Thrombus Extension into the Common Femoral Vein after Endovenous Ablation of the Greater Saphenous Vein for the Treatment of Venous Insufficiency

Objectives: To clarify reflux patterns in the sapheno-femoral junction in legs with varicose veins that display incompetence in the proximal long saphenous vein on duplex scan examination. Patients and method: One hundred consecutive extremities were selected for ultrasound studies. Venous reflux was examined in the common femoral vein and long saphenous vein at five selected levels in the vicinity of the sapheno-femoral junction. Results: Duplex ultrasound examination confirmed that in 44 extremities reflux was detectable both in the long saphenous vein and common femoral vein indicating ‘true’ sapheno-femoral incompetence. In 56 legs reflux was limited to the long saphenous vein, whilst the first saphenous valve remained competent. The ultrasound examination suggested that in these cases the reflux originated from the numerous tributaries of the proximal long saphenous vein. Conclusion: Our findings emphasize the transfascial escape (reflux from the deep veins) is not a necessary precondition of long saphenous vein incompetence and related varicose veins.

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Minor tributary veins of the common femoral vein near the saphenofemoral junction – A postmortem study

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520939774 ◽

2020 ◽

Vol 35 (10) ◽

pp. 792-798

Author(s):

Dominic Mühlberger ◽

Achim Mumme ◽

Markus Stücker ◽

Erich Brenner ◽

Thomas Hummel

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Femoral Vein ◽

Ex Situ ◽

Common Source ◽

Vast Number ◽

Common Femoral Vein ◽

The Common ◽

Saphenofemoral Junction

Objectives Recurrent varicose veins after surgery are a frequent burden and the saphenofemoral junction is the most common source of reflux. Pre-existing branches of the common femoral vein near the saphenofemoral junction, which may increase due to haemodynamic or other reasons, could play a role in the development of recurrent varices. There exist only a few anatomical data about the prevalence of these minor venous tributaries of the common femoral vein near the saphenofemoral junction. Therefore, this study aimed to elucidate their frequency and distribution. Method A total of 59 veins from 35 anatomical donors were dissected. The common femoral vein with the adherent parts of the profunda femoris vein and the great saphenous vein was exposed and analysed ex situ. The number of minor tributaries to the common femoral vein was counted and their distances to the saphenofemoral junction as well their diameters were measured. Results We could identify up to 10 minor tributaries of the common femoral vein below the level of the great saphenous vein as far as 6 cm distally and up to four veins above the level as far as 5 cm proximally. The mean diameters of these vessels ranged from 0.5 to 11.7 mm. Most of these vessels were located near the saphenofemoral junction and 3 cm distally. Directly opposite to the opening of the great saphenous vein we could find at least one minor tributary of the common femoral vein in 57%. Conclusions There exist a vast number of minor tributaries of the common femoral vein and they are mainly located near the saphenofemoral junction. Nevertheless, their role in the development of recurrent varices is still unclear and further studies are necessary.

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Measuring diameters of great saphenous vein and common femoral vein using duplex ultrasound

Phlebologie ◽

10.12687/phleb2225-5-2014 ◽

2014 ◽

Vol 43 (05) ◽

pp. 263-267

Author(s):

E. Mendoza

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Duplex Ultrasound ◽

Standing Position ◽

Common Femoral Vein ◽

Venous Diameter ◽

The Common ◽

Proximal Thigh ◽

Transverse View

SummaryFor years, measurement of the diameter of the great saphenous vein and, occasionally, the common femoral vein has been a component of many clinical studies on varicose vein treatment. There is consensus that the measurements should be conducted with the patient in the standing position and with a transverse view through the vein, but no standardised site of measurement of the venous diameter has yet been established. The shape of the great saphenous vein varies greatly at the saphenofemoral junction. Due to the curvature of the great saphenous vein, it is difficult to find a point at which the transverse view measured is at right angles to the course of the vein. According to the available data, the optimal site for measuring the great saphenous vein diameter is the proximal thigh. When measuring the common femoral vein, a transverse view immediately distal to the junction of the great saphenous vein is suggested and studies have also confirmed this.

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Spiral Saphenous Vein Graft for Traumatic Injury to the Common Femoral Vein

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.04.458 ◽

2020 ◽

Vol 72 (1) ◽

pp. e271

Author(s):

Justin Gerard ◽

Sitaram V. Chivukula ◽

Michael Williams ◽

Margaret Rigamer ◽

Erin Farlow ◽

...

Keyword(s):

Saphenous Vein ◽

Vein Graft ◽

Saphenous Vein Graft ◽

Femoral Vein ◽

Traumatic Injury ◽

Common Femoral Vein ◽

The Common

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The ostial valve of the great saphenous vein

Phlebology The Journal of Venous Disease ◽

10.1258/phleb.2011.010096 ◽

2011 ◽

Vol 27 (4) ◽

pp. 179-183 ◽

Cited By ~ 3

Author(s):

