UNILATERAL VARIATION OF GREAT SAPHENOUS VEIN - PDF Document

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  1. INTERNATIONAL AYURVEDIC MEDICAL JOURNAL International Ayurvedic Medical Journal, ( UNILATERAL VARIATION OF GREAT SAPHENOUS VEIN Arya ashok1, Swapna kumary2 International Ayurvedic Medical Journal, (ISSN: 2320 5091) (November, 2017) 5(11) UNILATERAL VARIATION OF GREAT SAPHENOUS VEIN- A CADAVERIC STUDY A CADAVERIC STUDY 1PG Scholars, 2Associate professor Dept of Rachana Shareera Alva’s Ayurveda Medical college and Hospital Moodbidri Email: unnimayamatramkott1991@gmail.com Alva’s Ayurveda Medical college and Hospital Moodbidri, Karnataka, India unnimayamatramkott1991@gmail.com ABSTRACT The Great saphenous vein (*GSV) is a large superficial vein which is visible on the medial side of the thigh and leg. During our routine dissection a significant unilateral variation in the position of *GSV was observed at Alva’s Ayurvedic medical college Moodabidri. The vei gion. The aim of this article is to provide and define the variation of position of *GSV and its anatomical relation obtained from human cadaver. The dissimilarity in position of *GSV is very important in surg cal and clinical practice. The detailed explanation about the variation will be carried out in this paper. Keywords: Great saphenous vein, superficial INTRODUCTION The lower extremity venous system includes the superficial, deep, and perforating veins of the lower extremity are classified cording to their relationship to the muscular fa cia and are located in either the superficial or deep compartment. The superficial venous sy tem includes the reticular veins as well as the great and small saphenous veins and their trib taries1. vein (*GSV) is a large superficial vein which is visible on the medial side of the thigh and leg. During our routine dissection a significant unilateral variation in the position of *GSV was vein (*GSV) is a large superficial vein which is visible on the medial side of the thigh and leg. During our routine dissection a significant unilateral variation in the position of *GSV was observed at Alva’s Ayurvedic medical college Moodabidri. The vein was not superficial at the thigh r gion. The aim of this article is to provide and define the variation of position of *GSV and its anatomical relation obtained from human cadaver. The dissimilarity in position of *GSV is very important in surg linical practice. The detailed explanation about the variation will be carried out in this paper. linical practice. The detailed explanation about the variation will be carried out in this paper. n was not superficial at the thigh re- gion. The aim of this article is to provide and define the variation of position of *GSV and its anatomical relation obtained from human cadaver. The dissimilarity in position of *GSV is very important in surgi- : Great saphenous vein, superficial vein, varicose vein. The lower extremity venous system includes the and the deep fascia. Great Saphenous Vein (*GSV) secure firmly in position to the deep muscular fascia by a connective lamina that separates it from the superficial layers of the subcutaneous tissue. Anatomic investigations reveal that this lamina is a portion of the “me branous layer of the subcutaneous tissue” and it is termed as saphenous fascia fuses with the deep fascia and delimits a flat, fatty space called saphenous compartment which includes the *GSV and the acc arteries, nerves, and lymphatics. Great Saphenous Vein veins. The secure firmly in position to the deep by a connective lamina that separates it from the superficial layers of the subcutaneous tissue. Anatomic investigations reveal that this lamina is a portion of the “mem- branous layer of the subcutaneous tissue” and it saphenous fascia.2,3 This lamina fuses with the deep fascia and delimits a flat, saphenous compartment veins of the lower extremity are classified ac- cording to their relationship to the muscular fas- are located in either the superficial or The superficial venous sys- as well as the veins and their tribu- 4 GREAT SAPHENOUS VEIN Normally, all superficial veins are thought to course in the adipose tissue between the dermis course in the adipose tissue between the dermis and the accompanying lymphatics. all superficial veins are thought to

