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Functional Anatomy of Leg Veins

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Saphenous Vein-Sparing Strategies in Chronic Venous Disease

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Abstract

Varicose veins generate on superficial leg veins as primary illness or secondary to deep vein insufficiency. This chapter focusses on the aspects of superficial vein anatomy related to saphenous vein sparing surgery: relations, origin and drainage of the saphenous veins; principal tributaries, perforators and deep veins; as well as the implications of the venous compartments in the function of the system. Another focus is on the newest histological evidence concerning the vein wall and the consequences for pathology and for venous disease treatment.

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Literature

  1. Bergan JJ. Common anatomic patterns of varicose veins. In: Goldmann MP, Weiss RA, Bergan JJ, editors. Varicose veins and telangiectasias. St Louis: Quality Medical Publishing Inc; 1999. p. 70–86.

    Google Scholar 

  2. Cavezzi A, Labropoulos N, Partsch H, Ricci S, Caggiati A, Myers K, Nicolaides A, Smith P. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs—UIP consensus document. Part II. Anatomy. Eur J Vasc Endovasc Surg. 2006;31(3):288–99.

    Article  CAS  PubMed  Google Scholar 

  3. Mendoza E, Lattimer CR, Morrison N. Duplex ultrasound of superficial leg veins. Berlin: Springer; 2014.

    Book  Google Scholar 

  4. Tillaux P. Traité d’Anatomie Topograpique avec applications a la Chirurgie. Neuvième ed. Paris: Asselin et Houzeau Editeurs; 1897. p. 1011–73.

    Google Scholar 

  5. Franceschi C. Théorie et Pratique de la Cure Conservatrice et Hémodynamique de l’Insuffisance Veineuse en Ambulatoire, Précy-sous-Thil 1988 (Armançon).

    Google Scholar 

  6. Zamboni P, Cappelli M, Marcellino MC, Murgia AP, Pisano L, Fabi P. Does a varicose saphenous vein exist? Phlebology. 1997a;12:74–7.

    Article  Google Scholar 

  7. Zamboni P, Portaluppi F, Marcellino MG, Manfredini R, Pisano L, Liboni A. Ultrasonographic assessment of ambulatory venous pressure in superficial venous incompetence. J Vasc Surg. 1997b;26(5):796–802.

    Article  CAS  PubMed  Google Scholar 

  8. Caggiati A. Fascial relations and structure of the tributaries of the saphenous veins. Surg Radiol Anat. 2000;22:1–4.

    Article  Google Scholar 

  9. Caggiati A. Fascial relationships of the short saphenous vein. J Vasc Surg. 2001;34:241–6.

    Article  CAS  PubMed  Google Scholar 

  10. Caggiati A, Ricci S. The long saphenous vein compartment. Phlebology. 1999;12:107–11.

    Article  Google Scholar 

  11. Caggiati A, Ricci S. The caliber of the human long saphenous vein and its congenital variations. Ann Anat. 2000;182:1–7.

    Article  Google Scholar 

  12. Ricci S, Caggiati A. Does a double long saphenous vein exist? Phlebology. 1999;14:59–64.

    Article  Google Scholar 

  13. Caggiati A, Bergan JJ, Gloviczki P, Jantet G, Wendell-Smith CP, Partsch H. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg. 2002;36:416–22.

    Article  PubMed  Google Scholar 

  14. Lee BB, Nicolaides AN, Myers K, Meissner M, Kalodiki E, Allegra C, Antignani PL, Bækgaard N, Beach K, Belcaro G, Black S, Blomgren L, Bouskela E, Cappelli M, Caprini J, Carpentier P, Cavezzi A, Chastanet S, Christenson JT, Christopoulos D, Clarke H, Davies A, Demaeseneer M, Eklöf B, Ermini S, Fernández F, Franceschi C, Gasparis A, Geroulakos G, Gianesini S, Giannoukas A, Gloviczki P, Huang Y, Ibegbuna V, Kakkos SK, Kistner R, Kölbel T, Kurstjens RL, Labropoulos N, Laredo J, Lattimer CR, Lugli M, Lurie F, Maleti O, Markovic J, Mendoza E, Monedero JL, Moneta G, Moore H, Morrison N, Mosti G, Nelzén O, Obermayer A, Ogawa T, Parsi K, Partsch H, Passariello F, Perrin ML, Pittaluga P, Raju S, Ricci S, Rosales A, Scuderi A, Slagsvold CE, Thurin A, Urbanek T, M VAN Rij A, Vasquez M, Wittens CH, Zamboni P, Zimmet S, Ezpeleta SZ. Venous hemodynamic changes in lower limb venous disease: the UIP consensus according to scientific evidence. Int Angiol. 2016;35(3):236–352. Epub 2016 Mar 24. PubMed PMID: 27013029

