Great saphenous vein dilatation with reflux at the saphenofemoral junction: A rare underlying association of eccrine angiomatous hamartoma

Objective To describe the mid-term outcome after inferior selective crossectomy in a subset of patients with symptomatic chronic venous disease and both great saphenous vein and suprasaphenic valve incompetence. Methodsː Retrospective analysis of prospectively collected data was conducted. During an eight-year period, 1095 ligations of all saphenofemoral junction inferior tributaries and great saphenous vein stripping were performed in 814 Clinical, Etiology, Anatomy, Pathophysiology C2–C6 patients. Duplex ultrasound follow-up examinations were performed after 30 days, 6 months, and 2 years, and saphenofemoral junction hemodynamic patterns and varicose veins recurrence rates were evaluated. Results Two hundred and twenty patients completed the two-year follow-up period. At the 30-day Duplex ultrasound evaluations, two different hemodynamic patterns were described. Type 1, with physiological drainage of saphenofemoral junction superior tributaries, was observed in 214 patients. Type 2, without flow in saphenofemoral junction superior tributaries, was observed in six patients. Overall varicose vein recurrence rates were 0, 2.3, and 2.7% at the 30-day, 6-month, and 2-year follow-up examinations, respectively. At the two-year follow-up, Type 1 patients showed 0% varicose vein recurrence, while Type 2 patients showed 100%. Conclusionsː Inferior selective crossectomy seems to be a valid and safe option in case of both suprasaphenic valve and great saphenous vein incompetence. Duplex ultrasound evaluation, according to our protocol, allows us to identify two different saphenofemoral junction hemodynamic patterns that could predict varicose vein recurrence at mid-term. An optimal stump washing after inferior selective crossectomy, warranted by patency and large caliber saphenofemoral junction superior tributaries, seems to be the key point in preventing varicose vein recurrence in this context. However, large prospective studies regarding saphenofemoral junction modifications and varicose vein recurrence are needed to confirm these preliminary observations.

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Saphenofemoral recurrence from an an anatomist’s point of view

Phlebologie ◽

10.1055/a-1154-9122 ◽

2020 ◽

Vol 49 (03) ◽

pp. 133-138

Author(s):

Erich Brenner

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Point Of View ◽

Junction Region ◽

Anatomical Point ◽

Saphenofemoral Junction

AbstractFrom an anatomical point of view, recurrences at the saphenofemoral junction (SFJ) could result from various sources. For one, it could be caused by a recanalisation of an originally occluded great saphenous vein (GSV). Secondly, another vein in the junction region could take over the function of the GSV and dilate. A third variation is a – more or less successful – generation of a new vein. In the last case, a sufficient vein could be generated, an insufficient vein could arise, or an inadequate venous regeneration, so that a cluster of frail but incomplete vasculature remains (neovasculature).

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New Concept: Different Types of Insufficiency of the Saphenofemoral Junction Identified by Duplex as a Chance for a More Differentiated Therapy of the Great Saphenous Vein

Phlebology The Journal of Venous Disease ◽

10.1177/0268355513476215 ◽

2013 ◽

Vol 28 (5) ◽

pp. 268-274 ◽

Cited By ~ 14

Author(s):

M Stücker ◽

R Moritz ◽

P Altmeyer ◽

S Reich-Schupke

Keyword(s):

Clinical Practice ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Effective Therapy ◽

Optimal Therapy ◽

Different Types ◽

Type 3 ◽

Saphenofemoral Junction

Even though the item ‘saphenofemoral junction’ (SFJ) is anatomically well defined, the incontinence of the SFJ is often incompetently described in clinical practice and studies. Especially with regard to the optimal therapy of the great saphenous vein, it might be of importance to have a more distinct regard to the SFJ as it is known that about 10–30% of the saphenous refluxes have no femoral origin. Considering the terminal and preterminal valve three types of incompetence of the SFJ may be differentiated: Type 1: Incompetent terminal, but competent preterminal valve; Type 2: Competent terminal, but incompetent preterminal valve; Type 3: Incompetent terminal and preterminal valve (complete incompetence). A review on prior studies and reports leads to the assumption that the differentiation of the distinct types of SFJ-incompetence allows a more individual and – perhaps – more effective therapy. Finally, studies are necessary to evaluate the here given new concept.

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Great Saphenous Vein Diameter at the Saphenofemoral Junction and Proximal Thigh as Parameters of Venous Disease Class

European Journal of Vascular and Endovascular Surgery ◽

10.1016/j.ejvs.2012.10.014 ◽

2013 ◽

Vol 45 (1) ◽

pp. 76-83 ◽

Cited By ~ 47

Author(s):

E. Mendoza ◽

W. Blättler ◽

F. Amsler

Keyword(s):

Saphenous Vein ◽

Great Saphenous Vein ◽

Venous Disease ◽

Disease Class ◽

Vein Diameter ◽

Proximal Thigh ◽

Saphenofemoral Junction

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The relation among the diameter of the great saphenous vein, clinical state and haemodynamic pattern of the saphenofemoral junction in chronic superficial venous insufficiency

Phlebology The Journal of Venous Disease ◽

10.1258/026835507782101654 ◽

2007 ◽

Vol 22 (5) ◽

pp. 207-213 ◽

Cited By ~ 15

Author(s):

A Mdez-Herrero ◽

J Gutiérrez ◽

L Camblor ◽

J Carreño ◽

J Llaneza ◽

...

Keyword(s):

Surgical Approach ◽

Saphenous Vein ◽

Chronic Venous Insufficiency ◽

Venous Insufficiency ◽

Great Saphenous Vein ◽

Clinical State ◽

Control Group ◽

Superficial Venous Insufficiency ◽

Saphenofemoral Junction

Objective: To find out if there is a relation among the diameter of the great saphenous vein (GSV) when it is incompetent, the clinical gravity of the varicose syndrome and the type of insufficiency of the saphenofemoral junction (SFJ) in patients with chronic venous insufficiency (CVI) by means of duplex exploration. Methods: The sample included 145 extremities, 38 normal as a control group and 107 with incompetence of the GSV. According to the results of the Valsalva and Parana manoeuvres in the SFJ, they were distributed into four groups. The diameter of the GSV and the clinical state according to the clinical, aetiological, anatomical and pathological element classification were recorded for each group. Results: Statistically significant differences were obtained for the diameter and the clinical state in patients with positive manoeuvres with regard to other groups. The diameter was greater and the clinical state more severe (C4, C5 and C6) when two manoeuvres were positive. Conclusions: The presence of both positive manoeuvres in the SFJ is related to severe clinical states and greater diameters of the GSV, allowing the establishment of a prognosis of the CVI and the most suitable surgical approach.

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