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Veselá M, Beneš M, Dostálová G, Aleš Linhart, Kachlík D. Variations of the Saphenopopliteal Junction: An Ultrasonography Study in a Young Population, A Systematic Review and A Meta-Analysis. Angiology 2024; 75:527-535. [PMID: 36924269 DOI: 10.1177/00033197231164433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Saphenopopliteal junction classification has been developing, but still the precise knowledge of junction type is crucial for proper surgical treatment. We examined the saphenopopliteal junction by duplex venous scanning in 244 extremities in healthy volunteers (median age: 23.0 years, 83 females, 39 male) and performed a meta-analysis of 13 studies focusing on structural types of the junction. According to Schweighoffer's classification we distinguished 5 types of the junction and we subdivided type A according to Cavezzi's classification of gastrocnemial veins termination into two. We added type F (small saphenous vein-SSV terminates into popliteal vein-PV), described especially in cadaveric studies. In our study, the most frequent type was A1 (96 cases), followed by C (70), B (48), A2 (20), E (6), D (3) and F (0). The pooled prevalence estimate for types A + B + D + E was 54.7% (95% CI 40.9-69.6%) and for type C 24.4% (95% CI 19.3-29.5%), whereas in 17.1% (95% CI 6.3-27.9%) of cases, the SSV terminated in the PV with no cranial extension present. The knowledge of the saphenopopliteal junction and its variations prevalence can help clinicians to quickly identify the real type of the junction during routine examination. In mid-European population, the main type is A1 and worldwide type A.
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Affiliation(s)
- Michaela Veselá
- Department of Anatomy, Charles University Second Faculty of Medicine, Praha, Czech Republic
- Department of Internal. Cardiovascular Medicine,. General University Hospital in Prague,. First Faculty of Medicine, Charles University, Czech Republic
| | - Michal Beneš
- Department of Anatomy, Charles University Second Faculty of Medicine, Praha, Czech Republic
| | - Gabriela Dostálová
- Department of Internal. Cardiovascular Medicine,. General University Hospital in Prague,. First Faculty of Medicine, Charles University, Czech Republic
| | - Aleš Linhart
- Department of Internal. Cardiovascular Medicine,. General University Hospital in Prague,. First Faculty of Medicine, Charles University, Czech Republic
| | - David Kachlík
- Department of Anatomy, Charles University Second Faculty of Medicine, Praha, Czech Republic
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Hamdan R, Precup CG, Falchero C, Baldassini AL, Castillo C. Acute Thrombosis of an Aneurysm of the Small Saphenous Vein: A Case Report. Vasc Endovascular Surg 2024; 58:350-356. [PMID: 37946330 DOI: 10.1177/15385744231215571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND A venous aneurysm (VA) is a focal dilatation of a nonvariceal vein (diameter increased by at least 1.5 times compared to the adjacent upstream or downstream venous segment), which carries a risk of venous thromboembolism (VTE) when located in the deep veins of the lower limbs but also when it affects the veins above the muscle fascia. CASE We report the case of a 40-year-old woman who presented with a painful and disabling mass-like lesion of the upper third of the right calf. A Doppler ultrasound (DUS) examination revealed a small saphenous vein (SSV) dilated at the saphenopopliteal junction (SPJ) and thrombosed along its entire length. Anticoagulant treatment was initiated but although the thrombosis regressed on DUS, the functional impotence and the persistence of pain prompted a stripping of the SSV. Histology allowed the diagnosis of SSV's primary aneurysm. DISCUSSION Dilated segments of the saphenous vein are not always varicose veins (VVs). True VAs can develop on veins located above the muscular fascia and, like deep VAs, may trigger VTE. Small saphenous vein aneurysms have seldom been reported, and only a few clinical observations have described the thrombosis of a SSV aneurysm. Any mass in the popliteal fossa or upper part of the calf should be examined by DUS to look for an SSV aneurysm. Excision of the saphenous vein with junctional ligation is advised if thrombosis is present at the time of diagnosis.