    PubMed  Google Scholar 

  15. Meissner MH. Lower extremity venous anatomy. Semin Intervent Radiol. 2005;22(3):147–56.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Franceschi C, Zamboni P. Principles of venous haemodynamics. New York: Nova Science; 2010.

    Google Scholar 

  17. van Limborgh J. L’anatomie du systeme veineux de l’extremite inferieure en relation avec la pathologie variqueuse. Folia Angiol. 1961;8:240–57.

    Google Scholar 

  18. Strauss AL. Farbduplexsonographie der Arterien und Venen. Berlin: Springer; 1995.

    Book  Google Scholar 

  19. Vincent JR, Jones GT, Hill GB, van Rij AM. Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency. J Vasc Surg. 2011;54:62S–9S.

    Article  PubMed  Google Scholar 

  20. Bailly M. Cartographie CHIVA. In: Encyclopédie Medico-Chirurgicale. Paris: Editions Techniques; 1993. p. 43–161-B, 1–4.

    Google Scholar 

  21. Mendoza E. Handbuch CHIVA. Arrien GmbH; 2002.

    Google Scholar 

  22. Gianesini S, Occhionorelli S, Menegatti E, Zuolo M, Tessari M, Spath P, Ascanelli S, Zamboni P. CHIVA strategy in chronic venous disease treatment: instructions for users. Phlebology. 2015;30(3):157–71.

    Article  CAS  PubMed  Google Scholar 

  23. Coffman JD, Lempert JA. Venous flow velocity, venous volume and arterial blood flow. Circulation. 1975;52:141–5.

    Article  CAS  PubMed  Google Scholar 

  24. Fronek A, Criqui MH, Denenberg J, et al. Common femoral vein dimensions and hemodynamics including Valsalva response as a function of sex, age, and ethnicity in a population study. J Vasc Surg. 2001;33:1050–6.

    Article  CAS  PubMed  Google Scholar 

  25. Jamieson R, Calderwood CJ, Greer IA. The effect of graduated compression stockings on blood velocity in the deep venous system of the lower limb in postnatal period. BJOG. 2007;114:1292–4.

    Article  CAS  PubMed  Google Scholar 

  26. Nagahiro I, Watanuki Y, Sato S, et al. Venous velocity of the right femoral vein decreases in the right lateral decubitus position compared to the supine position: a cause of post-operative pulmonary embolism? Acta Med Okayama. 2007;61:57–61.

    PubMed  Google Scholar 

  27. Gianesini S, Sisini F, Di Domenico G, Secciero J, Malagoni AM, Menegatti E, Gambaccini M, Zamboni P. Lower limbs venous kinetics and consequent impact on drainage direction. Phlebology. 2017:268355516688775. https://doi.org/10.1177/0268355516688775. [Epub ahead of print].

    Article  Google Scholar 

  28. Broderick BJ. A haemodynamic study of the physiological mechanisms of the venous pump in the healthy human foot. Conf Proc IEEE Eng Med Biol Soc. 2008:1411–4. https://doi.org/10.1109/IEMBS.2008.4649430.

  29. Broderick BJ. Venous emptying from the foot: influences of weight bearing, toe curls, electrical stimulation, passive compression, and posture. J Appl Physiol. 2010;109(4):1045–52.

    Article  PubMed  Google Scholar 

  30. Farrah J, Saharay M, Georgiannos SN, Scurr JH, Smith PD. Variable venous anatomy of the popliteal fossa demonstrated by duplex scanning. Dermatol Surg. 1998;24:901–3.

    CAS  PubMed  Google Scholar 

  31. Moore HM, Gohel M, Davies AH. Number and location of venous valves within the popliteal and femoral veins – a review of the literature. J Anat. 2011;219:439–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Mühlberger D, Morandini L, Brenner E. An anatomical study of femoral vein valves near the saphenofemoral junction. J Vasc Surg. 2008;48:994–9.

