Anatomical Variations of the Saphenofemoral Junction in Patients with Varicose Veins
Varicose veins are an extremely common medical condition (present in 5-30% of adults). Surgery remains the gold standard of care in patients with varicose veins, however several newer interventions have been recently introduced which need to be evaluated. During the standard surgery it is imperative to demonstrate and ligate the tributaries of the saphenofemoral junction in combination with stripping of the great saphenous vein. We studied 228 patients with varicose veins who underwent surgery during two years. The number and name of tributaries at the saphenofemoral junction, presence of external pudendal artery and its relationship to the saphenofemoral junction were recorded. The number of tributaries varied from 2 to 7 at the first five centimeters of the great saphenous vein. The average number of branches was 3.87 and the most common branch was the superficial external pudendal vein. The external pudendal artery was identified during all surgical exploration. It crossed anterior to saphenofemoral junction in 39.5% and posterior in 60.5%. Anatomical variations in venous branches at the saphenofemoral junction are varied (from 2 to 7), so it is recommended to explore the location of varicose veins precisely to ensure appropriate surgical technique.
Raffetto J, Eberhardt RT. Chronic venous disorders: General considerations. In: Cronenwett JL, Johnston W, editors. Rutherford's Vascular Surgery. 7th ed. Philadelphia, PA: Saunders Elsevier; 2010. p. 831-40.
Brunicardi FC, Brandt ML, Andersen DK, Billiar TR,Dunn DL, Hunter JG, Matthews JB, Pollock RE. Schwartz's Principles of Surgery. 9th ed. New York: McGraw-Hill; 2010. p. 791-5.
Freischlag JA, Heller JA. Venous disease. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, editors. Sabiston Textbook of Surgery. 18th ed. Philadelphia, PA: Saunders Elsevier; 200. p. 2002-19.
Henke PK. Venous pathology. In: Cronenwett JL, Johnston W, editors. Rutherford's Vascular Surgery. 7th ed. Philadelphia, PA: Saunders Elsevier; 2010. p. 171-2.
Nael R, Rathbun S. Treatment of varicose veins. Curr Treat Options Cardiovasc Med 2009;11(2):91-103.
Nijsten T, van den Bos RR, Goldman MP, Kockaert MA,Proebstle TM, Rabe E, Sadick NS, Weiss RA, Neumann MH. Minimally invasive techniques in the treatment of saphenous varicose veins. J Am Acad Dermatol 2009;60(1):110-9.
Jadavji R, Stephenson J, Arshad A, Al-Leswas D,McCarthy MJ. Varicose veins. InnovAiT 2010;3(10):562-9.
Perkins JM. Standard varicose vein surgery. Phlebology 2009;24 (Suppl 1):34-41.
Donnelly M, Tierney S, Feeley TM. Anatomical variation at the saphenofemoral junction. Br J Surg 2005;92(3):322-5.
Pourhassan S, Zarras K, Mackrodt HG, Stock W. Recurrent varicose veins. Surgical procedure: results.Zentralbl Chir 2001;126(7):522-5.
Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, Schuller-Petrovic S, Sessa C. Prospectiverandomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation andstripping in a selected patient population (EVOLVeS Study). J Vasc Surg 2003;38(2):207-14.
Pichot O, Sessa C, Chandler JG, Nuta M, Perrin M. Role of duplex imaging in endovenous obliteration for primary venous insufficiency. J Endovasc Ther 2000;7(6):451-9.
La Falce OL, Ambrosio JD, Souza RR. The anatomy of thesuperficial external pudendal artery: a quantitative study. Clinics (Sao Paulo) 2006;61(5):441-4.
Henriet JP. Sapheno-femoral venous confluence and theexternal pudendal network: anatomical data and new statistics. Phlebologie 1987;40(3):711-35.
Bradbury AW, Stonebridge PA, Ruckley CV, Beggs I.Recurrent varicose veins: correlation between preoperativeclinical and hand-held Doppler ultrasonographicexamination, and anatomical findings at surgery. Br J Surg1993;80(7):849-51.
Lees T, Singh S, Beard J, Spencer P, Rigby C. Prospective audit of surgery for varicose veins. Br J Surg 1997;84(1):44-6.
Nabatoff RA. Simple palpation to detect vulvular incompetence in patients with varicose veins. J Am MedAssoc 1955;159(1):27-8.
Köroglu M, Eris HN, Aktas AR, Kayan M, Yeşildağ A, Cetin M, Parlak C, Gürses C, Akhan O. Endovenous laser ablation and foam sclerotherapy for varicose veins: does the presence of perforating vein insufficiency affect the treatment outcome? Acta Radiol 2011;52(3):278-84.