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Affiliation(s)
- Rémy Hamdan
- Department of Vascular Medicine, Mâcon Hospital, Mâcon, France
| | - Calin Gheorge Precup
- Department of Vascular Surgery, Hôpitaux Nord-Ouest de Villefranche-sur-Saône, Gleizé, France
| | - Catherine Falchero
- Department of Vascular Medicine, Hôpitaux Nord-Ouest de Villefranche-sur-Saône, Gleizé, France
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Tan J, Chen Y, Huang J, Xu W. A systematic review of endovenous ablation for the treatment of small saphenous varicose veins. VASA 2023; 52:355-365. [PMID: 37779391 DOI: 10.1024/0301-1526/a001091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Insufficiency of the small saphenous vein causes 15% of varicose veins in the lower extremities. Endovenous ablation for the treatment of small saphenous vein varices has become a trend, and an increasing number of studies have reported the effects of different types of endovenous ablation in patients with small saphenous varicose veins. The purpose of this systematic review is to summarize the results of existing studies on endovenous ablation for the treatment of small saphenous varicose veins, compare its role and efficacy, and provide insights into the future development of endovenous ablation for treating small saphenous varicose veins. A systematic review of literature published from January 1, 2002 to January 1, 2022 was conducted from PubMed, Embase, and China Academic Journals full-text databases. The pre-determined inclusion criteria were clinical literature of endovenous ablation for treating small saphenous varicose veins. Keywords included "ablation", "small saphenous vein", "lesser saphenous vein", "short saphenous vein", "xiaoyinjingmai" and "xiaorong". Of the 506 articles screened, 33 articles were included in this review: 19 articles were related to endovenous laser ablation, five were related to mechanochemical ablation, seven were related to radiofrequency ablation, and two were related to both endovenous laser ablation and radiofrequency ablation. The anatomical success rate of endovenous laser ablation, radiofrequency ablation, and mechanochemical ablation were 94.3%, 96.0%, and 88.1%, respectively, and the heterogeneities were all moderate. Most of the current studies are of a low-quality level of research. Hence, long-term follow-up studies and large-scale randomized controlled trials are required to obtain high-quality evidence. Although the gold standard for the treatment of small saphenous vein insufficiency remains unclear, endovenous ablation is still the recommended method.
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Affiliation(s)
- Junjie Tan
- Zhuhai Hospital affiliated with Jinan University (Zhuhai People's Hospital), Xiangzhou District, Zhuhai City, Guangdong Province, China
| | - Yanhui Chen
- Second Clinical Medical College of Jinan University (Shenzhen People's Hospital), Shenzhen City, Guangdong Province, China
| | - Jianwen Huang
- Zhuhai Hospital affiliated with Jinan University (Zhuhai People's Hospital), Xiangzhou District, Zhuhai City, Guangdong Province, China
- Zhuhai Interventional Medical Centre, Zhuhai Hospital affiliated with Jinan University (Zhuhai People's Hospital), Xiangzhou District, Zhuhai City, Guangdong Province, China
| | - Weiguo Xu
- Zhuhai Hospital affiliated with Jinan University (Zhuhai People's Hospital), Xiangzhou District, Zhuhai City, Guangdong Province, China
- Zhuhai Interventional Medical Centre, Zhuhai Hospital affiliated with Jinan University (Zhuhai People's Hospital), Xiangzhou District, Zhuhai City, Guangdong Province, China
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Park JK, Woo SY, Yang SS, Kim DI. Analysis of the postoperative hemodynamic changes in varicose vein surgery related with small saphenous vein reflux. Phlebology 2023; 38:516-522. [PMID: 37478564 DOI: 10.1177/02683555231186508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2023]
Abstract
PURPOSE To evaluate the postoperative hemodynamic changes in varicose vein surgery related with SSV reflux using APG. METHODS Totals of 181 limbs and 178 patients who underwent high ligation and stripping (HLS) (87 limbs), radiofrequency ablation (RFA) (43 limbs), or endovenous laser ablation (EVLA) (51 limbs) for SSV reflux from 1995 to 2022 were enrolled. We measured venous volume (VV), venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) preoperatively and at postoperative one and 6 months. RESULTS Comparing preoperative results to those at postoperative 1 month, the reduction rates of VV, VFI, and RVF were 27, 53, and 31%, while EF increased by 18% (p < 0.001). Comparing preoperative and postoperative 6 month, the reduction rates of VV, VFI, and RVF were 27, 45, and 35%, while EF increased by 27% (p < 0.001). CONCLUSIONS There were hemodynamic improvement in the lower leg after varicose vein surgery including HLS, RFA, and EVLA.
