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ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 2  |  Page : 115-117

A morphometric study of arch of the great saphenous vein and its clinical significance


Department of Anatomy, Kasturba Medical College, Manipal University, Manipal, Karnataka, India

Date of Web Publication5-Jul-2016

Correspondence Address:
Chandni Gupta
Department of Anatomy, Kasturba Medical College, Manipal University, Manipal - 576 104, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.185440

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  Abstract 

Objective: Varicosities in the lower limbs are the most important afflictions of the venous system, as well as of the peripheral vascular disorders. They are always caused by a fault in the valves inside the veins at the point where the superficial veins communicate with the deep veins. If the valve leaks, the blood flows backwards and this increases the pressure in the superficial veins, which, as blood stagnates, becomes swollen and varicose. The treatment of these varicose veins is surgery, for which the surgeons should have a sound knowledge of the anatomy of the great saphenous vein (GSV). So, the aim of our study was to establish palpable anatomical markers for its exploration and surgical approach.
Materials and Methods: In this study, 25 inguinofemoral regions of lower limbs were dissected. After exposing the arch of the GSV, we took the following measurements using a calliper - the distance separating the top of the arch of the GSV a) from the ventral-cranial iliac spine, b) from the pubic tubercle, and c) from the inguinal ligament. Statistical analysis of the measurements was done.
Results: The mean distance of the arch of the GSV from the ventral cranial iliac spine, pubic tubercle, and the inguinal ligament was 9.46 cm, 4.66 cm, and 2.75 cm respectively. In addition, we found in one case a duplication of the GSV just above the knee.
Conclusion: These measurements will help the surgeons in identifying the arch of the GSV before it opens into the anterior-internal surface of the femoral vein.

Keywords: Arch of the great saphenous vein, duplication, inguinal ligament, pubic tubercle, ventral cranial iliac spine


How to cite this article:
Gupta C, D'Souza AS. A morphometric study of arch of the great saphenous vein and its clinical significance. J NTR Univ Health Sci 2016;5:115-7

How to cite this URL:
Gupta C, D'Souza AS. A morphometric study of arch of the great saphenous vein and its clinical significance. J NTR Univ Health Sci [serial online] 2016 [cited 2022 Jan 19];5:115-7. Available from: https://www.jdrntruhs.org/text.asp?2016/5/2/115/185440


  Introduction Top


The venous drainage of the lower limb is divided into a superficial venous system and a deep venous system. The superficial veins run in the subcutaneous tissue, and the deep veins are deep to the deep fascia and they run along with all main arteries as venae comitantes. Superficial and deep veins have valves that are more abundant inside the deep veins. [1]

The superficial venous system of the lower limbs is represented by the great saphenous vein (GSV) (long saphenous vein), the small saphenous vein (lesser saphenous vein), and their tributaries. The superficial and deep venous systems are connected with each other by the perforating veins. [1]

The GSV is referred to be the longest vein in the body, maybe only because it does not change its name from one zone of the lower limb to the other. [1] At the femoral triangle, the GSV describes a curve with a lower concavity, making its arch. It then crosses the saphenous hiatus before flowing into the anterior-internal surface of the femoral vein. [2]

Varicosities in the lower limbs are one of the most significant conditions of the venous system. Varicose veins are abnormally tortuous (dilated, swollen) veins that are noticeable just underneath the skin surface, especially on the erect position. They are always caused by a fault in the one-way valves inside the veins at the point where the superficial veins are connected with the deep veins. Varicose veins are common in the posteromedial parts of the leg. [1]

So, the aim of our study was to establish palpable anatomical markers for its exploration and surgical approach and to look for any variation in the GSV.


  Materials and methods Top


In this study, 25 inguinofemoral regions of lower limbs were dissected. The incision was given on the medial side of the thigh from the inguinal ligament to the medial surface of the knee and then to the medial side of the leg till the ankle. The skin was reflected and the superficial fascia was cleaned up to expose the GSV. After exposing the arch of the GSV, we took the following measurements using a calliper.

The distance separating the top of the arch of the GSV:

  1. From the ventral-cranial iliac spine,
  2. From the pubic tubercle, and
  3. From the inguinal ligament [Figure 1].
Figure 1: Showing the measurement of arch of the great saphenous vein (GSV) from the 1. Ventral cranial iliac spine (VCIS), 2. Mid-point of inguinal ligament (IL) and 3. Pubic tubercle (PT)

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Any variation in the GSV was additionally noted and photographed.

Statistical analysis of the measurements was done.


  Results Top


The mean distance with standard deviation and range of arch of the GSV from the ventral cranial iliac spine, pubic tubercle, and the inguinal ligament is shown in [Table 1].
Table 1: Showing The Mean, SD And Range of All Distances of Arch of The Great Saphenous Vein From Various Bony Landmarks

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We found as well in one case there was duplication of the GSV in the thigh. The second vein was arising from the original GSV just above the knee and was running parallel to the original one in whole of the thigh and was draining into the femoral vein at the same place along with the normal one [Figure 2].
Figure 2: Showing duplication of great saphenous vein in the thigh region. GSV = Great saphenous vein, Double GSV = Double great saphenous vein, SA = Sartorius

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  Discussion Top


Ass Ndiaye et al. (2005) found the top of the arch of the GSV was projected out 10.88 cm from the ventral and cranial iliac spine, 3.83 cm from the pubic tubercle, and 4.19 cm from the inguinal ligament. [2]

But in the present study, we found the mean distance of arch of the GSV from the ventral cranial iliac spine, pubic tubercle, and the midpoint of inguinal ligament was 9.46 cm, 4.66 cm, and 2.75 cm respectively.