    Article  PubMed  Google Scholar 

  33. Van Bemmelen PS, Beach K, Bedford G, Strandness DE Jr. The mechanism of venous valve closure. Arch Surg: Its relationship to the velocity of reverse flow; 1990.

    Book  Google Scholar 

  34. Van Bemmelen PS. Regarding “The mechanism of venous valve closure in normal physiological conditions”. J Vasc Surg. 2003;37(1):237. author reply 237–8

    Article  PubMed  Google Scholar 

  35. Bernardini E, DeRango P, Piccioli R, Bisacci C, Pagliuca V, Genovese G, Bisacci R. Development of primary superficial venous insufficiency: the ascending theory. Observational and hemodynamic data from a 9 year experience. Ann Vasc Surg. 2010:709–20.

    Article  PubMed  Google Scholar 

  36. Caggiati A, Rosi C, Heyn R, Franceschini M, Acconcia MC. Age-related variations of varicose veins anatomy. J Vasc Surg. 2006;44(6):1291–5.

    Article  PubMed  Google Scholar 

  37. Chastanet S, Pittaluga P. Patterns of reflux in the great saphenous vein system. Phlebology. 2013;28(Suppl 1):S39–46.

    Article  Google Scholar 

  38. Daigle RJ. Techniques in non-invasive vascular diagnosis: an encyclopedia of vascular testing. Littleton: Summer Publishing LLC; 2008.

    Google Scholar 

  39. Guidi G, Licciardello C, Falteri S. Intrinsic spectral broadening in US Doppler as a combination of transit time and local geometrical broadening. Ultrasound Med Biol. 2000;26:853–62.

    Article  CAS  PubMed  Google Scholar 

  40. Osmanski BF, Bercoff J, Montaldo G, Loupas T, Fink M, Tanter M. Cancellation of Doppler intrinsic spectral broadening using ultrafast Doppler imaging. IEEE Trans Ultrason Ferroelectr Freq Control. 2014;61:396–1408.

    Google Scholar 

  41. Boni E, Bassi L, Dallai A, Guidi F, Meacci V, Ramalli A, Ricci S, Tortoli P. ULA-OP 256: a 256-channel open scanner for development and real-time implementation of new ultrasound methods. IEEE Trans Ultrason Ferroelectr Freq Control. 2016. https://doi.org/10.1109/TUFFC.2016.2566920.

    Article  PubMed  Google Scholar 

  42. Tavoni V, et al. Conventional echo color Doppler versus ULA-OP in the assessment of venous flow model. Veins Lymphat. 2017. https://doi.org/10.4081/vl.2017.6841.

  43. Barber RF, Shatara FI. The varicose disease. NY State J Med. 1925;25:16–24.

    Google Scholar 

  44. Hach W. Varicose veins of the deep perforating veins--a typical phlebologic disease picture. Vasa. 1985;14(2):155–7.

    CAS  PubMed  Google Scholar 

  45. Hadfield JIH. The anatomy of the perforating veins in the leg. In: The treatment of varicose veins by injection and compression. Stoke Mandeville Symposium, 1971, pp. 4–11.

    Google Scholar 

  46. Sarin S. Medial calf perforators in venous disease: the significance of outward flow. J Vasc Surg. 1992: Jul;16(1):40–6.

    Article  CAS  PubMed  Google Scholar 

  47. Zamboni P. Pathophysiology of perforators in primary chronic venous insufficiency. World J Surg. 2005;29(1):115–8.

    Article  Google Scholar 

  48. Labropoulos N, Mansour MA, Kang SS, Gloviczki BH. New insights into perforator vein incompetence. Eur J Vasc Endovasc Surg. 1999;18:228–34.

    Article  CAS  PubMed  Google Scholar 

  49. Delis K. Leg perforator vein incompetence: functional anatomy. Radiology. 2005;235:327–34.

    Article  PubMed  Google Scholar 

  50. Ibegbuna V, Delis KT, Nicolaides AN. Haemodynamic and clinical impact of superficial, deep and perforator vein incompetence. Eur J Vasc Endovasc Surg. 2006;31(5):535–41. Epub 2006 Jan 4

    Article  CAS  PubMed  Google Scholar 

  51. Labropoulos N, Tassiopoulos AK, Bhatti AF, Leon L. Development of reflux in the perforator veins in limbs with primary venous disease. J Vasc Surg. 2006;43:558–62.