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Affiliation(s)
- Joon-Kee Park
- Samsung Medical Center Division of Vascular Surgery, Seoul, Korea
| | - Shin-Young Woo
- Samsung Medical Center Division of Vascular Surgery, Seoul, Korea
| | - Shin-Seok Yang
- Samsung Medical Center Division of Vascular Surgery, Seoul, Korea
| | - Dong-Ik Kim
- Samsung Medical Center Division of Vascular Surgery, Seoul, Korea
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Apruzzi L, Bilman V, Ardita V, Favia N, Saracino C, Chiesa R, Baccellieri D. Comparison of mechanochemical ablation versus ligation and stripping for the treatment of incompetent small saphenous vein. Phlebology 2021; 37:48-54. [PMID: 34505545 DOI: 10.1177/02683555211045191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to compare the outcomes of mechanochemical ablation (MOCA) versus saphenopopliteal junction ligation and stripping (OS) for symptomatic small saphenous vein (SSV) insufficiency. METHODS This is a retrospective study including symptomatic SSV patients treated with MOCA using the ClariVein catheter (Merit Medical, South Jordan, Utah, USA) or OS from 2015 to 2019. RESULTS A total of 60 limbs (73.3% women, mean age 54.7 ± 14.4 years) were treated with MOCA and 58 limbs (63.8% women, mean age 54 ± 11.6 years) with OS. At 18 months follow-up, recurrence rates were 7.5% (4/53) for MOCA vs. 5.7% (3/52) for the OS group. MOCA group was associated with less pain at first postoperative day, and an early return to work (MOCA 3.5 ± 2.3 days vs. OS 14.2 ± 3.8 days, p < .0001). No cases of leg paresthesia/dysesthesia were observed in the MOCA group, while two patients (3.4%) presented neurological symptoms after OS treatment. CONCLUSION MOCA and OS are both safe and effective techniques for symptomatic SSV insufficiency. MOCA group demonstrated to be associated with less postoperative pain and early return to work compared to OS.
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Affiliation(s)
- Luca Apruzzi
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Victor Bilman
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vincenzo Ardita
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Favia
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Concetta Saracino
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Roberto Chiesa
- Vascular Surgery Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
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de Souza FCB, de Araujo WJB, Brandao ABDF, Mazzoni CDA, Erzinger FL, Caron FC, Ruggeri VGM. Evaluation of endolaser thermoablation of the small saphenous vein under local anesthesia. J Vasc Bras 2021; 20:e20200215. [PMID: 34394206 PMCID: PMC8336979 DOI: 10.1590/1677-5449.200215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 04/20/2021] [Indexed: 11/21/2022] Open
Abstract
Background The small saphenous vein (SSV) is affected in 15% of chronic venous insufficiency (CVI) cases. Conventional surgery is the standard technique for treatment of SSV insufficiency, but sural nerve injury is a complication of great concern. Endovenous laser ablation is a surgical technique for treatment of CVI that is considered likely to reduce morbidity and mortality. Objectives To evaluate patients with CVI undergoing endovenous laser ablation of the SSV at least 30 days after the procedure. Methods We analyzed 54 lower extremities in 46 patients scheduled for 1470-nm endovenous laser ablation under local anesthesia to treat CVI in a tertiary hospital. Patients were evaluated preoperatively, intraoperatively, and postoperatively over 30 days with clinical examination, physical examination, and ultrasound. Results In the 54 lower extremities treated, there was a significant difference (p < 0.003) in terms of reduction in the diameter of treated veins (6.37 mm preoperatively and 5.15 mm on the 30th postoperative day) and improvement in the venous clinical severity score (VCSS) (means of 8.02 preoperative and 6.11 on the 30th postoperative day) (95%CI, 5.01-7.21) (p < 0.02). Postoperative complications such as paresthesia and phlebitis were present and diagnosed in 5 and 3 patients, respectively, but did not affect their quality of life or routine activities. Conclusions Intravenous laser ablation of the SSV proved to be safe and effective for reducing clinical symptoms and improving quality of life.