  2. Arya Ashok & Swapna Kumary: Unilateral Variation Of Great Saphenous Vein- A Cadaveric Study thigh frequently unite to form a large acces- sory saphenous vein which joins the main vein near the sapheno-femoral junction.6 Near the fossa ovalis it is joined by the su- perficial epigastric, superficial circumflex il- iac vein, and superficial external pudendal veins. Tributaries of the *GSV are superficial to the saphenous space and the saphenous fasci7. These veins are visible on the surface of the limb even if they are not varicose. When the tributaries are large, they may be erroneously considered to be a portion of a double or dupli- cated *GSV.8 The duplication of the *GSV was explained by the different authors. In this particular case, uni- lateral variation in position of the *GSV was observed. CADAVERIC STUDY The observation of variation was done during the routine dissection of lower limb region, at Alva’s Ayurvedic Medical College Moodabidri. The cadaver was 60 year old male body without any deformity and well preserved. A curved in- cision was made from anterior superior iliac spine towards the pubic tubercle. A curved inci- sion was made from pudental cleft towards the upper medial side of thigh and was extended till tibial tuberosity. After reflecting the skin and removing the fatty layer, *GSV was identified in the medial part of anterior surface of thigh. Its origin, course and tributeries on both sides were observed and identified. COURSE The *GSV is the longest vein in the body, origi- nates from the dorsal vein of the big toe merges with the dorsal venous arch of the foot. After passing in front of the medial malleolus, it runs up the medial side of the leg. At the knee, it runs over the posterior border of the medial epi- condyle of the femur bone. The *GSV then courses anteriorly to lie on the anterior surface of the thigh before entering an opening in the fascia lata called the saphenous opening. It forms an arch, the saphenous arch, to join the common femoral vein in the region of the femo- ral triangle at the sapheno-femoral junction. The point where the *GSV empties into the common femoral vein is called the Saphenofemoral Junc- tion (SFJ). A typical *GSV contains an average of 7 valves throughout its entire length, and it is the most common superficial vein to develop venous reflux5. TRIBUTERIES At the ankle it receives branches from the sole of the foot through the medial marginal vein. In the lower leg it anastomoses freely with the small saphenous vein, communicates by perforator veins (Cockett perforators) with the anterior and posterior tibial veins and re- ceives many cutaneous veins Near the knee it communicates with the pop- liteal vein by the Boyd perforator. In the thigh it communicates with the femo- ral vein by perforator veins (Dodd perfora- tor) and receives numerous tributaries; those from the medial and posterior parts of the IAMJ: NOVEMBER, 2017 4080

  3. Arya Ashok & Swapna Kumary: Unilateral Variation Of Great Saphenous Vein- A Cadaveric Study OBSERVATION During the routine dissection the variation of *GSV was observed unilaterally in the right thigh region of the male cadaver. 1 2 4 3 5 Fig 1:- variation of long saphenous vein in right leg (1)Femoral artery (2) Femoral vein (3)*GSV (4) Accessory Saphenous vein (5) Flap of adductor longus RIGHT THIGH – A flap of adductor longus muscle was present completely overlapping the distal part of *GSV upto 15cm till sephano femoral junction. An ac- cessory saphenous vein was also present which Note:- Course of * GSV from dorsal vein of big toe till adductor longus muscle was normal. joins *GSV near the sephano femoral junction running parallel and external to the *GSV. Ac- cessory saphenous vein was also covered by ad- ductor muscle flap. 1 1 2 2 3 5 5 4 3 6 7 4 7 6 FIG 2: Variation of *GSV in the right thigh where the muscle flap is removed and the normal left leg IAMJ: NOVEMBER, 2017 4081

  4. Arya Ashok & Swapna Kumary: Unilateral Variation Of Great Saphenous Vein- A Cadaveric Study (1) Femoral vein (2)*GSV (3)Adductor longus (4)Gracillis muscle (5)Sartorius (6)Rectus femoris (7)Vastus medialis. RIGHT LEG – The course of *GSV can be seen in between the adductor longus muscle fibres along accessory *GSV. LEFT LEG - The course of *GSV is normal as mentioned earlier (which is superficial to adduc- tor longus muscle) DISCUSSION The *GSV is the main truncal vein of the lower leg and drains blood from the inner part of the foot, the skin and fat of the front and inner as- pect of the lower leg, and the inner part of the thigh. Saphenous means evident, as the word suggests *GSV is a superficial vein, but in the present case the course of *GSV is not superficial and it passes in between the muscle fibres of adductor longus. The knowledge of anatomy of *GSV is very much important in clinical and surgical practices for the following reasons: CLINICAL IMPORTANCE:- As the course of *GSV is in between the mus- cle flap of Adductor longus : a) Adduction and medial rotation of the thigh may compress *GSV and may cause thrombo- phlebitis. b) Contraction and relaxation of adductor mus- cle fibres may hinder the normal pumping of venous blood and may cause venous diseases like varicose veins and ulceration. SURGICAL IMPORTANCE:- *GSV is removed for auto transplantation in coronary artery bypass operations when arterial grafts are not available or if many grafts are re- quired, such as in a triple bypass or quadruple bypass9.*GSV is widely used in auto transplan- tation because and it has superior long-term patency compared to synthetic grafts and re- moval of the saphenous vein will not hinder normal circulation in the leg due to the presence of collateral circulation. In this case in the right thigh, stripping of *GSV cannot be done as it is overlapped by adductor longus muscle flap. Thus Position of *GSV is most important in surgical point of view. The venous anatomy of the lower extremities is substantially more variable and complicated than the corresponding arterial anatomy. A thor- ough understanding of this anatomy is essential to an understanding of the underlying patho- physiology of chronic venous disease as well as its diagnosis and treatment CONCLUSION This kind of unilateral variations of long saphenous vein in relation to adductor longus muscle even though very rarely reported, but it has to be considered. These variations of *GSV may results in varicose veins; thrombophlebitis and it cannot be removed for auto transplanta- tion in coronary artery bypass operations. So the knowledge regarding anatomical varia- tions about its origin ,tributaries and course of long saphenous vein needed to take care during surgery and to plan accordingly during various surgical interventions of this region, as well as for general practitioners in differentiating the clinical case of long saphenous vein. IAMJ: NOVEMBER, 2017 4082

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