Association between Anatomical Variation of the Great Saphenous Vein and Venous
            Failure in Patients Undergoing Vascular Ultrasound of the Lower Limbs

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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The superficial venous pump

Veins and Lymphatics ◽

10.4081/vl.2018.7280 ◽

2018 ◽

Vol 7 (2) ◽

Author(s):

Konstantin Mazayshvili

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Lower Limbs ◽

Superficial Fascia ◽

Step Cycle ◽

Cross Sectional ◽

Blood Flows ◽

Active Function ◽

Vein Segment ◽

The Relationship

The present study has revealed the relationship between the cross sectional area of the great saphenous vein and the degree of tension in the superficial fascia of the thigh. We conducted an ultrasound examination with 27 patients (54 lower limbs) in both standing and walking positions. With an increase and decrease in the degree of tension of the superficial fascia, the blood is pushed to the sapheno-femoral junction. Nearly 200 mm3 of blood flows in, and is pushed out of, a 100-mm great saphenous vein segment in the thigh, towards the sapheno-femoral junction during a step cycle. As a result, the active function of the fascial compartment of the great saphenous vein has been found. We have called this mechanism the superficial venous pump.

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ULTRASTRUCTURAL CHANGES IN THE WALL OF THE GREAT SAPHENOUS VEIN AT THE VARICOSE DISEASE OF VEINS OF LOWER LIMBS DEPENDING ON AGE AND ILLNESS DURATION

MORPHOLOGICAL NEWSLETTER ◽

10.20340/mv-mn.18(26).02.26-31 ◽

2018 ◽

Vol 26 (2) ◽

pp. 26-31

Author(s):

I. A. Chekmareva ◽

Kh. A. Abduvosidov ◽

O. V. Paklina ◽

E. A. Makeeva ◽

L. L. Kolesnikov

Keyword(s):

Endothelial Dysfunction ◽

Young People ◽

Connective Tissue ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Lower Limbs ◽

Ultrastructural Changes ◽

Middle Aged ◽

Aged People ◽

Varicose Disease

The aim of the study was features of ultrastructural changes in cellular elements and connective tissue carcass of the great saphenous vein (GSV) at varicose disease in depending on the duration of the disease in persons of different ages. An examination by light microscopy of 133 fragments of BPV, excised during phlebectomy in 19 patients, and an electron microscopic examination of 532 preparations were performed. Depending on the age of the patients, four age groups was distinguished: 18-44 years old (young people); 45-59 years (middle-aged people); 60-74 years old (the elderly), 75-90 years old (persons of senile age). In the wall of the GSV of young people with a small duration of the disease, there were poorly expressed pathomorphological changes characterized by moderately expressed endothelial dysfunction and minor hypertrophy of smooth muscle cells (SMC) of the middle shell. In the group of middle-aged people, in addition to age-related changes in the structure of the wall of varicose dilated GSV, pathological changes are noted that are characteristic of the long course of the disease with the development of endothelial dysfunction. The phenotypic heterogeneity of the SMC in the middle shell intensifies, and the communication links between them is altered. Disorganization of connective tissue leads to a decrease in the strength of the connective tissue vein skeleton. Hypertrophy of SMC, as a universal compensatory-adaptive response of cells, develops in response to an increase in functional load with hemodynamic disturbances in the veins of the lower limbs and to compensate for the quantitative deficiency of SMC as a result of their death. In elderly and senile age the duration of varicose disease is more than 10 years, on average - up to 25-30 years. The number of destructively altered SMC is increasing, degenerative processes and sclerotic changes are progressing. The ultrastructural analysis of biopsies showed that at the initial stage of development of varicose disease in young people with a small duration of varicose disease, morphological changes in the structure of the GSV wall are poorly expressed. With the increase in the age of the patient and the duration of the disease, changes in GSV are progressed. Involute degenerative-dystrophic changes are most pronounced in patients over 60 years of age and are an aggravating factor during varicose transformation of the GSV wall. In elderly and senile age, the compensatory possibilities of the cells decrease, the sclerotic degenerative changes in the wall of the GSV are progressed.