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Affiliation(s)
| | - Walter Jr Boim de Araujo
- Hospital Angelina Caron, Campina Grande do Sul, PR, Brasil.,Instituto da Circulação - Excelência em Angiologia, Cirurgia Vascular e Endovascular, Curitiba, PR, Brasil
| | - Adriana Buechner de Freitas Brandao
- Hospital Angelina Caron, Campina Grande do Sul, PR, Brasil.,Instituto da Circulação - Excelência em Angiologia, Cirurgia Vascular e Endovascular, Curitiba, PR, Brasil
| | | | - Fabiano Luiz Erzinger
- Hospital Angelina Caron, Campina Grande do Sul, PR, Brasil.,Instituto da Circulação - Excelência em Angiologia, Cirurgia Vascular e Endovascular, Curitiba, PR, Brasil
| | - Filipe Carlos Caron
- Hospital Angelina Caron, Campina Grande do Sul, PR, Brasil.,Instituto da Circulação - Excelência em Angiologia, Cirurgia Vascular e Endovascular, Curitiba, PR, Brasil
| | - Viviane Gomes Milgioransa Ruggeri
- Hospital Angelina Caron, Campina Grande do Sul, PR, Brasil.,Instituto da Circulação - Excelência em Angiologia, Cirurgia Vascular e Endovascular, Curitiba, PR, Brasil
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Çiçek ÖF, Kadiroğullari E, Günertem E, Diken A, Yalçınkaya A, Çiçek MC, Uzun A, Çağlı K. Successful long-term limb salvage using cephalic and small saphenous vein grafts: A case report. Int J Crit Illn Inj Sci 2020; 10:140-142. [PMID: 33409129 PMCID: PMC7771617 DOI: 10.4103/ijciis.ijciis_60_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/16/2020] [Accepted: 02/25/2020] [Indexed: 11/24/2022] Open
Abstract
In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV.
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Affiliation(s)
- Ömer Faruk Çiçek
- Department of Cardiovascular Surgery, Selçuk University Faculty of Medicine, Konya, Turkey
| | - Ersin Kadiroğullari
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Eren Günertem
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Adem Diken
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Adnan Yalçınkaya
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
| | - Mustafa Cüneyt Çiçek
- Department of Cardiovascular Surgery, Konya Education and Research Hospital, Konya, Turkey
| | - Alper Uzun
- Department of Cardiovascular Surgery, Ankara Education and Research Hospital, Ankara, Turkey
| | - Kerim Çağlı
- Department of Cardiovascular Surgery, Turkiye Yuksek Ihtisas Education and Research Hospital, Ankara, Turkey
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Kubat E, Ünal CS, Geldi O, Çetin E, Keskin A, Karapınar K. Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers. SAO PAULO MED J 2020; 138:98-105. [PMID: 32491084 PMCID: PMC9662839 DOI: 10.1590/1516-3180.2019.0230.r1.06112019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 11/06/2019] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.
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Affiliation(s)
- Emre Kubat
- MD. Attending Physician, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Celal Selçuk Ünal
- MD. Assistant Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Onur Geldi
- MD. Attending Physician, Department of Cardiovascular Surgery, Zonguldak Atatürk State Hospital, Zonguldak, Turkey.
| | - Erdem Çetin
- MD. Assistant Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Aydin Keskin
- MD. Attending Physician, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
| | - Kasım Karapınar
- MD. Professor, Department of Cardiovascular Surgery, Karabük Training and Research Hospital, Karabük, Turkey.