    Article  PubMed  Google Scholar 

  52. Recek C, Karisch E, Gruber J. (Changes of the perforating veins and deep calf veins after elimination of saphenous reflux) Veränderungen der Perforansvenen und tiefen Unterschenkelvenen nach Beseitigung des Saphena-Refluxes. Phlebologie (Stuttgart). 2000;29(1):37–40.

    Google Scholar 

  53. Mendoza E. CHIVA – ein Handbuch. Wunstorf: Arrien Verlag; 2002.

    Google Scholar 

  54. Lattimer CR, Mendoza E. Superficial venous reflux duration and cessation with two concurrent duplex probes. J Vasc Surg Venous Lymphat Disord. 2015;3(2):154–60.

    Article  PubMed  Google Scholar 

  55. Gloviczki P, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg. 2011;53(5 suppl):2S–48S.

    Article  PubMed  Google Scholar 

  56. Edwards JE, Edwards EA. The saphenous valves in varicose veins. Am Heart J. 1940;19:338–51.

    Article  Google Scholar 

  57. Rose SS, Ahmed A. Some thoughts on the etiology of varicose veins. J Cardiovasc Surg (Torino). 1986;27:534–43.

    CAS  Google Scholar 

  58. Bassi GL. Le varici degli arti inferiori. Turin: Minerva Medica; 1962.

    Google Scholar 

  59. Mühlberger D, Morandini L, Brenner E. Venous valves and major superficial tributary veins near the saphenofemoral junction. J Vasc Surg. 2009;49:1562–9.

    Article  PubMed  Google Scholar 

  60. Caggiati A, Macchiarelli G, Familiari G. Topographical structural variations of the human long saphenous vein and its age-related remodelling as revealed by correlated light and scanning electron microscopy. Phlebology. 1998;13:156–62.

    Article  Google Scholar 

  61. Dhital KK, Burnstock G. Adrenergic and non-adrenergic neural control of the arterial wall. In: Camilleri J-P, Berry CL, Fiessinger J-N, Bariety J, editors. Disease of the arterial wall. London: Springer; 1989. p. 97–126.

    Chapter  Google Scholar 

  62. Mashiah A, Rose SS, Hod I. The scanning electronic microscope in the pathology of varicose veins. Isr J Med Sci. 1991;27:202–6. May;125(5):617-9. PubMed PMID: 2184798

    CAS  PubMed  Google Scholar 

  63. Thulesius O, Ugaily-Thulesius L, Gjores JE, Neglen P. The varicose saphenous vein, functional and ultrastructural studies, with special reference to smooth muscle. Phlebology. 1988;3:89–95.

    Article  Google Scholar 

  64. Baird RN, Abbott WM. Elasticity and compliance of canine femoral and jugular vein segments. Am J Physiol. 1977;233(1):H15–21.

    CAS  PubMed  Google Scholar 

  65. Norgren L, Thulesius O, Gjöres JE, Söderlundh S. Foot-volumetry and simultaneous venous pressure measurements for evaluation of venous insufficiency. Vasa. 1974;3(2):140–7.

    CAS  PubMed  Google Scholar 

  66. Norgren L, Thulesius O. Pressure-volume characteristics of foot veins in normal cases and patients with venous insufficiency. Blood Vessels. 1975;12(1):1–12.

    CAS  PubMed  Google Scholar 

  67. Zamboni P, Marcellino MG, Portaluppi F, Manfredini R, Feo CV, Quaglio D, Liboni A. The relationship between in vitro and in vivo venous compliance measurement. Int Angiol. 1996;15(2):149–52.

    CAS  PubMed  Google Scholar 

  68. Bax W, Bos E, Saxena PR. Heterogeneity of endothelin/sarafotoxin receptors mediating contraction of the human isolated saphenous vein. Eur J Pharmacol. 1993;239:267–8.

    Article  CAS  PubMed  Google Scholar 

  69. Biochl-Daum B, Schuller Petrovic S, Woltz M, Korn A, Bohler K, Eichler KG. Primary defect in alpha adrenergic responsiveness in patients with varicose veins. Clin Pharmacol Ther. 1991;49:49–52.

    Article  Google Scholar 

  70. Zamboni P, Portaluppi F, Marcellino MG, Quaglio D, Manfredini R, Feo CV, Stoney RJ. In vitro versus in vivo assessment of vein wall properties. Ann Vasc Surg. 1998;12(4):324–9.

