Pelvic veins can be the site of isolated reflux in the absence of any saphenous ,trunk involvement. They can then be responsible for real varices of the thigh or leg associated with distal reentry perforating veins. Thig situation is observed, in particular, when pelvic veins communicate with the deep venous network; for example, perineal veins (Figure 71-3) communicating with the internal pudendal or latero-uterine venous network, or, more rarely, anterior perforating veins of the groin derived from the intrapelvic venous…
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Intersaphenous anastomoses can connect the short and long saphenous networks in the thigh or the leg. In the thigh, this communication is sometimes ensured by a Giacomini vein (Figure 70-2) or by an anterior tributary in the thigh which reaches the posterolateral border of the popliteal fossa. The two saphenous networks are very close at the knee and sometimes communicate at this level via a supra- or subaponeurotic vein. The bulge of the medial head of the gastrocnemius muscle separates…
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Tributaries and accessory saphenous veins differ in terms of the structure of their wall and their topography. Tributaries have a fragile wall, frequently associated with a tortuous, varicose appearance, with thin-walled ectatic zones interrupted by thick-walled zones. In contrast, accessory saphenous veins possess a more solid, reinforced media and can consequently be considered to have a “saphenous” type of wall. Topographically, accessory saphenous veins remain relatively linear and run close to the main saphenous trunk. In contrast, tributaries are often…
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The main trunk of the long saphenous vein arises from the medial marginal vein, anteriorly to the medial malleolus. It ascends vertically behind the medial border of the tibia, then behind the medial condyle of the femur to reach the femoral vein below the inguinal ligament. In addition to the anatomical variants of its junction with the femoral vein, the long saphenous vein is also characterized by the complexity of its accessory and satellite networks. It is essential to remember…
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Miniaturization of optical fibers has made arteries, and subsequently veins, accessible to investigation “from the inside.” Venous endoscopy has thrown new light on the anatomy and morphology of valves, by studying them in situ. On endoscopy, the venous wall appears pearly white, smooth, and linear. Venous valves are seen as bicuspid folds derived from the wall and lined by endothelial cells. Between their free edge and their parietal insertion, the two cusps form a space called the valvular sinus, which…
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One of the major advances in phlebology certainly consists of investigation of superficial veins by ultrasonography linked to Doppler. Morphological and anatomical data are also obtained with an increasingly better resolution. Doppler ultrasound, which assesses the velocity of displacement of red blood cells, identifies the direction of circulation of venous blood and therefore allows a dynamic investigation (Figure 5). Equipment Investigation of superficial veins by ultrasonography uses three types of apparatus. Two-dimensional (2D) ultrasonography provides a direct, real-time image of…
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Several opacification techniques can be used to visualize all or part of the venous system of the lower limbs. Ascending phlebography This is performed by percutaneous puncture of a vein of the dorsum of the foot with the patient in the supine position on a large-cassette serial radiography apparatus. A series of tourni quets is applied at different levels (malleoli, knees, proximal thigh), essentially to reveal deep vein thromboses’ of the iliac, femoral, popliteal and leg veins. However, the gastrocnemial,…
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The long saphenous vein is the longest superficial vein in man. It arises anterior to the anterior edge of the medial malleolus (first constant anatomical landmark). It has a linear course in the leg. It ascends vertically, posterior to the medial border of the tibia. It is accompanied by the leg branch of the saphenous nerve. This anatomical relation obviously carries a risk of sensory disorders following stripping. At the knee, the long saphenous vein travels posteriorly to the lateral…
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Like all medical disciplines, phlebology is primarily based on clinical examination. The data of the clinical interview are completed by those of inspection and palpation, performed with the subject standing. The limb examined is placed in external rotation, with the knee slightly flexed, the heel on the ground, and with muscles relaxed in order to allow palpation of the saphenous vein, accessory saphenous vein, tributaries and veins of pelvic origin. Clinically, the long saphenous territory can be divided into six…
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