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Garagozlo C, Kadri O, Atalla M, Polanco F, Massaband A, Coey J, Sulaiman S. The anatomical relationship between the sural nerve and small saphenous vein: An ultrasound study of healthy participants. Clin Anat 2018; 32:277-281. [PMID: 30328148 DOI: 10.1002/ca.23302] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 10/03/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Procedures involving the small saphenous vein (SSV) can result in sural nerve (SN) damage due to the proximity of the two structures. The relationship between the SN and SSV has previously been described in cadaveric studies with limited scope on surface landmarks. This study investigates the relationship between the SN and SSV in vivo through ultrasound. Transverse/short-axis ultrasound scans of 128 legs (64 healthy participants) were taken by a single observer using a GE Logiq e ultrasound system with a 5-13 Hz linear transducer (GE Logiq 12L-RS). The SN was identified and traced from the lateral malleolus to the popliteal fossa noting its course and proximity to the SSV. The distance between the SN and SSV was measured at points representing the distal 50% and 25% of the total leg length (the distance between the medial tibial condyle and the inferior edge of the medial malleolus). The SN and SSV were visualized in all participants regardless of BMI and atypical anatomical relationship were noted in 20.3%. The SN pierced the fascia in the distal 25.9% ± 5.3% of the total leg length. The distance between the SN and SSV was 4.06 ± 1.8 mm and 3.4 ± 1.4 mm in the distal 50% and 25% points of the total leg length, respectively. There was no significant effect of sex or body side. The SSV is a viable option for multiple vein harvest. Ultrasound visualization can be a beneficial tool for delineating variations of the SN in relation to SSV prior to surgery. Clin. Anat. 32:277-281, 2019. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Cameron Garagozlo
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - Omar Kadri
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - Mina Atalla
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - Fernando Polanco
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - Andrew Massaband
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
| | - James Coey
- St. George's International School of Medicine Keith B. Taylor Global Scholars Program, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom.,Department of Anatomy, St. George's University, Grenada, West Indies
| | - Sara Sulaiman
- Department of Applied Sciences, Faculty of Health and Life Sciences, Northumbria University, Newcastle-upon-Tyne, NE1 8ST, United Kingdom
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Abstract
Given the high prevalence of chronic venous diseases (CVD), defining criteria to screen patients who are in need for intervention is attaining primacy. An important clinical criterion for treating CVD is incompetence of larger veins. We have assessed the association of size of afflicted veins with disease severity in patients with CVD to define an acceptable criterion to identify patients who need intervention. Demographic characteristics and risk factors were recorded from 6350 patients. Based on physical examination and venous duplex ultrasound study, patients were classified into clinical severity, etiology, anatomy, and pathophysiology (CEAP) classes and grouped according to the size of the veins which had varicosities. Patients with reflux in smaller veins (vein size <4 mm diameter) were considered as type I and those with varicosities in truncal veins (>4 mm diameter) as type II. Risk ratio was determined by multivariate regression analysis. About 47.67% of patients in this study were found to have CEAP class 3 disease. Compared with varicose veins of large truncal veins, patients with varicosities in smaller superficial veins had 2.85-fold ( p < 0.01) more risk of edema and 5.71-fold ( p < 0.01) higher prevalence of hyperpigmentation. Varicosities in small superficial veins were associated with higher risk of ulceration (odds ratio 3.93, 95% confidence interval 2.51-6.18) compared with truncal vein reflux. Our study reveals that presence of small varicose veins in patients without truncal saphenous reflux involvement is associated with severe manifestations of venous insufficiency such as edema and skin lesions even in the absence of varicosities in truncal saphenous veins.