    Article  CAS  PubMed  Google Scholar 

  71. Zamboni P, Portaluppi F, Marcellino MG, et al. Ann Vasc Surg. 1998;12:324. https://doi.org/10.1007/s100169900162

    Article  CAS  PubMed  Google Scholar 

  72. Davies AH, Magee TR, Hayward J, Harris R, Baird RN, Horrocks M. Non-invasive methods of measuring venous compliance. Phlebology. 1992;7:78–81.

    Article  Google Scholar 

  73. Nicolaides AN, Cardiovascular Disease Educational and Research Trust, European Society of Vascular Surgery, The International Angiology Scientific Activity Congress Organization, International Union of Angiology, Union Internationale de Phlebologie at the Abbaye des Vaux de Cernay. Investigation of chronic venous insufficiency: a consensus statement (France, March 5-9, 1997). Circulation. 2000;102(20):E126–63.

    Article  CAS  PubMed  Google Scholar 

  74. Clarke JH, Vadeskis SN, Hobbs JT, Nicolaides AN. Venous wall function in the pathogenesis of varicose veins. Surgery. 1992;111:402–8.

    CAS  PubMed  Google Scholar 

  75. Barber DA, Wang X, Gloviczy P, Miller VM. Characterization of endothelin receptors in human varicose veins. J Vasc Surg. 1997;26:61–9.

    Article  CAS  PubMed  Google Scholar 

  76. Barker JE, Anderson J, Treasure T, Piper PJ. Influence of endothelium and surgical preparation on responses of human saphenous vein and internal thoracic artery to angiotensin II. Br J Clin Pharmacol. 1994;38:57–62.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  77. Jenkinson DH, Barnard EA, Hoyer D, Humhrey PPA, Leff P, Shankley NP. International Union of Pharmacology Committee on receptors nomenclature and drug classification, IX: recommendations on terms and symbol in quantitative pharmacology. Pharmacol Rev. 1995;47:255–66.

    CAS  PubMed  Google Scholar 

  78. Li Q, Feenstra M, Pfaffendorf M, Eijsman L, Van Zwieten PA. Comparative vasoconstrictor effects of Angiotensin II, II, and IV in human isolated saphenous vein. J Cardiovasc Pharmacol. 1997;29:451–6.

    Article  CAS  PubMed  Google Scholar 

  79. Rizzi A, Quaglio D, Vasquez G, Mascoli F, Amadesi S, Calò G, Regoli D, Zamboni P. Effects of vasoactive agents in healthy and diseased human saphenous veins. J Vasc Surg. 1998;28(5):855–61.

    Article  CAS  PubMed  Google Scholar 

  80. Sjoberg T, Norgren L, Andersson KE, Steen S. Comparative effects of the alfa adrenoceptors agonists noradrenaline, phenylephrine and clonidine in the human saphenous vein in vivo and in vitro. Acta Physiol Scand. 1989;136:463–71.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Vascular Diseases Center, University of Ferrara, Ferrara, Italy

    Sergio Gianesini M.D.

  2. USUHS University, Bethesda, MD, USA

    Sergio Gianesini M.D.

  3. School of Vascular Surgery and Vascular Diseases Center, University of Ferrara, Ferrara, Italy

    Paolo Zamboni M.D.

  4. Unit of Translational Surgery, AOU Ferrara, Ferrara, Italy

    Paolo Zamboni M.D.

  5. Venenpraxis, Wunstorf, Germany

    Erika Mendoza M.D., Ph.D.

Authors
  1. Sergio Gianesini M.D.
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  2. Paolo Zamboni M.D.
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  3. Erika Mendoza M.D., Ph.D.
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Editor information

Editors and Affiliations

  1. School of Vascular Surgery and Vascular Diseases Center, University of Ferrara, Ferrara, Italy

    Paolo Zamboni

  2. Venenpraxis Wunstorf, Wunstorf, Niedersachsen, Germany

    Erika Mendoza

  3. Translational Surgery Unit-Vascular Disease Center, University of Ferrara Vascular Disease Center, Ferrara, Italy

    Sergio Gianesini

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Gianesini, S., Zamboni, P., Mendoza, E. (2018). Functional Anatomy of Leg Veins. In: Zamboni, P., Mendoza, E., Gianesini, S. (eds) Saphenous Vein-Sparing Strategies in Chronic Venous Disease. Springer, Cham. https://doi.org/10.1007/978-3-319-70638-2_2

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