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A transverse section of the inguinal region
(Figure 60-A)
reveals, from lateral to medial: the sartorius muscle (M. sartorius),
the femoral artery just before giving rise to the arteria profunda
femoris, the femoral vein, the termination of the long saphenous
vein inside its aponeurotic sheath, and f nally, the adductor
longus muscle (M. adductor longus ).
The ultrasonographic appearance is typical at this level
(Figure
60-B). On transverse sections, with the transducer placed
along the inguinal fold, a "Mickey Mouse" appearance
is observed. The femoral vein (10 to 15 mm in diameter) forms
the face, and the femoral artery (6 mm) and long saphenous vein
(3 to 5 mm) form the two ears.
During ultrasound investigation, the transducer is then displaced
distally. The long saphenous trunk becomes separated from the
femoral vein by "rolling" over adductor longus muscle
(Figure 60-C). An anterior branch is sometimes observed
anterior to the long saphenous trunk. The femoral and profunda
femoris arteries are observed posteriorly and laterally.
Ultrasound examination of this region must determine the diameter
of the saphenofemoral junction, detect any anatomical variation
of the saphenofemoral junction and, in the case of reflux, specify
its origin.
|
Figure 60A |
Figure 60B |  Figure 60C
|
Figure 60
|
Only minor variations of the diameter of the saphenofemoral
junction are observed in healthy subjects. Depending on the
phase of the menstrual cycle or the duration of standing prior
to the examination, its diameter varies between 3 and 5 mm.
In contrast, all types of anatomical variants are common (see
Volume 1). For example, the external pudendal artery sometimes
occupies the saphenofemoral angle or, more rarely, passes in
front of the saphenofemoral junction.
Finally, when reflux is detected by Doppler examination on the
long saphenous trunk, five possible origins can be attributed
in the inguinal region. The most common site of reflux is a
lesion of the saphenous ostial valve at the saphenofemoral junction.
More rarely, this valve is perfectly competent and reflux is
derived from a tributary of the saphenofemoral junction (see
Volume 1). In other cases, reflux arises from a proximal perforating
vein, an accessory saphenous vein, or even a perineal network.
Further reading
Henriet J.P. Le confluent veineux saphéno-fémoral et le réseau
artériel honteux externe : données anatomiques et statistiques
nouvelles. Phlébologie 1987; 40: 711-35.
Vin E, Schadeck M. La maladie veineuse superficielle. Masson Ed, Paris, 1990.
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