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Affiliation(s)
- N. Radhakrishnan
- St.Thomas Institute of Research on Venous Diseases, Changanassery, Kerala, India
| | - Deepu George
- St.Thomas Institute of Research on Venous Diseases, Changanassery, Kerala, India
| | - R. Jayakrishnan
- St.Thomas Institute of Research on Venous Diseases, Changanassery, Kerala, India
- Nelson Mandela Academic Hospital, Mthatha, South Africa
| | - S. Sumi
- Department of Cardiovascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
| | - C.C. Kartha
- Department of Cardiovascular Diseases and Diabetes Biology, Rajiv Gandhi Centre for Biotechnology, Thiruvananthapuram, Kerala, India
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Rodriguez-Acevedo O, Elstner KE, Martinic K, Ibrahim RI, Tomazini Martins R, Arduini F, Ibrahim N. ClosureFast endovenous radiofrequency ablation for great saphenous vein and small saphenous vein incompetence: Efficacy and anatomical failure patterns. Phlebology 2018; 34:266-271. [PMID: 30208755 DOI: 10.1177/0268355518799609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recurrence rates and patterns after endovenous radiofrequency ablation (ERFA) are poorly documented. OBJECTIVE To assess the incidence and anatomical recurrence patterns of saphenous vein reflux after ERFA. METHOD Two hundred patients previously treated with ERFA were recalled for clinical assessment and venous-duplex ultrasound at three years post-treatment. RESULTS A total of 106 patients (68F, 38M) with a mean age of 49.4 years (SD +11.5y) were assessed. Mean follow-up was 42.1 months (SD + 20.1m). Further varicose veins were identified in 31 patients (29.2%). Recanalization/recurrence/failure was diagnosed in 16 patients (15.1%), including 18 trunks (8.7%), 13 great saphenous vein (6.3%) and 5 small saphenous vein (2.4%). Twenty-seven patients (25%) developed neo-incompetence in 31 trunks and 12 non-saphenous veins. All patients with truncal recanalization had a body mass index > 29 (range 29-42). CONCLUSION Disease progression was twice as high as the recanalization rate at three years post-treatment using ERFA in this study. Raised body mass index may be a contributing factor; however, further longitudinal studies are required. Patient self-selection bias may have also influenced our results.
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Affiliation(s)
| | | | - Kui Martinic
- 1 Sydney Centre for Venous Disease, Sydney, Australia
| | | | | | | | - Nabeel Ibrahim
- 1 Sydney Centre for Venous Disease, Sydney, Australia.,2 Department of Clinical Medicine, Macquarie University, Sydney, Australia
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Witte ME, Zeebregts CJ, de Borst GJ, Reijnen MMPJ, Boersma D. Mechanochemical endovenous ablation of saphenous veins using the ClariVein: A systematic review. Phlebology 2017; 32:649-657. [PMID: 28403687 DOI: 10.1177/0268355517702068] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective To systematically review all available English literature on mechanochemical endovenous ablation and to report on the anatomical, technical, and clinical success. Methods A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on mechanochemical endovenous ablation for the treatment of insufficient great and/or small saphenous vein. Methodological quality of the included studies was evaluated using the MINORS score. The primary outcome measure was anatomical success, defined as closure of the treated vein on follow-up duplex ultrasound imaging. Secondary outcomes were technical and clinical success, and major complications defined as deep venous thrombosis, pulmonary embolisms or paresthesia. Results The literature search identified 759 records, of which 13 were included, describing 10 unique cohorts. A total of 1521 veins (1267 great saphenous vein and 254 small saphenous vein) were included, with cohort sizes ranging from 30 to 570 veins. The pooled anatomical success rate after short-term follow up was 92% (95% CI 90-94%) ( n = 1314 veins). After 6 and 12 months these numbers were 92% (95% CI 88-95%) ( n = 284) and 91% (95% CI 86-94%) ( n = 228), respectively. The long-term anatomical success rates at 2 and 3 years were 91% (95% CI 85-95%) ( n = 136) and 87% (95% CI 75-94%) ( n = 48), respectively. Major complications and especially nerve injury were very rare (≤ 0.2%). All studies were of moderate or good quality using the MINORS scoring scale. Conclusions Mechanochemical endovenous ablation using the ClariVein in combination with liquid sclerosant is associated with an anatomical success rate ranging from 87% to 92% and good clinical success. To date, no randomized controlled trials are available studying the anatomical success after mechanochemical ablation, compared to the endothermal ablation. The risk of major complications is very low after the procedure.
