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The femoral region is characterized by the presence of one or
several perforating veins within the adductor canal. These veins,
usually called Dodd's perforators, connect the long saphenous
trunkr or one of its tributaries with the femoral vein.
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Figure 61A |  Figure 61B
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Figure 61 : Perforating veins
of the adductor canal (Dodd's perforators).
Anatomical variants and ultrasonographic correlations. |
The adductor canal
(Figure 61-A), situated in the lower
third of the thigh, is delimited anteriorly by the vastus medialis
muscle
(M. vastus medialis), posteriorly by the tendon
of the adductor magnus muscle (
M. adductor magnus) and
laterally by the aponeurosis of the adductor canal. This aponeurosis
is perforated, above, by the deep branch of the accessory saphenous
nerve and Dodd's perforator, and below, by the saphenous nerve
and the great anastomotic artery.
The adductor canal contains, from its base towards the surface,
the saphenous nerve and the accessory saphenous nerve, the femoral
artery, and the femoral vein which forms a half spiral around
the femoral artery.
On transverse ultrasound sections
(Figure 61-B), the
long saphenous vein, in its aponeurotic "sheath",
travels along the posterior margin of the sartorius muscle (M.
sartorius). Dodd's perforator may be detected at this level
when its diameter exceeds 2 mm.
This perforating vein has a variable origin: long saphenous
or accessory trunk, a tributary, or sometimes even a subaponeurotic
collateral channel.
In the first case, it arises from the deep surface of the long
saphenous vein at the junction of the middle and lower thirds
of the thigh. It is 4 to 8 cm long and travels obliquely upwards,
medially and anteriorly. It is accompanied by an arterial branch
and a deep sensory branch of the accessory saphenous nerve.
It finally drains into the medial surface of the femoral vein.
This perforating vein may be unique or multibranched by receiving
indirect branches derived from the adjacent muscle. The adductor
canal sometimes contains a real group of perforating veins (as
many as six), but only one or two of them will be demonstrated
on ultrasonography.
A decisive, although little known, factor in the pathogenesis
of recurrence consists of the possibility of duplication of
the saphenous trunk in two superimposed planes
(Figure 61-C).
On ultrasonography, the dilated long saphenous trunk, which
can be followed from the groin, appears te, leave its aponeurotic
"sheath"' mid-thigh
(Figure 61-D). This actually
corresponds to a supra-aponeurotic duplication into which the
guidewire will be introduced during stripping. The true long
saphenous trunk may not be visualized on ultrasonography when
it is less than 2 mm in diameter. Failure to recognize this
long saphenous trunk which has not left its aponeurotic "sheath",
constitutes a frequent factor of poststripping recurrence, especially
as this vein may receive Dodd's perforator.
In other cases, the long saphenous trunk is duplicated in the
same plane
(Figure 61-E) and Dodd's perforator then divides
forming a lambda appearance
(Figure 61-F).
Anatomical variants and intimate relations with arteries and
nerves account for the difficulty of surgical treatment of perforating
veins of the femoral region.
Figure 61C : Perforating veins
of the adductor canal (Dodd's perforators).
Anatomical variants and ultrasonographic correlations. |  Figure 61D
|
Figure 61E |
Figure 61F |
Further reading
Davy A. Les varices. Entretiens phlébologiques. Expansion Scientifique
Française, Paris, 1974.
Lawday-Mussot S. La veine perforante du canal de Hunter : son incidence dans
la pathologie variqueuse et son traitement. Phlébologie 1991; 44: 603-13.
Muller J.M. Anatomie chirurgicale de la veine perforante du canal de Hunter.
Phlébologie 1987; 40: 575-82.
Rettori R. Le rôle des perforantes de la face interne de la cuisse dans
la récidive variqueuse. Phlébologie 1982; 35: 475-83.
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