while in the limbs with the reflux below the mid-thigh at a baseline, the recurrence rate was 25% (p = 0.036). Conclusion Isolated phlebectomy with a preservation of incompetent great saphenous vein leads to disappearance of reflux in a majority of cases and to significant decrease of vein diameter in all the cases. ASVAL procedure could be considered as a less aggressive and less expensive approach in selected cases. Clear indications for isolated phlebectomy need to be established.

scholarly journals Cytokines Produced by Lymphocytes in the Incompetent Great Saphenous Vein

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Ewa Grudzińska ◽  
Andrzej Lekstan ◽  
Ewelina Szliszka ◽  
Zenon P. Czuba
Keyword(s):  
Saphenous Vein ◽  
Oscillatory Flow ◽  
Great Saphenous Vein ◽  
Interleukin 1 ◽  
Lymphocyte Culture ◽  
Chronic Venous Disease ◽  
Control Group ◽  
Venous Disease ◽  
Culture Supernatants ◽  
Necrosis Factor

The pathogenesis of chronic venous disease (CVD) remains unclear, but lately inflammation is suggested to have an important role in its development. This study is aimed at assessing cytokines released by lymphocytes in patients with great saphenous vein (GSV) incompetence. In 34 patients exhibiting oscillatory flow (reflux) in GSV, blood was derived from the cubital vein and from the incompetent sapheno-femoral junction. In 12 healthy controls, blood was derived from the cubital vein. Lymphocyte culture with and without stimulation by phytohemagglutinin (PHA) was performed. Interleukins (IL) 1β, 2, 4, 10, 12 (p70), and 17A; interleukin 1 receptor α (IL-1ra); tumor necrosis factor-α (TNF-α); interferon-gamma (IFN-γ); and RANTES were assessed in culture supernatants by the Bio-Plex assay. In both stimulated and unstimulated samples, in the examined group, IL-1β and IFN-γ had higher concentrations and RANTES had lower concentrations when compared to those in the control group. In the examined group, IL-4 and IL-17A had higher concentrations without stimulation and TNF-α had higher concentrations with stimulation. The GSV samples had higher IL-2, IL-4, IL-12 (p70), and IFN-γ concentrations without stimulation and lower IL-2 and TNF-α concentrations with stimulation when compared to those of the upper limb in the examined group. These observations indicate that the oscillatory flow present in incompetent veins causes changes in the cytokine production by lymphocytes, promoting a proinflammatory profile. However, the relations between immunological cells, cytokines, and the endothelium require more insight.

Neovascularization in Restoration of Continuity of the Rat Femoral Vein following Surgical Interruption

1987 ◽  
Vol 2 (1) ◽  
pp. 1-5 ◽  
Author(s):  
G.M. Glass
Keyword(s):  
Surgical Treatment ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Histological Studies ◽  
Venous Circulation ◽  
Main Vein

Recurrence of varicose veins after surgical treatment by ligation and transection has been usually attributed to development of varicosity in veins collateral to the transected vessels. Early studies reported regeneration of the great saphenous vein at the site of previous transection. The present study in the rat was undertaken to determine whether restoration of normal venous circulation in a limb after surgical interruption of the main vein develops through enlargement of collateral veins or by restoration of continuity of the interrupted vein as a result of neovascularization at the site of ligation. Following ligation in continuity or ligation and surgical transection of the rat common iliac or femoral vein, phlebographic, surgical exploratory and histological studies showed restoration of its continuity through newly formed vessels. These findings suggest that in recurrence of varicose veins the roles of neovascularization and of collateral veins deserve further investigation.

scholarly journals CHIVA to treat saphenous vein insufficiency in chronic venous disease: characteristics and results

2019 ◽  
Vol 18 ◽  
Author(s):  
Felipe Puricelli Faccini ◽  
Stefano Ermini ◽  
Claude Franceschi
Keyword(s):  
Local Anesthesia ◽  
Saphenous Vein ◽  
Varicose Veins ◽  
Low Cost ◽  
Nerve Damage ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Recurrence Rates ◽  
Disease Characteristics ◽  
Aesthetic Results

Abstract There is considerable debate in the literature with relation to the best method to treat patients with chronic venous disease (CVD). CHIVA is an office-based treatment for varicose veins performed under local anesthesia. The aim of the technique is to lower transmural pressure in the superficial venous system and avoid destruction of veins. Recurrence of varicosities, nerve damage, bruising and suboptimal aesthetic results are common to all treatments for the disease. This paper evaluates and discusses the characteristics and results of the CHIVA technique. We conclude that CHIVA is a viable alternative to common procedures that is associated with less bruising, nerve damage, and recurrence than stripping saphenectomy. The main advantages are preservation of the saphenous vein, local anesthesia, low recurrence rates, low cost, low pain, and no nerve damage. The major disadvantages are the learning curve and the need to train the team in venous hemodynamics.

