Anomalous high bifurcation of the common femoral artery at the groin: management of GSV incompetence with endovenous laser ablation

Termination of the great saphenous vein at variable levels

The assessment of the saphenofemoral junction (SFJ) is important in the diagnosis and treatment of venous reflux of the great saphenous vein (GSV). In the clinical practice of venous medicine, the SFJ is used to represent the region at which the saphenous arch connects with the common femoral vein (CFV). A number of notable variations of the SFJ have been documented, and rare variable courses of the GSV have been described recently. Our case study reports two unusual GSV terminations. In both cases, the SFJ was located below the confluence of the profunda femoris vein (PFV) with the femoral vein (FV). Case 1 showed the SFJ was formed by the GSV and FV; whereas case 2 showed the PFV was joined by the GSV after a transposition with the FV. Anatomical variations of the SFJ are rare; however, they are increasingly diagnosed with the use of duplex ultrasound. The identification of SFJ variants warrants a safe endovenous procedure and prevents surgical complications.

Rare Vascular Anomalies in the Femoral Triangle During Varicose Vein Surgery

Background

We observed several cases of rare vascular anomalies within the femoral triangle during varicose vein operations.

Methods

From among 2,093 patients who underwent stripping operations of the great saphenous vein between January 2002 and June 2016, 14 cases of rare vascular anomalies were enrolled in this study.

Results

Twelve cases of femoral artery and vein transposition (0.57%), 1 case of separate entrance of the great saphenous vein trunk and its tributaries (0.05%), and 1 case of separate entrance with femoral artery and vein transposition (0.05%) were observed. The preoperative diagnosis rate was 71% (10 of 14) using duplex ultrasound. In all cases of femoral artery and vein transposition, the saphenofemoral junction was located at the lateral or posterolateral side of the superficial femoral artery, corresponding to complete or incomplete transposition, respectively. Among the 12 cases of femoral artery and vein transposition, 5 cases were complete transposition and 7 cases were incomplete transposition. In 2 cases of separate entrance of the great saphenous vein trunk and its tributaries, the separated tributaries formed a common trunk before connecting to the femoral vein.

Conclusion

The anatomy of the saphenofemoral junction may infrequently be altered in some individuals. Detailed preoperative sonographic examinations and meticulous groin dissection during the operation are necessary to prepare for unexpected anatomical variations.