Page 264 - Libro 2

244 PART 4 — PERIPHERAL VENOUS
of the anatomy of the superficial veins may alter the planned surgery as well as the surgical approach used. Information on the venous configuration will help to minimize the amount of surgical dissection needed.
This chapter will describe the techniques involved in ultrasonic evaluation of the superficial venous systems. Material pertaining to the great saphenous, small saphenous, basilic, and cephalic veins will be presented. Relevant anatomy, scanning techniques, tips, diagnostic criteria, and pathologic characteris- tics will be reviewed.
ANATOMY
THE GREAT SAPHENOUS VEIN
Prior to discussing the saphenous anatomy, it is important to briefly review the nomenclature of the venous system. A multidisciplinary panel published a consensus paper in which nomenclature was re- vised and standardized in an attempt to avoid some commonly confused terms.4,5 Table 16-1 lists several of the major changes regarding saphenous vein ter- minology. The great saphenous vein is the standard name for the vein that had been referred to as the greater or long saphenous vein. The small saphe- nous vein is the correct name for the vein previously known as the lesser or short saphenous vein. Sonog- raphers and vascular technologists should become familiar with this revised terminology.
Most anatomy textbooks display the great sa- phenous vein as a single trunk coursing medially along the thigh and terminating into the common femoral vein (Fig. 16-1). In the calf, the vein is often shown as traveling slightly anterior near the tibia to
Great saphenous vein
TABLE 16-1
Venous Nomenclature
Current Terminology
Great saphenous vein
Small saphenous vein
Anterior accessory great saphenous vein
Posterior accessory great saphenous vein
Cranial extension of the small saphenous vein
Previous Terminology
Greater saphenous vein Long saphenous vein
Lesser saphenous vein Short saphenous vein
Accessory saphenous vein
Accessory saphenous vein Leonardo’s vein
Posterior arch vein
Vein of Giacomini
Figure 16-1 Typical anatomic configuration of the great sa- phenous vein with a single medial dominant system in the thigh and an anterior dominant system in the calf.
the level of the medial malleolus. This is a common configuration for the great saphenous, but multiple variants exist. Extensive reviews of both ultrasound and venographic data have revealed complex system variability in both the thigh and calf.6,7
The thigh portion of the great saphenous vein has been found to have five common configurations (Fig. 16-2). In about 60% of cases, this vein is a sin- gle trunk that runs medially in the thigh. It curves slightly toward the inner thigh and typically has sev- eral large tributaries that empty into the vein before it joins the common femoral vein. These tributaries include the anterior (lateral) and posterior (medial) accessory and circumflex veins.
Less commonly, in only 8% of cases, the great saphenous is a single trunk that courses anterior– laterally in the thigh. This is likely a dominant ver- sion of the anterior accessory saphenous vein.
The remaining configurations encountered in the thigh all demonstrate some degree of duplication. The saphenous vein may have two separate systems run- ning both medially and laterally throughout the entire length of the thigh. These double systems remain separate from each other below the knee as well. This pattern occurs in 8% of cases. Sometimes the