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Incidence of Duplication of Great Saphenous Vein in the Thigh and Its Clinical Significance – a Case Report

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Incidence of Duplication of Great Saphenous Vein in the Thigh and Its Clinical Significance – a Case Report eISSN 1308-4038 International Journal of Anatomical Variations (2013) 6: 165–166 Case Report Incidence of duplication of great saphenous vein in the thigh and its clinical significance – a case report Published online September 25th, 2013 © http://www.ijav.org T. Ramesh RAO [1] Abstract Rachana KORKODE [2] Varicose vein surgery remains one of the most common general surgical operations performed in the United Kingdom. Varicose veins have been shown to affect up to 15% of men and 25% of women in Western society. The majority of varicose vein surgery involves ligation and stripping Department of Anatomy, Melaka Manipal Medical College of the great saphenous vein and its tributaries. A missed duplication of a great saphenous vein (Manipal Campus), International Centre for Health can be a partial explanation for recurrent varicose veins after surgery. Therefore this case report Sciences, Manipal University, Manipal [1], Department of would serve as ray of light for knowing the possible anatomical variations associated with the Anatomy, Kasturba Medical College Mangalore, Manipal great saphenous vein. During routine dissection we observed an unusual duplication of great University [2], Karnataka, INDIA. saphenous vein in the thigh on the left side of a 55-year-old male cadaver. However, such variation was not found on the opposite side and patients with such variations may be asymptomatic. © Int J Anat Var (IJAV). 2013; 6: 165–166. Dr. Rachana Korkode Department of Anatomy Kasturba Medical College Mangalore, Manipal University Karnataka, INDIA. +91 9611132430 [email protected] Received August 25th, 2012; accepted March 30th, 2013 Key words [great saphenous vein] [vascular variation] [saphenous vein grafts] Introduction Case Report The great saphenous vein (GSV) commences at the medial end During routine gross anatomy dissection of the lower limb for of the dorsal venous arch, and after receiving branches from the purpose of teaching medical students, Manipal University, the sole, which join it by turning over the medial border of we observed a rare case of duplication of GSV in the middle the foot, it turns proximally, anterior to the medial malleolus. one third of the thigh, on the left side. However, the formation It ascends about a finger’s breadth posterior to the medial and rest of the course of the GSV were as usual. Therefore an border of the tibia accompanied by the saphenous nerve, which attempt has been made to highlight its clinical implications in becomes superficial just distal to the knee. It then passes relation to its duplication in the thigh. The medical history of posterior to the medial condyle of the knee, accompanying this 55-year-old male cadaver was not available. Following the the saphenous branch of the descending genicular artery, dissection, the duplicated GSV was photographed. However and continues along the medial side of the thigh, to about 3.7 such variation was not found in the opposite lower limb. cm distal to the inguinal ligament, where it perforates the cribriform fascia and dips through the saphenous opening in Discussion the fascia lata to join the femoral vein. Throughout its length Varicose veins are common in the postero-medial parts of the there are numerous communications with the deep veins, lower limb and may cause considerable discomfort. Frequently especially in the leg. These occur at the knee, mid-length of the GSV and its tributaries become varicosed. Varicose veins leg, ankle and foot. Communications in the thigh occur only are formed when the valves that prevent blood flow from the below the mid-length. Valves within these communications deep veins through the perforating veins to the superficial are so oriented that blood from the superficial channels flows veins are incompetent and the result is that the superficial into deep. There are from 10-20 valves in the GSV. The vein is veins become tortuous and dilated. The GSV is commonly used often duplicated especially distal to the knee. The GSV is often for coronary arterial bypass because it is readily accessible, harvested for grafts used both in peripheral and coronary enough distance occurs between its tributaries and the artery surgery [1, 2]. perforating veins so that usable length can be harvested and 166 Rao and Korkode 3 1 2 1 1 1 Figure 1. Unusual duplication of great saphenous vein on the left side of the thigh. (1: Great saphenous vein; 2: femoral vein; 3: femoral artery) its wall contains a higher percentage of muscular and elastic majority of varicose vein surgery involves the ligation and fibers than any other superficial veins [3]. stripping of the GSV and its tributaries [5]. Varicose veins have multiple etiological factors like hereditary In the literature there is a range from 1% to 20 % of duplication weakness of the vein walls, incompetent valves, elevated (up to 20%) of the GSV reported, because there is a lack of an intra-abdominal pressure as a result of multiple pregnancies, accurate definition of the GSV and objective parameters for abdominal tumors and chronic cough, thrombophlebitis of an anatomical identification. Phlebography studies have been the deep veins, which result in superficial veins becoming the criterion standard for the identification of venous anatomy. the main venous pathway for the lower limb. The successful Now, duplex ultrasonography is regarded as the criterion surgical management of varicose veins includes the ligation standard for accurate detection of the veins. True duplication and division of all the important tributaries of the great or of the GSV is less common than the previous literature has small saphenous veins, to prevent a collateral circulation from suggested, namely 1.6% to 2%. It is recommended that the developing, and the ligation and division of all the perforating duplicated GSV should be treated to avoid an important risk veins responsible for the leakage of high-pressure blood from of recurrence of venous insufficiency [6]. the deep to the superficial veins. It is now common practice to remove or strip the superficial veins in addition to the ligation Conclusion [4]. The majority of varicose vein surgery involves the ligation and Varicose vein surgery remains one of the commonest general stripping of the GSV and its tributaries. Varicose vein surgery surgical operations performed in the United Kingdom. The remains one of the commonest general surgical operations routine stripping of the GSV in addition to disconnection of performed in the Western part of the world. A missed the sapheno-femoral junction and multiple stab avulsions duplication of a GSV can be a partial explanation for recurrent has been advocated to reduce the incidence of recurrence of varicose veins after surgery. Hence it is recommended that varicose veins. Varicose veins have been shown to affect up the duplicated GSV should be treated to avoid an important to 15% of men and 25% of women in Western society. The risk of recurrence of venous insufficiency. References [1] Anson BJ. Morris’ Human Anatomy. 12th Ed., New York, Mc Graw-Hill Book Company. 1966; [4] Snell RS. Clinical Anatomy. 7th Ed., Lippincott Williams and Wilkins. 2004; 614–618. 823–825. [5] Khwaja HA, Nott DM. A non-traumatic technique for removal of the great saphenous vein at [2] Standring S, ed. Gray’s Anatomy. 39th Ed., London, Elsevier Churchill Livingstone. 2005; varicose vein surgery. Grand Rounds. 2008; 8: 1–3. 1452–1453. [6] Kockaert M, de Roos KP, van Dijk L, Nijsten T, Neumann M. Duplication of the great [3] Moore KL, Dalley AF. Clinically Oriented Anatomy. 5th Ed., Lippincott Williams & Wilkins. saphenous vein: a definition problem and implications for therapy. Dermatol Surg. 2012; 38: 2006; 580–584. 77–82..
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