The role of circumflex femoral veins in the saphenofemoral junction incompetence: a case report

A 31 year-old female patient, an opera singer, came for a consultation, mainly for aesthetic problems of the lower limbs. An asymptomatic bilateral P-point pelvic shunt was demonstrated by the EchoDoppler, while no nutcracker syndrome was detected. The examination demonstrated a medial circumflex femoral vein (MCFV), going into the common femoral vein and then into the great saphenous vein (GSV). The Valsalva manoeuvre showed the GSV terminal valve incompetence. A dilated MCFV vein at the level of the saphenofemoral junction was the source of the reflux through the GSV, while the external iliac vein was competent. GSV reflux with Valsalva was present only in the lying position. Flow in the MCFV was directed toward the CFV during and after the Valsalva. The examination shows clearly that a GSV reflux can sometimes occur in absence of iliac reflux. Circumflex femoral veins (medial and lateral) are anatomical variations, but common findings during ordinary EchoColourDoppler investigations of the venous system of the lower limbs.

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A rare case of anatomical variation of the femoral artery and vein

Anatomy Journal of Africa ◽

10.4314/aja.v9i2.199952 ◽

2020 ◽

Vol 9 (2) ◽

pp. 1826-1830

Author(s):

B. Ba ◽

T. Touré ◽

A. Kanté ◽

M. Koné ◽

K.D. Kouamenou ◽

...

Keyword(s):

Femoral Artery ◽

Rare Case ◽

Great Saphenous Vein ◽

Anatomical Variation ◽

Femoral Vein ◽

Iliac Vein ◽

External Iliac Vein ◽

Medial Side ◽

Femoral Vessels ◽

The Right

During a dissection of the two femoral trigons in a female corpse, about 14 years old, we discovered on the right side, the deep artery of the thigh arising from the medial side of the femoral artery and passed in front of the femoral vein above the mouth of the great saphenous vein; on both sides, there was the presence of a collateral canal which communicated the external iliac vein with the femoral vein on the right, on the left, it communicated the external iliac vein with the quadricipital vein. The lower part of the femoral vein was duplicated on both sides, but on the right, there was an interconnecting channel between the two trunks of the duplication. Variations of the femoral vessels are very frequent and can be responsible for an incident during the practice of certain gestures at the level of the femoral trigon such as: catheterization of the femoral artery or vein, the treatment of femoral hernias. Key words: Deep thigh artery, collateral venous canal, external iliac vein, anatomic variations.

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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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The classic saphenofemoral junction and its anatomical variations

Phlebology The Journal of Venous Disease ◽

10.1177/0268355516635960 ◽

2016 ◽

Vol 32 (3) ◽

pp. 172-178 ◽

Cited By ~ 4

Author(s):

Panos Souroullas ◽

Rachel Barnes ◽

George Smith ◽

Sandip Nandhra ◽

Dan Carradice ◽

...

Keyword(s):

Varicose Veins ◽

Femoral Vein ◽

Anatomical Variations ◽

Median Number ◽

Consecutive Series ◽

Recurrence Rates ◽

Common Femoral Vein ◽

Anterolateral Thigh ◽

The Common ◽

Saphenofemoral Junction

Background The intraoperative anatomy of the saphenofemoral junction can vary from the ‘textbook’ description of six independent proximal tributaries: three medial – superficial external pudendal, deep external pudendal and the posteromedial thigh branch – and three lateral – superficial epigastric, superficial circumflex iliac and the anterolateral thigh branch. Varicose veins can recur following inadequate initial open surgery with failure to identify, ligate and divide these tributaries. An appreciation of common anatomical variations could minimise recurrence rates following surgery. This study aimed to identify common anatomical variations within our patient cohort. Methods This prospective observational study documented diagrammatically the anatomy of saphenofemoral junction in a consecutive series of 172 patients undergoing unilateral, primary saphenofemoral junction ligation for symptomatic superficial venous insufficiency. Diagrams recorded the number of tributaries and their relationship to the saphenofemoral junction, the existence of bifid systems and the relationship of the external pudendal artery to the saphenofemoral junction. Results In sum, 110 women and 62 men with a mean age of 47.2 (IQR 21–77) years were studied. The median number of saphenofemoral junction tributaries was 4 (IQR 0–7). In 74 cases (43.0%), at least one tributary drained directly into the common femoral vein (IQR 0–4), commonly the deep external pudendal (91.9%). The anterolateral thigh branch was identified in 62 cases (35.8%) and the posteromedial thigh branch in 93 cases (53.8%). The external pudendal artery was identified in 150 cases (87.2%) and was superficial to the great saphenous vein in 36 cases (20.9%). Conclusions Significant variations exist in the saphenofemoral junction anatomy. Familiarity with anatomical saphenofemoral junction variations is imperative to ensure operative success and reduce recurrence. Thorough dissection of the common femoral vein is necessary not only to ensure all proximal tributaries are identified and ligated but also as a safety mechanism in preventing avulsion trauma of direct common femoral vein tributaries.

