The saphenous vein: derivation of its name and its relevant anatomy

Ultrasonography study on the segmental aplasia of the great saphenous vein

PURPOSE

To assess the frequency and anatomic distribution of the segmental aplasia of the great saphenous vein (GSV) using ultrasonography in patients who presented with a clinical etiologic anatomic and pathophysiologic (CEAP) score 1 and above.

MATERIALS AND METHODS

A prospective study on 670 limbs of 335 consecutive patients evaluated for segmental aplasia of the GSV with ultrasonography. The difference of segmental aplasia of the GSV between patients with and without GSV insufficiency was searched.

RESULTS

Segmental aplasia of the GSV was found in 223 of 670 limbs (33%). Segmental aplasia of the GSV was seen in 65 of 189 limbs (34.4%) with GSV insufficiency and 45 of 146 limbs (30.8%) with normal GSV on the right side (P = 0.52), and 65 of 194 limbs (33.5%) with GSV insufficiency and 44 of 141 limbs (31.2%) with normal GSV on the left side (P = 0.72).

CONCLUSION

Segmental aplasia of the GSV was seen in one-third of patients who had a CEAP score 1 and above. The frequency of the segmental aplasia was almost the same in the right and the left limbs and was similar in patients with or without GSV insufficiency.

Avicenna's concept of pain

Ibn Sina (Latin name – Avicenna, 980–1037) is a famous Muslim physician who wrote The Canon of Medicine. Pain-related writings within The Canon were identified and analysed and compared to Galen and Modern Pain Theory. We found evidence in The Canon that Avicenna challenged Galen's concept of pain. Galen insisted that injuries (breach of continuity) were the only cause of pain. In contrast, Avicenna suggested that the true cause of pain was a change of the physical condition (temperament change) of the organ whether there was an injury present or not. Avicenna extended Galen's descriptions of 4 to 15 types of pain and used a terminology that is remarkably similar to that used in the McGill Pain Questionnaire.

Anatomical basis of an original pedal approach to the great saphenous vein for surgery

Varicose vein repair often necessitates a distal approach to the great saphenous vein (GSV). The classic method involves a medial pre-malleolar approach. We propose a more distal approach via the medial surface of the foot where there is a cutaneous landmark, which can be used to locate the GSV in a simple, reliable and reproducible fashion. In 20 cadaveric feet, we dissected out the GSV exploiting the above-mentioned cutaneous landmark. We then extended the dissection up as far as the medial pre-malleolar region (from where the GSV is classically approached) in order to be able to compare the diameter of the vein at the two different points (in the foot and in the pre-malleolar region). We also compared the cutaneous landmark with ultrasonographic location of the GSV in 22 feet of healthy subjects. Both dissections and ultrasound examinations demonstrated the reliability of the cutaneous landmark. Moreover, no significant difference was detected in the diameter of the GSV at the two different approach points. This original distal approach to the GSV requires only minor modifications of current practice for varicose veins surgical treatment.