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A rare anatomical variation of great saphenous vein at the level of saphenofemoral junction

Radiology Case Reports ◽

10.1016/j.radcr.2018.07.028 ◽

2018 ◽

Vol 13 (6) ◽

pp. 1128-1129 ◽

Cited By ~ 1

Author(s):

Timo Quickert ◽

Mohammed Alagha

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Anatomical Variation ◽

Saphenofemoral Junction

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Graduated compression stockings effects on chronic venous disease signs and symptoms during pregnancy

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519846740 ◽

2019 ◽

Vol 35 (1) ◽

pp. 46-55 ◽

Cited By ~ 2

Author(s):

Orlando Adas Saliba Júnior ◽

Hamilton Almeida Rollo ◽

Orlando Saliba ◽

Marcone Lima Sobreira

Keyword(s):

Pregnant Women ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Intervention Group ◽

Signs And Symptoms ◽

Lower Limbs ◽

Control Group ◽

Venous Disease ◽

Compression Stockings

Objectives To evaluate the effectiveness of compression stockings in controlling the varicose veins in pregnant women. Method A prospective controlled randomized clinical trial was performed, including 60 women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Diameters of the great saphenous vein and small saphenous vein in the lower limbs of pregnant women in an orthostatic position were analyzed using Duplex-ultrasound. The symptomatology and CEAP were evaluated. Results Great saphenous vein diameters in the intervention group were 0.37 cm initial and 0.32 cm final (p < 0.0001) in the right leg and 0.28 cm and 0.38 cm (p < 0.0001) in the control group. CEAP classification presented worsening in the control group (p < 0.0001). The signs and symptoms in the control vs. intervention group: pain (86.67% vs. 23.33%; p < 0.0001), edema (70.00% vs. 33.33%; p = 0.0045), and leg heaviness (93.33% vs. 13.33%; p < 0.0001). Conclusions Compression stockings were effective in controlling the varicose veins related to pregnancy.

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Compression stocking prevents increased venous retrograde flow time in the lower limbs of pregnant women

Phlebology The Journal of Venous Disease ◽

10.1177/0268355520939371 ◽

2020 ◽

Vol 35 (10) ◽

pp. 784-791

Author(s):

Orlando Adas Saliba Junior ◽

Hamilton Almeida Rollo ◽

Orlando Saliba ◽

Marcone Lima Sobreira

Keyword(s):

Pregnant Women ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Intervention Group ◽

Lower Limbs ◽

Control Group ◽

Venous Reflux ◽

Compression Stockings ◽

Reflux Time ◽

Significant Difference

Objectives To analyze the effect of graduated compression stockings on the venous reflux in the lower limbs of pregnant women. Method A controlled randomized clinical trial was performed with sixty women: intervention group (n = 30), who used compression stockings, and control group (n = 30). Using duplex-ultrasound, the reflux time and peak reflux velocity in the great saphenous vein and small saphenous vein were analyzed. Results Great saphenous vein reflux times in the intervention group were 0.13 s at the beginning (initial) and 0.04 s at the end of pregnancy (final) in the right leg and 0.02 s and 0.34 s (p < 0.0001) in the control group. No patient in the intervention group experienced pathological reflux at the end of the pregnancy. There was a significant difference in the reflux time measured from both the great saphenous vein and small saphenous vein and peak reflux velocity between the groups. Conclusion Compression stockings prevent increased venous reflux in lower limbs of pregnant women.

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A Rare Anatomical Variation of the Great Saphenous Vein Course

CardioVascular and Interventional Radiology ◽

10.1007/s00270-017-1628-y ◽

2017 ◽

Vol 40 (10) ◽

pp. 1653-1654

Author(s):

Hakan İmamoğlu ◽

Nuri Erdoğan ◽

Serap Doğan ◽

Güven Kahriman

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Anatomical Variation

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Variants of Localization and Extension of Hypo- and Aplasia of the Great Saphenous Vein in Patients with Primary Varicose Great Saphenous Veins

Archive of Clinical Medicine ◽

10.21802/acm.2019.2.5 ◽

2019 ◽

Vol 25 (2) ◽

Author(s):

Rostyslav Sabadosh

Keyword(s):