In our study, the distance from the inguinal ligament is different from theirs because they measured it just above the ring but we measure it from the mid-inguinal point that is more reliable than theirs.

Kaiser et al. (1993) found a double-system in 25% of 20 GSVs. [3] Ruoff et al. (1987) found 18% duplication in 102 limbs. [4] Buchbinder et al. (1987) found a duplicate system in one of the 15 patients. [5] Kupinski et al. (1993) found a branching double system in 8% of 1,400 limbs. [6] Head et al. (1995) demonstrated a duplicated system in 11 of 100 patients. [7] Van Dijk et al. (1996) demonstrated a duplication of the GSV in 20% of 44 patients. [8] Ricci et al. (1999) found a true duplication in 1% of 610 patients. [9] Klitfod and Baekgaard (2003) found a duplication of the GSV in four of 44 patients. [10] Kockaert et al. (2012) stated that now duplex is regarded as the criterion standard for accurate detection of the veins. True duplication of the GSV is less common than the previous literature has suggested, namely 1.6-2%. In addition, he recommended that the duplicated GSV should be treated to avoid an important risk of recurrence of venous insufficiency. [11]

Corrales et al. (2002) found 49% forms of duplications out of 103 phlebographies and only one patient with a true duplication in the thigh and another patient with duplication in the calf. [12]

Haythem A Al-Sayigh (2009) found in 20% of cases, the GSV was doubled, 10% in the calf, and 10% in the thigh. [1]

In our study, we additionally got one duplication of GSV only in the thigh out of 25 cases.

The GSV has a significant part as an autograft for arterial bypass operation; as a result, its anatomical variations, including duplication, received great attention. Reports that mention that saphenous vein duplication is fairly common, have done so as part of preoperative vein assessment before arterial bypass operation; however, there are probable implications as well for recurrence; subsequently varicose vein operation arising from a persistent trunk of a duplicated GSV; however, this could only be established by a future study. [1]


  Conclusion Top


The arch of the GSV shows abundant variations relating to the number and manner of anastomosis of its confluents. The setting out of permanent signs made up by the ventral-cranial iliac spine, the inguinal ligament, and the pubic tubercle, combined with the data on anatomical variations, allows meticulous, atraumatic operation helping to avoid relapses and to avoid or reduce the consequences.

The measurement that we have done from various bony landmarks will, in addition, be helpful for surgeons who are doing surgery for varicose veins.

Financial support and sponsorship

There is no financial help from the organizing research committee.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Al-Sayigh HA. The incidence of double great saphenous vein among Iraqi people: Case series study. Med J Babylon 2014;6:2.  Back to cited text no. 1
    
2.
Ndiaye A, Ndiaye A, Ndoye JM, Diarra O, Diop M, Dia A, et al. The arch of the great saphenous vein: Anatomical bases for failures and recurrences after surgical treatment of varices in the pelvic limb. About 54 dissections. Surg Radiol Anat 2006;28:18-24.  Back to cited text no. 2
    
3.
Kaiser A, Duff C, Scherrer C, Enzler M, Hauser M, Brunner U. Proximo-distal course of the diameter of the great saphenous vein and distribution of the number of side branches as an inherent difficulty in infra-inguinal arterial in situ bypass. Helv Chir Acta 1993;59:893-6.  Back to cited text no. 3
    
4.
Ruoff BA, Cranley JJ, Hannan LA, Aseffa N, Karkow WS, Stedje KG, et al. Real-time duplex ultrasound mapping of the greater saphenous vein before in situ infrainguinal revascularization. J Vasc Surg 1987;6:107-13.  Back to cited text no. 4
    
5.
Buchbinder D, Semrow C, Friedell ML, Ryan T, Calligaro K, Rollins D. B-mode ultrasonic imaging in the preoperative evaluation of saphenous vein. Am Surg 1987;53:368-72.  Back to cited text no. 5
    
6.
Kupinski AM, Evans SM, Khan AM, Zorn TJ, Darling RC 3 rd , Chang BB, et al. Ultrasonic characterization of the saphenous vein. Cardiovasc Surg 1993;1:513-7.  Back to cited text no. 6
    
7.
Head HD, Brown MF. Preoperative vein mapping for coronary artery bypass operations. Ann Thorac Surg 1995;59:144-8.  Back to cited text no. 7
    
8.
van Dijk LC, Wittens CH, Pieterman H, van Urk H. The value of pre-operative ultrasound mapping of the greater saphenous vein prior to ′closed′ in situ bypass operations. Eur J of Radiol 1996;23:235-7.  Back to cited text no. 8
    
9.
Ricci S, Caggiati A. Does a double long saphenous vein exist? Phlebology 1999;14:59-64.  Back to cited text no. 9
    
10.
Klitfod L, Baekgaard N. Treatment of recurrent varices in the region of the long saphenous vein. A follow-up study. Ugeskr Laeger 2003;165:3013-5.  Back to cited text no. 10
    
11.
Kockaert M, de Roos KP, van Dijk L, Nijsten T, Neumann M. Duplication of the great saphenous vein: A definition problem and implications for therapy. Dermatol Surg 2012;38:77-82.  Back to cited text no. 11
    
12.
Corrales NE, Irvine A, McGuiness R, Dourado R, Burnand KG. Incidence and pattern of long-saphenous vein duplication and its possible implications for recurrence after varicose vein surgery. Br J Surg 2002;89:323-6.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1]


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