Endovenous laser ablation in patients with wide diameter of the proximal segment of the great saphenous vein: Comparison of methods

2014 ◽  
Vol 30 (10) ◽  
pp. 700-705 ◽  
Author(s):  
V Starodubtsev ◽  
M Lukyanenko ◽  
A Karpenko ◽  
P Ignatenko
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Great Saphenous Vein ◽  
Chronic Venous Disease ◽  
Proximal Segment ◽  
Venous Disease ◽  
Endovenous Laser Ablation ◽  
Safety And Efficacy ◽  
Wide Diameter ◽  
Saphenous Veins

Objective To estimate the safety and efficacy of using the laser 1560 nm wavelength for treatment of chronic venous disease in patients with wide diameters of the proximal segment of the great saphenous vein. Methods In the study 88 patients with lower limb varicose veins were included. Maximum diameter of the great saphenous vein proximal segment varied from 15 to 34 mm (22 ± 2.3) in all patients. In the 1st group in 34 cases crossektomy and endovenous laser ablation (EVLA) were performed. In the 2nd group in 30 cases EVLA regardless diameter of the great saphenous vein proximal segment was performed. In the 3rd group in 34 cases EVLA taking into account the diameter of the great saphenous vein proximal segment was performed. The laser 1560 nm wavelength was used. Linear endovenous energy density in the 1st and 2nd groups was 90 J/cm for the proximal segment and trunk of great saphenous vein. Linear endovenous energy density in the 3rd group was personalized on the size of the veins: 100 J/cm for diameter of great saphenous vein proximal segment 15–20 mm, 150 J/cm for diameter 20–30 mm, 90 J/cm for middle and distal segments of great saphenous vein. Results In the 1st group obliteration of the trunk of the great saphenous veins and accessory great saphenous veins in all cases without additional interventions was reached. In the 2nd group at four cases (13.3%) the second procedure EVLA was carried out, after which the obliteration of the trunk was achieved. In the 3rd group the obliteration of the trunk of great saphenous vein was achieved without additional interventions. Conclusion Our experience of using the laser 1560 nm wavelength for the treatment of the chronic venous disease in patients with wide diameter of the proximal segment of great saphenous vein shows the safety and efficacy of this technique. EVLA has to be personalized on the size of the segments of vein in patients with wide proximal segment of great saphenous vein.

scholarly journals Damage to Cranial Extension of the Small Saphenous Vein and Vein of Giacomini in Lower Limb Varicose Vein Disease

2016 ◽  
Vol 23 (3) ◽  
Author(s):  
Rostyslav Vasyliovych Sabadosh
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Subsequent Development ◽  
Chronic Venous Disease ◽  
Venous Disease ◽  
Results Of Treatment ◽  
Surgical Tactics ◽  
Primary Chronic Venous Disease ◽  
Antegrade Flow

Abstract. The vein of Giacomini is often identified with the cranial extension of the small saphenous vein despite the fact that according to the international interdisciplinary anatomical nomenclature they are distinguished from one another.The objective of the research was to improve the results of treatment of patients with lower limb primary chronic venous disease disease studying the variation in anatomy and pathology of the vein of Giacomini and the cranial extension of the small saphenous vein with subsequent development of differential surgical tactics.Materials and methods. 502 patients with primary chronic venous disease on 605 legs were examined and treated. Each patient underwent preoperative ultrasonographic triplex scanning of the lower limb venous system.Results. Varicose dilatation of the vein of Giacomini was observed in 3.8% of patients (95% CI 2.4-5.6 %), and the pathology of the cranial extension of the small saphenous vein was detected in 1.7% of patients (95% CI 0.8-3.0%). When the arch of the small saphenous vein was present the following variations in the pathology of the vein of Giacomini were observed: 1) the spread of reflux from the great saphenous vein to the vein of Giacomini; 2) reflux from the terminal valve of the small saphenous vein intensified the antegrade flow of blood within the vein of Giacomini resulting in reflux in the great saphenous vein distal to the point where the vein of Giacomini drained into the great saphenous vein. The causes of failure of the valves in the trunk of the cranial extension of the small saphenous vein included: 1) reflux from the ostium of the cranial extension of the small saphenous vein; 2) perforating vein reflux; 3) reflux from the terminal valve of the small saphenous vein.Conclusions.  The pathology of the vein of Giacomini and the cranial extension of the small saphenous vein is not homogeneous; therefore, surgical tactics in every patient has to be hemodynamically justified and differentiated depending on the pathways of pathological reflux spreading. 

scholarly journals Saphenous Ladder Formed by Almost Completely Duplicated Great Saphenous Vein

2020 ◽  
Vol 18 (1) ◽  
pp. 99-101
Author(s):  
Vasanthakumar Packiriswamy ◽  
Satheesha B Nayak
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Great Saphenous Vein ◽  
Varicose Veins ◽  
Femoral Vein ◽  
Saphenous Veins ◽  
Left Lower Limb ◽  
Male Cadaver ◽  
Complete Duplication ◽  
Femoral Triangle

Knowledge of normal as well as variant great saphenous vein is useful as it is the vein that can get varicosed; the vein that is used in bypass surgeries and the vein that is used for cannulation purpose. We observed almost complete duplication of the great saphenous vein in the left lower limb of an adult male cadaver. Both the great saphenous veins arose from the medial end of the dorsal venous arch and coursed parallel to each other throughout the limb. They united in the femoral triangle to form a short (1 inch long) common great saphenous vein. Common great saphenous vein terminated into the femoral vein. There were four communicating veins connecting the two great saphenous veins in the leg, giving the appearance of a venous ladder. Knowledge of this variation could be extremely useful in treatment of varicose veins of lower limb, in catheterizations and in various surgical procedures of the lower limb.

Sign in / Sign up

Export Citation Format

Share Document