The Great Saphenous Vein

The Great Saphenous vein is scanned from the groin in proximal-to-distal direction.

In the thigh, the GSV lies within the saphenous compartment (see Figure 18.5).19 The superficial fascia and the muscular fascia define the saphenous compartment and provide the typical ultrasound image of an Asian eye (see Figure 18.5c).25

Anterior and posterior accessory veins are often identified in the thigh (see Figure 18.6). These veins are often incompetent and receive reflux from the saphenous vein.19 Varying patterns of reflux through the different components of the SFJ and GSV system have been documented. Classification of abnormal, refluxing venous patterns has been a difficult task because of the anatomic variability of the vascular structures involved. In 2005 a panel of experts proposed a new classification of Great Saphenous vein reflux. This classification is shown in Figure 18.7.26,27

Saphenofemoral Junction Diagram

FIGURE 18.4 A. The saphenofemoral junction includes the Great Saphenous vein, the superficial iliac circumflex, the superficial epigastric, and the pudendal veins. B. Illustration of the SFJ with its valves. Modified from the De Venarum Ostiolis, of Jeronimus Fabricius Ab Acquapendente, Venice, 1603. TV, terminal valve; PTV, preterminal valve; SSV, suprasaphenic valve; ISV, infrasaphenic valve. (Adapted from Caggiati et al.25)

FIGURE 18.4 A. The saphenofemoral junction includes the Great Saphenous vein, the superficial iliac circumflex, the superficial epigastric, and the pudendal veins. B. Illustration of the SFJ with its valves. Modified from the De Venarum Ostiolis, of Jeronimus Fabricius Ab Acquapendente, Venice, 1603. TV, terminal valve; PTV, preterminal valve; SSV, suprasaphenic valve; ISV, infrasaphenic valve. (Adapted from Caggiati et al.25)

Saphenofemoral Valve

FIGURE 18.5 A. The saphenous compartment (SaphC) is bound superficially by the saphenous fascia (SF) and deeply by the muscular fascia (MF). It contains the saphenous veins (SV) and the saphenous nerve (SN). The accessory saphenous veins (ASV) lie external to this compartment, close to the dermis (D). SC, superficial compartment; DC, deep compartment. (Adapted from Reference 19.) B. Axial section from a cadaveric limb. The Great Saphenous vein enclosed in the saphenous compartment is clearly visualized. MF, muscular fascia; SL saphenous ligament. (Adapted from Reference 25.) C. Sonography of the Great Saphenous vein at mid thigh. The hyperechoic saphenous fascia (SF) and muscular fascia (MF) define the saphenous compartment in which the Great Saphenous vein courses.

FIGURE 18.5 A. The saphenous compartment (SaphC) is bound superficially by the saphenous fascia (SF) and deeply by the muscular fascia (MF). It contains the saphenous veins (SV) and the saphenous nerve (SN). The accessory saphenous veins (ASV) lie external to this compartment, close to the dermis (D). SC, superficial compartment; DC, deep compartment. (Adapted from Reference 19.) B. Axial section from a cadaveric limb. The Great Saphenous vein enclosed in the saphenous compartment is clearly visualized. MF, muscular fascia; SL saphenous ligament. (Adapted from Reference 25.) C. Sonography of the Great Saphenous vein at mid thigh. The hyperechoic saphenous fascia (SF) and muscular fascia (MF) define the saphenous compartment in which the Great Saphenous vein courses.

Diameters of the GSV at several levels should always be recorded. The term superficial venous aneurysms has been proposed for segmental dilations of the GSV and Small Saphenous vein (SSV).28 The term varicosities refers to more elongated and dilated superficial veins, such as the accessory saphenous veins (see Figure 18.8). The level, distance from the heel pad or floor, and antero-posterior and latero-lateral diameters of venous aneurysms should be recorded.28

In the leg, anterior and posterior arch veins can ascend parallel to the GSV (see Figure 18.6).19

Inter-saphenous veins are often present as communications between the GSV and Small Saphenous vein (SSV).

Accessory Saphenous Vein

FIGURE 18.6 In 2005, a panel of experts proposed a new classification to be used in a prospective multicenter study testing the A.S.V.A.L. (selective ablation of varicose veins in local anesthesia) method. The classification reports five major types of saphenofemoral reflux. The recognition of each of them can guide different therapeutic approaches, such as the A.S.V.A.L. (Adapted from Pittaluga et al.2627)

FIGURE 18.6 In 2005, a panel of experts proposed a new classification to be used in a prospective multicenter study testing the A.S.V.A.L. (selective ablation of varicose veins in local anesthesia) method. The classification reports five major types of saphenofemoral reflux. The recognition of each of them can guide different therapeutic approaches, such as the A.S.V.A.L. (Adapted from Pittaluga et al.2627)

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