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.

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.

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. 

Which Vein Stripper, Metal or Plastic Disposable?

1991 ◽  
Vol 6 (3) ◽  
pp. 149-151 ◽  
Author(s):  
C.R.R. Corbett ◽  
W.J. Harries
Keyword(s):  
Randomized Trial ◽  
Saphenous Vein ◽  
Prospective Randomized Trial ◽  
Long Saphenous Vein ◽  
Below The Knee ◽  
Single Use ◽  
The Cost ◽  
Mean Time

When stripping the long saphenous vein it is recommended that the stripper be passed from the groin downwards. If the stripper is passed from below the knee upwards, there is a possibility of it entering the deep veins. Cases are recorded of the consequent, inadvertent, stripping of the deep veins. Plastic ‘single use’ disposable strippers may be easier to handle than metal strippers and perhaps easier to pass against the valves. A prospective randomized trial was carried out in 80 limbs to compare the performance of plastic and metal strippers. In 37 of 40 limbs the metal stripper could be passed from the groin to below the knee and in 36 of 40 limbs the plastic stripper could also be passed in this way. Hence a stripper could be passed downwards in 73 of 80 (91%) limbs. However, the plastic strippers passed more quickly to below the knee, in a mean time of 24 s compared with 36 s for the metal strippers (Wilcoxon's test, P = 0.03). Against this is the cost of £8.00 for a pair of plastic disposable strippers.

A Study of Tourniquets in the Investigation of Venous Insufficiency

1991 ◽  
Vol 6 (2) ◽  
pp. 133-139 ◽  
Author(s):  
G.M. McMullin ◽  
P.D. Coleridge Smith ◽  
J.H. Scurr
Keyword(s):  
Doppler Ultrasound ◽  
Saphenous Vein ◽  
Venous Insufficiency ◽  
Venous Pressure ◽  
Venous Disease ◽  
Retrograde Flow ◽  
Pneumatic Tourniquet ◽  
Long Saphenous Vein ◽  
Duplex Doppler ◽  
Source Of Error

Tourniquets are used extensively in the assessment of the venous system. They are employed not only for clinical tourniquet tests but are also used during examinations by Doppler ultrasound, plethysmography and venography, and during ambulatory venous pressure measurements. Surgical management is based on conclusions reached by the use of tourniquets. This study was undertaken to evaluate the pressure required to prevent reflux in the incompetent long saphenous vein. A total of 44 limbs with sapheno–femoral incompetence were studied. Duplex doppler ultrasound was used to detect retrograde flow within the long saphenous vein during inflation of a 2.5 cm wide pneumatic tourniquet applied around the thigh. The pressure required to prevent reflux, the diameter of the imaged vein and the circumference of the thigh were measured. The pressure required to prevent reflux varied from 40 mmHg to 300 mmHg. There was a correlation between this pressure and the circumference of the thigh ( r = 0.62 P < 0.001). There was no correlation with the diameter of the vein. In conclusion, tourniquets introduce a source of error into evaluation of venous disease.

SHORTTERM FOLLOW UP OF EVLA: COMPLICATIONS AND MANAGEMENTS, A SINGLE CENTER EXPERIENCE OF BANGLADESH

2020 ◽  
pp. 10
Author(s):  
Keyword(s):  
Laser Ablation ◽  
Saphenous Vein ◽  
Varicose Vein ◽  
Varicose Veins ◽  
Large Population ◽  
Venous Disease ◽  
Ablation Therapy ◽  
Single Center Experience ◽  
Below The Knee ◽  
Pregnancy And Delivery

Dodd and Cockett defined varicose veins, saying “a varicose vein is one which has permanently lost its valvular efficiency.” [1] Varicose veins constitute a progressive disease, remission of the disease does not occur, except after pregnancy and delivery. [2] The first documented reference of varicose veins was found as illustrations on Ebers Papyrus dated 1550 B.C. in Athens. [3]Greek philosopher Hippocrates (460-377 B.C.) described the use of compressive bandages and was advisor of small punctures in varicose veins. First patient who underwent operation for his varicose vein appears to be Canus Marius, the Roman tyrant. Giovanni Rima (1777-1843) introduced mid thigh ligation of the saphenous vein. Ligation of the sapheno-femoral junction as it is practiced today was first described by John Homans in his paper in 1916. [2] The Mayo Brothers, postulating that there would be additional benefit in removing the saphenous vein, pursued excision of the GSV through an incision extending from the groin to below the knee. The final technologic leap was introduction of the intraluminal stripper by Babcock. [2] In the era of minimally invasive surgery, the first documented case of Endovenous Laser Ablasion was published in 1999 using 810 nm Diode Laser. Since then several wavelengths were introduced; 810, 940, 980, 1064, 1320, 1470 and newly introduced 1940 nm. [4, 5] It is generally agreed that varicose veins affect from 40 to 60% of women and 15 to 30% men. [6] During the 1930s to 1960s, several large studies reported the prevalence of varicose veins to roughly average 2% in the general population. [7] However, more recently, large population studies such as Edinburgh Vein Study demonstrated an age-adjusted prevalence of truncal varices of 40% in men and 32% in women. [8] Vein ablation is the most modern treatment option for superficial venous disease. Several endovenous modalities are getting popular for the treatment of varicose vein. Endovenous laser ablation therapy is the first endovenous procedure that had made the revolution in the treatment of varicose vein. [9] In Bangladesh, Laser ablation was first started at another center with 980 nm bare fiber and a good number of cases were done. We introduced ELVeSᴿ Radialᴿ fiber for the first time in the country using biolitecᴿ LEONARDOᴿ Mini 1470 nm during last week of March, 2018.