Saphenous Vein ◽

Lower Limb ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Lower Limbs ◽

Ultrasound Scan ◽

Saphenous Veins ◽

Vein Segment ◽

Surgical Tactics ◽

The Relationship

The objective of the research was to improve the diagnostics and treatment of patients with primary varicose great saphenous veins by studying their frequency and systematizing the variants of localization and extension of great saphenous vein hypoplasia and aplasia in its trunk. Materials and Methods. The study included 560 patients with varicose veins of the lower limbs and pathological refluxes in different segments of the great saphenous vein. All the patients underwent triplex ultrasound scan of the lower limb venous system. Results. Among the patients with pathological reflux in a certain GSV segment, hypo- and aplasia of its segments were observed in 32.5% of the cases (95% CI 28.6-36.6%). Aplasia of this vein was observed twice as less frequently than hypoplasia (p<0.05). In 2.3% of the cases (95% CI 1.2-3.9%), hypoplasia of a certain GSV segment evolved to aplasia, or vice versa. It was found that the GSV trunk may have several hypo- or aplastic regions separated by its normal or varicose segment – bi-level hypo- or aplasia that was observed in 3.8% of the patients with hypo- or aplasia (95% CI 1.6-7.8%). In bi-level hypo- or aplasia, 2 hypoplastic regions were detected in 85.7% of the cases (95% CI 42.1-99.6%) and 2 aplastic regions were found in 14.3% of the cases (95% CI 0.4-57.9%). There were proposed to distinguish the following variants of GSV hypo- and aplasia: 1) simple: total, proximal, segmental and distal; 2) bi-level: proximal segmental, distal segmental and bi-segmental. In addition, for every dysplastic vein segment, the type of malformation should be indicated, namely hypoplasia, aplasia, or hypo/aplasia. Conclusions. The study conducted allowed assessing the relationship between the variants of GSV hypo- and aplastic segment localization and extension and different variations of pathological refluxes of the GSV in its trunk for further choice of surgical tactics.

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Saphenous reflux patterns in C2 patients: A record of 1196 ultrasound reports

Phlebology The Journal of Venous Disease ◽

10.1177/0268355519889868 ◽

2019 ◽

Vol 35 (6) ◽

pp. 409-415 ◽

Cited By ~ 1

Author(s):

Felipe Coelho Neto ◽

Rodrigo Gomes de Oliveira ◽

Emerson Pereira Gregório ◽

Sergio Quilici Belczak ◽

Walter Junior Boim de Araujo

Keyword(s):

Saphenous Vein ◽

Ultrasound Examination ◽

Great Saphenous Vein ◽

Common Pattern ◽

Vascular Ultrasound ◽

Vein Reflux

Objectives To describe saphenous reflux patterns in patients classified as CEAP C2 by analysis of 2027 vascular ultrasound examination reports. Methods A total of 2027 venous mapping studies were reviewed and 1196 patients classified as CEAP C2 were selected. Patients were classified according to patterns of reflux for the great saphenous vein and for the small saphenous vein, and rates of great saphenous vein and small saphenous vein reflux were analyzed for both sexes. Results The overall prevalence of saphenous vein reflux was 45%. Males had significantly higher great saphenous vein reflux prevalence than females ( p < 0.001). The most common great saphenous vein reflux pattern in females was segmental reflux and the most common pattern in males was proximal reflux. Conclusions Saphenous vein reflux is common in C2 patients and is more frequent in males. Standardization of classifications of reflux patterns is very important for correct management of the disease.

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Heparin prophylaxis in major sclerotherapy (the Prosclep study)

Journal of Theoretical and Applied Vascular Research ◽

10.24019/jtavr.120 ◽

2021 ◽

Vol 6 (3) ◽

Author(s):

Alessandro Frullini ◽

Piero Giannetta ◽

Demetrio Guarnaccia ◽

Oronzo Walter Loparco ◽

Edy Pablo Lucca ◽

...

Keyword(s):

Saphenous Vein ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Lower Limbs ◽

Low Molecular Weight ◽

Simple Extension ◽

Thrombotic Complication ◽

Thrombotic Complications ◽

Significant Figures ◽

Heparin Prophylaxis

Objective To study the incidence and the possibility of preventing thrombotic complications during major sclerotherapy for venous insufficiency of lower limbs. Methods A total of 2489 sclerotherapy sessions were performed on 2010 patients. 1087 sessions (43.7%) were carried out without heparin prophylaxis while in 1402 sessions (56.3%) a prophylaxis with low molecular weight (LMWH) was used. Thrombotic complications were divided into a) post sclerotherapy transient extension (POSTE) if they consisted of a simple extension of sclerotherapy, and b) deep venous thrombosis (DVT) when the complication occurred in a location separate from that of sclerosis. Results The overall incidence of a thrombotic complication was 0.52%. Out of 2489 sessions, 8 cases of POSTE (0.32%) and 5 thromboses of a gastrocnemius vein (0.2%) were diagnosed The most significant figures were reached in the great saphenous vein (GSV) subgroup, where the incidence of complications was 1.91% without prophylaxis and 0.31% (p = 0.009) with prophylactic heparin. Conclusions In this study prophylaxis with LMWH significantly reduced the incidence of thrombotic complications when sclerotherapy of the great saphenous vein was performed.

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