International Journal of Anatomical Sciences 2011, 2(2): 22-25

Research Paper

Duplication of Great Saphenous Vein in South Indian Population

Udhaya K, Sarala Devi KV, Sridhar J, Melani Rajendran S.

Department of Anatomy, Vinayaka Mission Kirupananda Variyar Medical College, Salem 636 308, Tamilnadu, India.
Department of Surgery, Vinayaka Mission Kirupananda Variyar Medical College and Hospital, Salem 636 308, Tamilnadu, India.
Department of Anatomy, Sri Ramachandra Medical College, Chennai 600 117, Tamilnadu, India

Key words : Great Saphenous vein, Duplication, Varicose veins.

Abstract: The great saphenous vein is the conduit of choice as a graft in coronary artery bypass arterial reconstruction and for valvuloplasty in medical and surgical practice. The great saphenous vein is also used for bypass obstructions in case of atheromatous occlusion of the femoral and coronary arteries. The duplication of great saphenous vein is a frequent cause of failure to achieve the expected results following primary ligation for the treatment of varicose veins. The current study was therefore focussed on duplication of great saphenous vein and its incidence in South Indian population. For this purpose a total sample of 70 adult specimens of both sides, 22 male and 13 female cadavers were used. The results were analysed by dissection method. For this, the incidence is used as parameter. Duplication was observed bilaterally in one cadaver with the incidence of 3% which correlates with western population. The results conclude that precise knowledge about normal anatomy of great saphenous vein with their variations becomes mandatory for a successful clinician. The study about this fact  by our  Indian authors was scarce. Hence an attempt was made in the present study to find out duplication of Great saphenous vein in South Indian population.

The great saphenous vein originates from the inner part of the dorsal venous arch of the foot, by the union of medial end of dorsal  venous  arch  and  medial  marginal vein. After its formation, it passes in front of the  medial  malleolus,  single  trunk  lying along the posteromedial aspect of the knee joint, receiving anterior and posterior tributaries along its course, one hand breadth posterior to the patella, and then upto the fossa ovalis or saphenous opening (4 cm below  and  lateral  to  the  pubic  tubercle)where it enters the femoral vein (Williams et al.,2005).

The variations are more common in the upper segment of great saphenous vein, where   it   ends   near   the   femoral   vein. Common cause of recurrence of varicosities after high ligation and stripping are said to be failure to ligate the duplicated great saphenous vein if any (Linton, 1938; Sherman, 1944; Summers, 1953). The incidence and pattern of duplication have drawn attention to  the possible role of its variation as a source of recurrent varicose veins (Kosinski, 1926; Glasser, 1943; Daseler,   1946; Haeger,1977;Corrales,2002).A thorough and effective knowledge of the anatomical variations of the great saphenous vein like duplication, determines the good results of medical and surgical management.

Materials and Methods

The study was conducted in seventy adult specimens of both sides including 22 male and 13 female cadavers of age group 40 to 60 years, over a period of three years, in the department of Anatomy, Sri Ramachandra Medical College & Research Institute, Chennai. By dissection method, the course of great saphenous vein from the medial malleolus to the sapheno-femoral junction in both legs, the duplication of great saphenous vein with their termination into femoral vein and its tributaries were traced.

Observations

Out   of   70   specimens   dissected (Table-1), in 68, the great spahenous vein was seen normal (Fig. 1) and the duplication of the  great saphenous  vein  was observed only in one male cadaver bilaterally (Fig. 2 and 3). In the duplicated vein, the level of termination and their drainage pattern along with their terminal tributaries were noted separately for both sides. On both sides of a male cadaver, the duplicated vein was found to terminate into the femoral vein. On the right  side,  the  distance  measured  between the anterior superior iliac spine and sapheno- femoral junction was 9.7 cms and on the left side it was 10.1 cms. The sapheno-femoral junction was found to be 4.2 cms lateral to pubic tubercle on the right side and 4.5 cms lateral to pubic tubercle on the left side.

