Surgical Technique for Deep Venous Reflux Suppression in Femoral Vein Duplication

Diagnostic Value of Lower Extremity Venous Duplication via Digital Subtraction Angiography Guided Venography

INTRODUCTION

Lower limb venous anomalies, including duplicated veins, are common and have significant impacts on the outcomes and efficacy of venous surgery. Digital subtraction angiography (DSA) guided venography, serving as the tertiary diagnostic option for venous disorders, offers valuable informations to clinical practitioners.

PATIENTS AND METHODS

A retrospective study was conducted on 195 patients with suspected venous disease, evaluating 259 limbs with venography imaging. Two experienced interventional vascularists evaluated the images to determine the incidence and characteristics of variances in the femoral, popliteal, great saphenous, and small saphenous veins. Moreover, blood samples were collected to assess the safety of the venography procedure by monitoring changes in renal function.

RESULT

Duplication variations were found in the lower limb veins, with the highest prevalence in the femoral vein (11.28%, 22/195), followed by the great saphenous vein (4.1%, 8/195), and the popliteal vein (1.54%, 3/195). No severe contrast agent allergies or postoperative complications were reported. No statistically significant differences were found in creatinine and urea levels pre- and post-operation for patients without duplication variations, those with duplication of the great saphenous, femoral, or popliteal vein (P < .05).

CONCLUSION

DSA-guided venography is effective in identifying venous variations in lower limb disease. DFV is the most common recurrent vein, while DPV is the least. Adequate preparation ensures safety, high spatial resolution, dynamic imaging, and low tissue interference.

Variations in the Clinical Anatomy of the Femoral and Popliteal Vessels

Objective:

The aim of this study was to assess the topography of the femoral and popliteal vessels focusing mainly on the venous variants, in patients with chronic venous disease (CVD).

Materials and Methods:

Duplex ultrasonography (DUS) was performed on 200 patients with varicose veins (VVs) and 253 patients with postthrombotic syndrome (PTS). In addition, an anatomical dissection was performed on 30 amputated lower extremities, without signs of CVD.

Results:

Duplication of the femoral vein (FV) was found in 14% of patients with VVs. Multiple FV trunks were identified in 42% of patients with PTS. One patient had a developmental anomaly with a hypoplastic FV and dilated deep FV. Two trunks of the popliteal vein (PV) below the knee level were detected in 83.3% of cases during anatomical dissection, in 87.5% of cases in patients with VVs, and in 90.1% of cases in PTS subjects during DUS. In 98.2% of cases, popliteal artery (PA) had a typical bifurcation. One patient was presented with a duplication of PA above the level of the knee. In 1.8% of cases, the PA was divided into an anterior tibial and peroneal artery.

Conclusion:

This study found variant anatomy in the FV and PV, which is frequent, with major changes occurring in patients with PTS. Variant anatomy of the PA was also found and is considered uncommon, occurring in less than 2% of cases.