C Tasch ◽

E Brenner

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Relevant Literature ◽

Functional Anatomy ◽

Common Femoral Vein ◽

Venous Valves ◽

The Common ◽

Medical University ◽

Clear Description

Background Venous valves have been classified into parietal (PVs) and ostial valves (OVs). PVs are located within the lumen of veins, whereas the OVs are located directly at the confluence of two veins. In the common femoral vein (CFV), the most prominent PVs are the suprasaphenic and infrasaphenic valve. The terminal valve (often designated as ‘valvule ostiale’ in the relevant literature in French) defined as that lying between the orifice of the great saphenous vein (GSV) and the most proximal of the major superficial tributary veins and the preterminal valve represent the most important PVs in the GSV. While PVs are well studied, there is not much literature on the OVs of the superficial venous system, especially of the GSV. Objective In order to investigate the presence of OVs (defined strictly as valves located at the entrance of a tributary vein) in the GSV, we carried out studies on specimens obtained from bodies bequested to the Division of Clinical and Functional Anatomy of Innsbruck Medical University. Methods Ninety-eight specimens consisting of the CFV and the attached tributary veins including the GSV were investigated. Results In five of these (5.1%), a single-cusped OV, in six (6.1%) a two-cusped OV and in 10 (10.2%) remnants of an OV were identified. Thus, OVs do not seem to be primarily present in all GSVs. Conclusion The distinction between PVs and OVs is not always clear in literature, and as a consequence misinterpretations may occur. Very often the terminal valve of the GSV, which is in fact a PV, is designated as an ‘ostial valve’. In view of its widespread use, we suggest that the term ‘ostial valve’ together with its clear description be included in the consensus documents of the ‘Union Internationale de Phlébologie’.

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Die Reproduzierbarkeit des veno-arteriellen FlowIndex für die quantitative Erfassung des hämodynamischen Schweregrads von venösen Erkrankungen

VASA ◽

10.1024/0301-1526.32.4.199 ◽

2003 ◽

Vol 32 (4) ◽

pp. 199-203 ◽

Cited By ~ 6

Author(s):

Kahle ◽

Hennies ◽

Bolz ◽

Pritsch

Keyword(s):

Standard Deviation ◽

Healthy Volunteers ◽

Venous Insufficiency ◽

Varicose Veins ◽

Femoral Vein ◽

Volume Flow ◽

Postthrombotic Syndrome ◽

Clinical Grade ◽

Common Femoral Vein ◽

The Common

Background: The ratio of volume flow in the common femoral vein and artery denoted as venous-arterial Flowindex (VAFI) is significantly increased in venous insufficiency according the clinical grade of the disease. This study was done to investigate the reliability and reproducibility of VAFI as quantitative pattern. Patients and methods: In 43 patients with varicose veins C4–6 EPAS,D,PPR (PVV), 40 with postthrombotic syndrome C4–6 ESAS,D,PPR,O (PTS) and 48 healthy volunteers volume flow in the common femoral vein (VFV) and artery (VFA) were measured by duplex. Division of VFV by VFA calculated VAFI. VAFI-measurement was repeated 5 times at an interval of ten minutes in 63 subjects (23 PVV, 20 PTS, 20 healthy) and it was performed at three different days in 68 subjects (20 PVV, 20 PTS, 28 healthy). Results: Mean VAFI ± standard deviation was 1.39 ± 0.26 in PVV, 1.42 ± 0.26 in PTS and 0.93 ± 0.13 in healthy veins (p < 0.001). VAFI remained stable and significantly increased (p < 0.001) in PVV and PTS compared to healthy veins during 40 minutes and also within three different days. Conclusion: The venous-arterial flowindex VAFI is a reproducible pattern of the hemodynamic severity in venous insufficiency.

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Comment to: Diameter reduction of the great saphenous vein and the common femoral vein after CHIVA long-term results, by Mendoza E. Phlebologie 2013;42:65–69.

Veins and Lymphatics ◽

10.4081/bybliolab.2013.5 ◽

2013 ◽

Vol 2 (1) ◽

pp. 5

Author(s):

Stefano Ricci

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Long Term Results ◽

Common Femoral Vein ◽

The Common ◽

Diameter Reduction

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CHIVA with endoluminal procedu res: Laser versus VNUS

Phlebologie ◽

10.12687/phleb2346-1-2017 ◽

2017 ◽

Vol 46 (01) ◽

pp. 5-12 ◽

Cited By ~ 8

Author(s):

F. Amsler ◽

E. Mendoza

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Surgical Techniques ◽

Light Reflection ◽

Common Femoral Vein ◽

General Data ◽

The Common ◽

Proximal Thigh ◽

Saphenofemoral Junction

SummaryIntroduction: Since it’s description the CHIVA strategy was performed with surgical techniques. After the introduction of endoluminal heat techniques these might be applied also in the CHIVA context.Method: 104 patients were investigated before and 3–6 months after the treatment of the great saphenous vein (GSV) with CHIVA strategy using enoluminal heat techniques to close the groin segment (VNUS Closure-Fast™ or LASER [1470 nm, Intros radial]). General data (age, sex, BMI) and phlebological data (QoL as reflected in VCSS, clinics as C[CEAP], refilling time after muscle pump measured with light reflection rheography, diameters of GSV at the groin and proximal thigh, as well as diameters of the common femoral vein) were measured and compared.Results: Significant reduction of diameters of GSV at proximal thigh from 6.5 ± 1.6 to 3.7 ± 1.1 and VFC from 15.2 ± 2.3 to 14.8 ± 2.2 were recorded, as well as reduction of clinical scores (VCSS from 5.6 ± 3.1 to 2.2 ± 2 and C[CEAP] from 3.2 ± 1 to 2.1 ± 1.1). Refilling time improved from 20.3 ± 11 to 28.8 ± 10.2. Results are comparable to those achieved after surgical crossectomy and published in other series.Conclusion: The disconnection of the insufficiency point at the saphenofemoral junction seems to be possible in the context of CHIVA Strategy applying endoluminal heat technique. No difference could be found between both techniques, Laser or VNUS Closure-Fast™.

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