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Venous anatomy
Published in Joseph A. Zygmunt, Venous Ultrasound, 2020
In the lower portion of the leg, the great saphenous is joined by two other tributaries: the posterior accessory saphenous vein of the leg, previously called the posterior arch vein or vein of Leonardo, and the anterior accessory saphenous vein of the leg. Clinically important, the posterior accessory saphenous vein is most often involved with the Cockett or posterior tibial perforating veins in the presentation of venous ulceration. This point needs to be stressed as it is commonly not well appreciated by novices. In most instances, the distal great saphenous vein does not connect to the Cockett or posterior tibial perforators. Almost universally, the posterior tibial perforators connect the posterior tibial veins and the posterior accessory saphenous vein (previously the posterior arch vein). (This is more fully illustrated in Figure 1.21 in the section “Perforating veins.”)
Anatomy of veins and lymphatics
Published in Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland, Manual of Venous and Lymphatic Diseases, 2017
Ken Myers, Paul Hannah, Marcus Cremonese, Lourens Bester, Phil Bekhor, Attilio Cavezzi, Marianne de Maeseneer, Greg Goodman, David Jenkins, Herman Lee, Adrian Lim, David Mitchell, Nick Morrison, Andrew Nicolaides, Hugo Partsch, Tony Penington, Neil Piller, Stefania Roberts, Greg Seeley, Paul Thibault, Steve Yelland
The anterior and posterior accessory saphenous veins lie in individual saphenous compartments near their proximal ends. The anterior accessory saphenous vein is present in at least 50% of limbs and lies anterior and lateral to the great saphenous vein and anterior to the femoral vein, forming the alignment sign seen on ultrasound (see Chapter 10). There are variations of the origin of the anterior accessory saphenous vein (Figure 2.18).
Laser treatment of the incompetent saphenous vein
Published in Peter Gloviczki, Michael C. Dalsing, Bo Eklöf, Fedor Lurie, Thomas W. Wakefield, Monika L. Gloviczki, Handbook of Venous and Lymphatic Disorders, 2017
Generally good outcomes have been reported when laser ablation is combined with other treatment modalities. Mekako et al.33 have demonstrated the feasibility of performing laser ablation in concert with ambulatory phlebectomy. Neglén et al.34 demonstrated good outcomes when combining laser ablation with deep vein stenting for superficial venous insufficiency and concomitant deep vein obstruction. Theivacumar and colleagues35 have demonstrated that, in some patients, the incompetent GSV in the presence of a grossly incompetent anterior accessory saphenous vein will recover competence following ablation of the anterior accessory saphenous vein alone. Myers et al.36 have advocated for laser ablation for incompetent major tributaries, while others have demonstrated the safety and efficacy of laser ablation for the incompetent vein of Giacomini.37
What is the optimal treatment technique for great saphenous vein diameter of ≥10 mm? Comparison of five different approaches
Published in Acta Chirurgica Belgica, 2021
Emre Kubat, Celal Selçuk Ünal, Onur Geldi, Erdem Çetin, Aydın Keskin
All extremities included in the study were divided into five groups as follows: HLS (n = 94), EVLA at 980 nm wavelength (n = 151), EVLA at 1,470 nm wavelength (n = 109), RFA (n = 264), and CAC (n = 79). The preoperative GSV diameter, CEAP class, VCSS scores, and body mass index (BMI) were recorded. Postoperative procedure-related complications such as bruising, thrombophlebitis, pigmentation, paresthesia, skin burns, deep vein thrombosis (DVT) or pulmonary thromboembolism, and wound infections, postoperative pain severity, concomitant surgical procedures such as microphlebectomy and anterior accessory saphenous vein (AASV) interventions (ablation/stripping), VCSS scores at 1 year, recurrence and occlusion at 6 months and 1 year were also evaluated. The postoperative pain severity was evaluated using the Visual Analog Scale (VAS). Postoperative follow-up was carried out by clinical examination and DUS. Recurrence was defined as new-onset varicose veins following the procedure [1]. Occlusion was defined as the complete occlusion of the vein with no reflux on the Duplex ultrasound scan in the treated GSV segment. The reasons of the recurrences were also recorded.