Sex No ofCadavers No ofSpeci-mens Duplica-tion Normal
Male 22 44 limbs 2 limbs 42 limbs
Female 13 26 limbs - 26 limbs
Total 35 70 limbs 2 limbs 68 limbs

Table-1 Details of cadaver samples studied for great saphenous vein

On observing the drainage pattern of the right side, the duplicated great saphenous vein on the lateral part of the thigh drained into  the  femoral  vein  at  the  fossa  ovalis along  with  the  superficial  circumflex  iliac vein whereas the duplicated vein observed on the medial part of the right side drained into  the  femoral  vein  at  the  fossa  ovalis along with the external pudendal vein and superficial epigastric vein (Fig. 2) Similarly on the left side, the medially observed duplicated vein drained into the femoral vein at the fossa ovalis along with the external pudendal vein whereas the laterally observed duplicated vein on the left side drained into the femoral vein at the fossa ovalis along with the superficial circumflex iliac vein and superficial epigastric vein (Fig. 3) No other abnormalities were detected in the specimen other than duplication. The remaining 68 specimens   showed   normal   course   and pattern of great saphenous vein without any duplication.

Fig. 1 Normal great saphenous vein

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(FV-Femoral vein;SCIV – Superficial circumflex iliac vein;SEV-Superficial epigastric vein;EPV-  External pudendal vein;GSV-Great saphenous vein)

Discussion

The great saphenous vein has an important role as autograft for arterial by- pass surgery (Shah et al., 1986). A proper understanding of the anatomy of the super- ficial veins is elementary for improving the results of operative treatment. Duplications    of great  saphenous  vein  are often  demon- strated by dissection  during  arterial bypass surgery.

Fig. 2 Duplication of great saphenous vein on right side  (FV-Femoral vein;SCIV-Superficial circumflex iliac vein;SEV-Superficial epigastric vein;EPV-External pudendal vein;GSV-Great saphenous vein).

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Fig. 3 Duplication of great saphenous vein on left side   (FV-Femoral vein;SCIV-Superficial circumflex iliac vein;SEV-Superficial epigastric vein;EPV-External pudendal vein;GSV-Great saphenous vein)

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Clinicians  unfamiliar  with  venous insufficiency,  particularly  disorders  of  the  superficial venous system like duplication, often underestimate the complexity of the problem and the importance of proper evaluation before initiating treatment. In addition to a directed history, evaluation and physical examination, additional evaluation with use of a variety of non-invasive diagnostic instruments, including duplex ultrasound, may be necessary before the treatment of varicose disease (Ricci, 1999) for determining the cause and severity. The precise anatomy of the great saphenous vein should be determined preoperatively by phlebography since this information is valuable for proper surgical planning before vein is used as a graft or for in situ bypass in the lower extremity. Phlebography (Saphenography)  is  a  reliable  method  for pre-operative assessment of variations and connections of great saphenous vein especially when anteroposterior and lateral images are taken (Shah et al.1986; Veith et al., 1979).
Glasser  (1943)  reported  and classified the venous drainage at the region of fossa ovalis into 19 sapheno-femoral drainage patterns after dissecting 50 bodies (100  limbs)  and  according  to  him duplication belongs to Type-V B which shows double great saphenous vein joining at the fossa ovalis with the incidence of 3% . In the present study (South Indian population), the duplication was found bilaterally in one male cadaver with the incidence of 3% which correlates with the study of Glasser (1943) in Western population. Similar reports and references in South  Indian  population  regarding duplication of great saphenous vein were scarce to compare and correlate our present study.   Hence   many  reports   from   South Indian population are awaited.

Conclusion

A thorough understanding of the anatomical  variations  of  great  saphenous vein is important in providing information for the vascular surgical operations concerning with lower extremity. Further studies are required involving more samples Udhaya et al. – Duplication of great saphenous vein to  gather  information  pertaining  to frequency of true duplications of the great saphenous vein in Indian population.

References

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Glasser, S.T. An anatomic study of the venous variations at the fossa ovalis. The significance of recurrences following ligations. Arch Surg.46: 289-95, 1943.

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