Investigation of Venous Disease

2001 ◽  
Vol 16 (1) ◽  
pp. 6-11 ◽  
Author(s):  
P. D. Coleridge Smith
Keyword(s):  
Lower Limb ◽  
Continuous Wave ◽  
Varicose Veins ◽  
Duplex Ultrasonography ◽  
Venous Disease ◽  
Venous Reflux ◽  
Long Saphenous Vein ◽  
Limited Application ◽  
Venous Function ◽  
Anatomical Information

Aim: To review the investigations which are performed in patients presenting with varicose veins prior to treatment. Method: A review of current literature in the field of the investigation of venous disease of the lower limb has been conducted using MedLine. Synthesis: Continuous wave (CW) Doppler is effective in detecting venous reflux in the sapheno-femoral junction and the long saphenous vein. In the popliteal fossa, for perforating veins and for the deep veins this technique has reduced accuracy. Duplex ultrasonography is widely used in the management of venous disease of the lower limb. This investigation provides reliable anatomical information but limited functional data about the veins. Phlebography and varicography are effective investigations but are being replaced by duplex ultrasonography. Plethysmographic tests assess venous function but are poor at anatomical identification of the problem. They may be used in the monitoring of venous function during treatment and in identifying the contribution of superficial venous reflux in patients with combined deep and superficial venous disease. Conclusion: Clinical examination is no longer sufficient to assess patients with venous disease of the lower limb prior to surgery. CW Doppler is the minimum investigation but duplex ultrasonography is the most effective non-invasive investigation. Plethysmographic tests have limited application in the management of varicose veins.

Does a Double Long Saphenous Vein Exist?

1999 ◽  
Vol 14 (2) ◽  
pp. 59-64 ◽  
Author(s):  
S. Ricci ◽  
A. Caggiati
Keyword(s):  
Saphenous Vein ◽  
Lower Limb ◽  
Healthy Subjects ◽  
Varicose Veins ◽  
Duplex Ultrasound ◽  
Clear Definition ◽  
Arterial Grafts ◽  
Long Saphenous Vein ◽  
Saphenous Veins ◽  
Definition Of

Background: The incidence of reduplication of the long saphenous vein (LSV) reported in the literature is highly variable, perhaps due to the lack of a clear definition. Objective: To use ultrasonography to re-evaluate the incidence of LSV reduplication in healthy subjects and Patients with varicose veins on the basis of a new definition of this anatomical aspect. Methods: The presence of two parallel superficial venous channels in the lower limb was sought in a series of 610 duplex ultrasound examinations. The LSV was identified, by the ‘eye’ sign, running deeply in the hypodermis, closely ensheathed by two hyperechogenic laminae (the saphenous compartment). Tributary veins were identified by their more superficial course, lying outside the compartment. True LSV reduplication was considered to be present when two venous channels were Present within the saphenous compartment. Results: True reduplication of the LSV is extremely rare (1%) and only affects a segment of vein. Large tributaries running parallel to the LSV do not comprise true reduplication, but may act as a ‘functional double vein’. Better understanding of the anatomy of the LSV may improve operative treatment for varicose veins and improve the use of saphenous veins as arterial grafts.

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.

EPIDEMIOLOGY OF PRIMARY VARICOSE VEINS OF LOWER LIMB IN A TERTIARY CARE HOSPITAL.

2021 ◽  
pp. 30-32
Author(s):  
Praveen Kumar Nookala ◽  
Sandeep Mahapatra ◽  
Anusha Arumalla ◽  
Muneer Ahmad Para ◽  
Venu Gopal Mustyala ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Lower Limb ◽  
Varicose Veins ◽  
Tertiary Care ◽  
Clinical Manifestations ◽  
Lower Limbs ◽  
Venous Disease ◽  
Care Hospital ◽  
Study Results ◽  
Primary Varicose Veins

Introduction: Epidemiological studies plays an important role in providing information on the spectrum and frequency of venous disease distribution in a population. In India, study encompassing the clinical evaluation and surgical management of varicose veins on the conventional lines seems a necessity to improve the quality care with the available resources. We have undertaken an epidemiological study on inuence of age, sex, body mass index, posture on clinical manifestations and complications of varicose veins of lower limbs in patients attending the Department of Vascular Surgery . Materials and Methods: A prospective observational study was conducted in Department of vascular surgery on patients with primary varicose veins of lower limb. Patients with secondary varicose veins, recurrent varicose veins, patients less than 18 years, deep vein thrombosis& peripheral arterial disease were excluded from the study. Results: In the present study 88.89% of ulcer patients had combined saphenofemoral(SFJ) and perforator incompetence, while 11.11% of ulcer patients had combined saphenofemoral, saphenopopliteal (SPJ)and perforator incompetence.14% patients present with combined SFJ, SPJ and perforator incompetence. The patients with higher CEAP classication had combined SFJ and SPJ valvular incompetence. Most commonly, the disease affected the males in the age group of 40-50 years. Conclusion: The present study shows that prolonged standing , obesity ,increasing age are the common risk factors for development of varicose veins.

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