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Anatomy of recurrences following resection of the saphenofemoral junction

Anatomy of recurrences following resection of the saphenofemoral junction

Mechanisms True recurrences must be distinguished from residual varicose veins. There are two main causes for recurrence following groin surgery: – anatomical causes – hemodynamic causes anatomical causes are situated either at or away from the saphenofemoral junction (Figure 41). In the first case, they can result from a technical error: – excessively low ligation of the long saphenous vein away from the saphenofemoral junction, with persistence of a stump of arch (6), – persistence of a subfascial anterior branch…

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Suprapubic varicose veins

Suprapubic varicose veins

The presence of suprapubic varicose veins must always be investigated by clinical examination. They occur in only two situations: most frequently in the case of internal iliac or common iliac thrombosis (Figure 37; A) and, more exceptionally, in the case of agenesis, hypoplasia or compression of an iliac vein. In acute iliac thrombosis, the possible collaterals are situated in three planes (Figure 37) a deep plane (presacral venous plexus), an intermediate plane (visceral venous plexus), a superficial subcutaneous plane (suprapubic…

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Gluteal varices

Gluteal varices

In the posterior compartment of the thigh, the femoral vein communicates directly with the valved ischial veins (caudal gluteal). Their perforating veins, which are responsible for gluteal varices, may be derived from: ischial veins, the profunda femoris vein, these two systems communicating with the internal iliac vein, superior rectal veins and hemorrhoidal veins which drain into the inferior mesenteric vein, which belongs to the portal system. Figure 36 Anatomical origin of vulval, perineal and gluteal varices. Vulval varices Perineal varices…

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Vulval varices

Vulval varices

Vulval varices, reported in 5% to 10% of pregnancies, may appear suddenly by the second month of pregnancy. They tend to occur more frequently from the second pregnancy onwards and are generally asymptomatic. However, they may be accompanied by vulval heaviness, pruritus or burning. These varices may be supplied in three different ways: an incompetent long saphenous arch, via a superficial external pudendal branch; the internal iliac vein, via internal pudendal veins or uterine and vaginal veins; left or right…

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Perineal varices

Perineal varices

These varicose veins, frequent in women after pregnancies, are more rarely observed in men, apart from competitive sportsmen (Figure 35). They are situated very superficially medial to the long saphenous vein and tend to be multiple, anastomosed between each other and tortuous. They communicate directly with the intrapelvic venous network via the internal pudendal veins or via uterine veins in women. They generally respond well to sclerosis or phlebectomy. When they are the site of reflux, they can supply the…

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Congenital anomalies

Congenital anomalies

Although rare, congenital malformations or angiodysplasias are nevertheless extremely varied. The Klippel-Trenaunay syndrome certainly constitutes the commonest anomaly. This syndrome consists of an association of cutaneous angiomas, lengthening of the lower limb, and congenital varicose veins which therefore appear before puberty. This pure venous malformation corresponds to agenesis or hypoplasia- of the iliac vein, femoral vein or popliteal veina When it is associated with one or several arteriovenous fistulas, it constitutes the ParkesWeber syndrome. Several elements must be investigated in…

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Saphenopelvic communications

Saphenopelvic communications

The superficial veins of the lower limbs are normally only connected to the pelvic venous system via the femoral vein which becomes the external iliac vein above the inguinal ligament (Figure 27). The internal iliac vein or hypogastric vein is avalvular and drains all of the ipsilateral pelvic organs. In particular, if receives the uterine veins and the parietal plexus (retropubic, sacral, gluteal and obturator veins). Ovarian veins drain into the inferior vena cava on the right and into the…

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Tributaries of cutaneous drainage

Tributaries of cutaneous drainage

The tributaries of the saphenofemoral junction can constitute anatomical traps: when they do not drain directly into the long saphenous vein when they communicate with the deep pelvic venous network (Click here). The tributaries which ensure the cutaneous drainage of regions situated above the inguinal skin crease include, from lateral to medial: the superficial circumflex iliac vein which drains the trochanteric region, the trunk of abdominal (or epigastric) subcutaneous veins derived from anastomosis of abdominal vessels, especially periumbilical vessels, the…

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Accessory saphenous veins

Accessory saphenous veins

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. Figure 30 Types of anastomosis of an accessory saphenous veine….

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H-shaped junction

H-shaped junction

This is a particular case of association of an accessory saphenous vein with the main saphenous trunk. It constitutes a surgical trap when the first arch exposed drains directly into a large underlying long saphenous vein, which may be confused with the femoral vein. The surgeon may then be faced with two situations when looking for the arch of the saphenous vein. In the first case, he identifies a “first arch” which simulates the arch of the long saphenous vein,…

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