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Frequency of refluxive tributaries of the junction region in the groin in patients with recurrent varicose veins of the thigh

Phlebologie ◽

10.12687/phleb2300-2-2016 ◽

2016 ◽

Vol 45 (03) ◽

pp. 149-153 ◽

Cited By ~ 4

Author(s):

E. Mendoza ◽

M. Dörler ◽

M. Stücker ◽

S. Reich-Schupke

Keyword(s):

Great Saphenous Vein ◽

Varicose Veins ◽

Femoral Vein ◽

Iliac Vein ◽

Junction Region ◽

Duplex Scan ◽

Recurrent Varicose Veins ◽

History Of ◽

Saphenofemoral Junction ◽

Thigh Region

SummaryBackground A long stump and neovascularisation are commonly discussed reasons for recurrence of varicosis in the groin after “disconnection” of the saphenofemoral junction (SFJ) and stripping of the great saphenous vein (GSV). A third possible reason for recurrence with non femoral reflux emerging from tributaries of the junction region, is often underrated. The aim of the study was to report on the source of reflux for recurrent varicose veins of the thigh in patients who already had a history of disconnection of the SFJ and stripping of the GSV.Methods In this two-centre study, consecutive patients with a history of disconnection of the SFJ, stripping of the GSV and visible or palpable varicose veins of the thigh region were included. Their data and venous diagnostics (DPPG, duplex scan) were recorded and evaluated by a standardised protocol.Results 101 legs were included. In 58.4 % there was a long stump of the GSV as a source for variose veins of the thigh. In the other legs (42,6 %) the source for the reflux was not a long stump with contact to the femoral vein but residual tributaries of the SFJ, e.g. the superficial epigastric vein or the superficial circumflex iliac vein.Conclusions Residual refluxive tributaries of the SFJ seem to be an important source for recurrent varicose veins of the thigh. Further prospective studies should focus on suitable therapeutic options.

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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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Morphometric characteristics of competent proximal valves of the great saphenous vein and superficial femoral vein in vivo according to ultrasound angioscanning data

Regional blood circulation and microcirculation ◽

10.24884/1682-6655-2019-18-3-16-22 ◽

2019 ◽

Vol 18 (3) ◽

pp. 16-22

Author(s):

E. K. Gavrilov ◽

H. L. Bolotokov ◽

E. A. Babinets

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Femoral Vein ◽

Lower Boundary ◽

Average Diameter ◽

Lower Limbs ◽

Functional Test ◽

Natural Form ◽

Superficial Femoral Vein ◽

Venous Diameter

Introduction. It seems relevant to study the ultrasound anatomy and physiology of the proximal valve segments of the superficial femoral vein (SFV) and the great saphenous vein (GSV) to develop effective reconstructive surgical interventions on venous valves in chronic vein diseases.The aim of the survey was to study the ultrasound anatomy of the venous wall, the size and shape of the proximal SFV and GSV valves are normal at rest and during the functional test Valsalva.Material and methods. Proximal valve SFV studies were performed in 144 lower limbs in 115 people (mean age 51.1 ± 14.4 years, 60 women and 55 men), proximal GSV valves studies - in 82 lower limbs in 67 persons (average age 45, 1 ± 13.3 years, 33 women, 34 men). A longitudinal and transverse ultrasound scanning of the femoral vein bifurcation and safenofemoral junction areas were performed, the structures of the proximal SFV and GSV valves were visualized, the valve shape was measured and the diameter of the veins was measured at the level valves at the base of the valves (inlet diameter), at the point of maximum ectasia (diameter of ectasia), at the upper border of the valve (diameter of the outlet), as well as measuring the length of the valve a (length to ectasia, the total length of the valve). The degree of ectasia over the valve was judged by calculating the relative venous diameter change (RVDC).Results. the average diameter of the SFV at the level of the lower boundary of its first valve was 10.01 ± 1.44 mm. The average diameter of the SFV at the level of the maximum ectasia of its first valve was 13,1±2 mm. The average value of the index of RVDC for SFV was 31%±10,4%. An increase in the diameter of the vein in the zone of supravalvular ectasia up to 20% corresponded to the spindle-shaped valve, more than 20% - to the clavate form, which was noted in the majority of the examined. The change in the relative venous diameter of the SFV on the Valsalva test was 38,2%±12,4%. The average diameter of the GSV at the base of the first valves was 6,07±1,25 mm. The average diameter of the GSV at the level of the maximum ectasia of the osteal valve was 9,44±1,69 mm. The average RVDC for GSV was 58%±24%.Conclusion. the natural form of proximal SFV and GSV valves is clavate with presence of the significant supravalvular ectasia, which was noted in the majority of the subjects alone and in all during the performance of the Valsalva functional test.

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External iliac vein compression and lower-extremity swelling caused by an iliopectineal ganglion: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2223-4 ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Kiyokazu Fukui ◽

Ayumi Kaneuji ◽

Norio Kawahara

Keyword(s):

Lower Extremity ◽

Femoral Vein ◽

Signs And Symptoms ◽

Iliac Vein ◽

Needle Aspiration ◽

Case Presentation ◽

Vein Thrombosis ◽

External Iliac Vein ◽

Iliac Vein Compression ◽

Deep Vein

Abstract Background A hip joint ganglion is a rare cause of lower-extremity swelling. Case presentation We report a case of a Japanese patient with ganglion of the hip with compression of the external iliac/femoral vein that produced signs and symptoms mimicking those of deep vein thrombosis. Conclusions Needle aspiration of the ganglion was performed, and swelling of the lower extremity promptly decreased. At 7.5 years after aspiration, there was no recurrence of swelling of the leg. Although the recurrence rate for ganglions after needle aspiration is high, it is worthwhile trying aspiration first.

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