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Affiliation(s)
- Marianne E Witte
- 1 Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands
| | - Clark J Zeebregts
- 2 Department of Surgery (Division of Vascular Surgery), University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Gert Jan de Borst
- 3 Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands
| | | | - Doeke Boersma
- 3 Department of Vascular Surgery, University Medical Center, Utrecht, The Netherlands.,4 Department of Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
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Nakayama M. The Incidence, Clinical Importance and Management of Incompetent Gastrocnemius Vein. Ann Vasc Dis 2016; 9:35-41. [PMID: 27087871 DOI: 10.3400/avd.oa.15-00105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2015] [Accepted: 02/04/2016] [Indexed: 11/13/2022] Open
Abstract
PURPOSE To report the incidence, clinical importance and management of the incompetent gastrocnemius vein. METHODS The incompetency was examined by duplex and pulse-Doppler ultrasound at the popliteal fossa in a standing position between July 2006 and August 2014. RESULTS Among 1805 legs surveyed, 14 legs showed primary incompetent gastrocnemius vein (0.78%). The incompetency was in medial gastrocnemius vein in 13 legs (93%). Clinical manifestation was varicose vein in the small saphenous territory in nine, varicose vein in great saphenous territory in one, congestive dermatitis in two, calf clamp in one and no symptom in one. The nine cases with varicose vein in the small saphenous territory received surgical management. These included three cases with residual varicose veins after saphenopopliteal disconnection and stripping small saphenous vein. The root of the gastrocnemius vein was divided leaving no complication. In cases without varicose vein in small saphenous territory, an elastic compression socks was useful in some degree. CONCLUSIONS Incompetency of gastrocnemius vein was not so rare. When a case is accompanied by small saphenous varicose veins, division of the root of gastrocnemius vein along with small saphenous vein stripping is recommended in order to reduce residual varicose vein.
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Affiliation(s)
- Mitsuyuki Nakayama
- Department of Vascular Surgery, Kanoiwa Hospital, Kamikanogawa, Yamanashi, Yamanashi, Japan
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14
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Boersma D, Kornmann VNN, van Eekeren RRJP, Tromp E, Ünlü Ç, Reijnen MMJP, de Vries JPPM. Treatment Modalities for Small Saphenous Vein Insufficiency: Systematic Review and Meta-analysis. J Endovasc Ther 2015; 23:199-211. [PMID: 26564912 DOI: 10.1177/1526602815616375] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein (SSV) incompetence. METHODS A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on the following therapies for incompetence of SSVs: surgery, endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), steam ablation, and mechanochemical endovenous ablation (MOCA). The search found 49 articles (5 randomized controlled trials, 44 cohort studies) reporting on the different treatment modalities: surgery (n=9), EVLA (n=28), RFA (n=9), UGFS (n=6), and MOCA (n=1). A random-effects model was used to estimate the primary outcome of anatomical success, which was defined as closure of the treated vein on follow-up duplex ultrasound imaging. The estimate is reported with the 95% confidence interval (CI). Secondary outcomes were technical success and major complications [paresthesia and deep vein thrombosis (DVT)], given as the weighted means. RESULTS The pooled anatomical success rate was 58.0% (95% CI 40.9% to 75.0%) for surgery in 798 SSVs, 98.5% (95% CI 97.7% to 99.2%) for EVLA in 2950 SSVs, 97.1% (95% CI 94.3% to 99.9%) for RFA in 386 SSVs, and 63.6% (95% CI 47.1% to 80.1%) for UGFS in 494 SSVs. One study reported results of MOCA, with an anatomical success rate of 94%. Neurologic complications were most frequently reported after surgery (mean 19.6%) and thermal ablation (EVLA: mean 4.8%; RFA: mean 9.7%). Deep venous thrombosis was a rare complication (0% to 1.2%). CONCLUSION Endovenous thermal ablation (EVLA/RFA) should be preferred to surgery and foam sclerotherapy in the treatment of SSV incompetence. Although data on nonthermal techniques in SSV are still sparse, the potential benefits, especially the reduced risk of nerve injury, might be of considerable clinical importance.
