Although the accessory saphenous veins represent a key element in explaining postoperative recurrences,
they also participate in the appearance of post stripping varicosities.
It is essential to clearly distinguish between the long saphenous
vein, the accessory saphenous vein and tributaries.
An anterior saphenous vein and an anterior tributary of the
thigh (anterolateral vein of the thigh) can be distinguished
by two main features: structure of the venous wall and topography.
The wall of the long saphenous vein contains a thick media and
is referred to as a "saphenous type" of vein wall.
The saphenous vein (from the Arabic "safin": "that
which is obvious") possesses a fairly regularly thickened
wall, a wall which is especially "obvious" on palpation,
which makes clinical examination all the more important to detect
accessory saphenous veins.
In contrast, an anterior tributary has a more fragile wall.
Consegtiently, it has a varicose, tortuous appearance with alternating
zones of marked ectasia with thin walls and- more rigid zones
with a thickened wall.
Topographically, an anterior saphenous vein remains relatively
linear and close to the main saphenous vein.
Several types of anastomosis of accessory saphenous veins can
be observed (Figure
). They may drain into the arch of the long saphenous
vein (A), directly into the femoral vein below (B) or above
(C) the arch, or even into a tributary of the arch (D).
When the accessory saphenous vein drains into the arch of the
long saphenous vein (Figure
), it is unlikely to be missed, except when its anastomosis
is situated in the saphenofemoral junction.
The accessory saphenous vein can anastomose directly with the femoral vein below
and independently of the arch of the saphenous vein (Figure 32
). This configuration illustrates the absolute necessity
of dissection of the femoral vein.
This type of direct anastomosis into the femoral vein can also
occur away from the long saphenous vein
This type of termination, situated above the saphenous opening,
therefore lies outside of the surgeon's field of vision. This
type of accessory saphenous vein may induce varicose disease
with an autonomous course. It can also supply a territory of
varicosities in the thigh or leg. Such lesions should be treated
by sclerotherapy; starting with the highest varicosity.
Finally, always at a distance from the arch of the long saphenous
vein, the accessory saphenous vein may sometimes drain into
a tributary of the arch, for example an external pudendal vein
). If this vein communicates with an intrapelvic vein,
an entire varicose network may be supplied independently of
a reconstructed saphenofemoral junction.
Benhamou A.C. La maladie variqueuse, Arnette Ed., Paris, 1990.
Griton Ph. Que penser des voies de drainage des télangiectasies. Ouest
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Vin F. Anatomie du système veineux des membres inférieurs. Artères
et Veines, 1983: 383-7.