PubMed · 5709474
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Z Cibor, A Cencora. [External saphenous vein. Anatomic data].. https://pubmed.ncbi.nlm.nih.gov/5709474/
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PURPOSE: To determine whether superficial thrombophlebitis (STP) can extend into the deep venous system (DVS) and whether this may result in pulmonary embolization. METHODS: All venous duplex ultrasound examinations performed in our vascular laboratory to rule out deep venous thrombosis from June 1, 1994, to June 24, 1996, were reviewed. RESULTS: Of 8313 limbs studied by duplex scanning in 6148 patients, 1756 limbs (21.1%) had a positive result for deep venous thrombosis. STP was demonstrated in 232 limbs (213 patients), of which 20 (8.6%) extended into the DVS. Fourteen (70%) were noted on the initial scan, and six (30%) were detected on serial follow-up scans. Eighteen (90%) originated in the proximal greater saphenous vein and extended across the saphenofemoral junction into the common femoral vein. Nine demonstrated "free-floating" thrombus with a "tongue" extending into the common femoral vein while still attached proximally to the greater saphenous vein. Extension of thrombus from the lesser saphenous vein into the popliteal vein was noted in two cases (10%). One pulmonary embolization was directly observed to occur in real time during scanning. No pulmonary embolization was seen when STP did not involve the DVS. CONCLUSIONS: STP can extend into the DVS. In this series STP of the proximal greater saphenous vein extended into the common femoral vein in 8.6% of the cases, of which 10% embolized to the lungs. When the DVS is involved, standard deep venous thrombosis treatment (heparin, warfarin, bed rest) should be instituted. We recommend duplex imaging for STP involving the greater saphenous vein in the thigh to rule out occult deep venous thrombosis. STP is not always benign and self-limiting as previously described.
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Perforating veins in the femoral canal, which establish a communication, on the medial aspect of the thigh, between the deep venous system and: either the trunk of the long saphenous vein, single or double, or one or several separate trunks, follow three anatomical patterns which clinical examination, phlebography and, now, echo-doppler, can identify clearly. When they are incompetent, they increase the natural progress of the varicose disease, after surgery of the long saphenous vein. Often, they are associated with a redux at the level of the saphenofemoral junction and also, sometimes, with an incompetence, primary or recurrent, at the short sapheno-popliteal junction, or, furthermore, with an incompetence of the medial gastrocnemial veins and their accompanying perforators, within the popliteal venous complex. Anastomotic networks between the different superficial venous territories in the inguino-genital region, the femoral canal and the supero-medial aspect of the leg, explain the cross-evolution between different systems. Sclerotherapy is effective when the perforators are not too large and their reflux not too important. If it fails, it is necessary to operate after precise localization of the sites of reflux through good imaging. A good picture is obtained with B mode ultrasound examination and hemodynamic studies with pulsed doppler and, even more reliably, with color Doppler. Thus, in recurrences in the femoral region, color Doppler will show up certain perforators which, despite being dilated, are nevertheless competent and do not need to be dealt with.