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Affiliation(s)
- Doeke Boersma
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Verena N N Kornmann
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Ellen Tromp
- Department of Epidemiology and Statistics, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Çagdas Ünlü
- Department of Vascular Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
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15
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Natsis K, Paraskevas G, Lazaridis N, Sofidis G, Piagkou M. Giacomini vein: thigh extension of the small saphenous vein - report of two cases and review of the literature. Hippokratia 2015; 19:263-265. [PMID: 27418788 PMCID: PMC4938476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Varicose vein surgery is very commonly performed. Also, it is very frequently employed for recurrent disease. The recognition of the normal or variant veins, inducing incompetency, is a prerequisite for effective treatment. The thigh extension of the small saphenous vein, the so-called Giacomini vein, was extensively described in 1873 by Carlo Giacomini in an incidence of 72%. However, such a vein is usually underestimated in classic surgical textbooks. DESCRIPTION OF CASES We present two cases of Giacomini vein found in two cadavers, dissected for academic purposes in the Department of Anatomy, where the small saphenous vein displayed a thigh extension without terminating into the popliteal vein. In one case Giacomini vein drained into the large saphenous vein, while in the other case the vein divided into two branches, separately draining into the large saphenous vein and the subcutaneous tissue of the gluteal region. CONCLUSION Due to the fact that Giacomini vein could be incompetent, associated with or without varicose saphenous vein trunks, the vascular surgeon should keep in mind that anatomical entity, to include it in preoperative ultrasound scanning control. Moreover, this vein could be utilized as an autologous graft, when the large saphenous is not available. Hippokratia 2015; 19 (3): 263-265.
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Affiliation(s)
- K Natsis
- Department of Anatomy, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki Greece
| | - G Paraskevas
- Department of Anatomy, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki Greece
| | - N Lazaridis
- Department of Anatomy, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki Greece
| | - G Sofidis
- Department of Anatomy, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki Greece
| | - M Piagkou
- Department of Anatomy, Medical School, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki Greece
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Lekich C, Parsi K. Heterotopic ossification of small saphenous vein and panniculitis ossificans of chronic venous insufficiency presenting with livedo racemosa. Phlebology 2013; 29:401-6. [PMID: 23846577 DOI: 10.1177/0268355513495829] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Livedo racemosa is a reticulate eruption that presents with branched and partially blanchable incomplete rings. Livedo racemosa is distinct from livedo reticularis, a similar condition that presents with a diffuse and symmetrical blanchable eruption. In contrast to livedo reticularis which may be physiological, livedo racemosa is always associated with an underlying pathology. To our knowledge, this is the first report of panniculitis ossificans and heterotopic ossification of small saphenous vein (SSV) presenting with livedo racemosa. METHODS We present a 70-year-old male referred for investigation and management of progressive pigmentation and 'lipodermatosclerosis' of lower limbs. There was no history of deep venous thrombosis but an earlier ultrasound had detected a non-occlusive thrombus in the left SSV. Examination and investigations revealed the skin eruption to be livedo racemosa and the associated subcutaneous induration and nodularity to be due to panniculitis ossificans. Biopsy of the SSV demonstrated segmental heterotopic ossification. Duplex ultrasound demonstrated bilateral superficial and deep venous incompetence but no evidence of an acute or chronic venous thrombosis. The patient was diagnosed with heterotopic ossification secondary to venous insufficiency and managed conservatively. CONCLUSION Livedo racemosa may be an early sign of panniculitis ossificans and its presence should trigger further diagnostic investigations.
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Affiliation(s)
| | - Kurosh Parsi
- Department of Dermatology, St. Vincent's Hospital, Sydney, Australia University of New South Wales, Sydney, Australia
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