Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 25  |  Issue : 4  |  Page : 116-118

Unilateral double great saphenous vein: A clinically significant case report


Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka, India

Date of Web Publication22-Dec-2015

Correspondence Address:
Naveen Kumar
Department of Anatomy, Melaka Manipal Medical College (Manipal Campus), Manipal University, Manipal, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2211-4122.172491

Rights and Permissions
  Abstract 

Great saphenous vein (GSV) is the longest vein in the body originating from the dorsum of the foot at medial malleolus to the level of groin skin crease. It is one among the clinically significant superficial veins of the lower limb. Double or duplication of GSV is considered to be one of its rarest variant forms, which might be often mistaken with the accessory saphenous vein. The overall incidence of duplicated GSV is reported to be 1%. We report herein, a unilateral duplication of GSV with its morphological and clinical perspectives. The major clinical complication that is often encountered from its duplication is recurrent incompetence of the GSV, which predisposes varicosity. Therefore, a thorough knowledge of venous anatomy is important for clinicians and sonographers.

Keywords: Duplication, femoral vein, great saphenous vein, superfi cial veins of lower limb, varicosity


How to cite this article:
Padavinangadi A, Kumar N, Swamy RS, Satheesha NB, Mohandas Rao K G. Unilateral double great saphenous vein: A clinically significant case report. J Cardiovasc Echography 2015;25:116-8

How to cite this URL:
Padavinangadi A, Kumar N, Swamy RS, Satheesha NB, Mohandas Rao K G. Unilateral double great saphenous vein: A clinically significant case report. J Cardiovasc Echography [serial online] 2015 [cited 2020 Aug 13];25:116-8. Available from: http://www.jcecho.org/text.asp?2015/25/4/116/172491


  Introduction Top


The great (long) saphenous vein (GSV) is a superficial vein representing preaxial vein of the lower limb. It begins in the medial marginal vein of the foot and ends in the femoral vein below the inguinal ligament. During its course, it ascends in front of the tibial malleolus and obliquely crosses the lower part of the medial surface of the tibia to its medial border and ascends to the knee. It reaches the saphenous opening in the thigh and drains into the femoral vein. [1]

GSV is known to show aberrant formation, termination, and various patterns of tributaries. However, its complete duplicating morphology is hardly ever reported to the best of our knowledge.

Accessory GSV and double GSV are often misinterpreted as synonyms. While accessory saphenous vein is generally smaller in size, the two veins of duplicate GSV will have the same caliber. [2] The present case report describes a rare morphological variation of GSV, as a unilateral duplication throughout its extent.

Incompetency of valves of GSV marks the common cause of varicosity. To achieve increasing success and efficacy of surgical treatments and in decreasing the recurrence rates of varicosity, the knowledge and identification of anatomical variations of veins of the limbs are obligatory to the clinicians.


  Case report Top


During routine cadaveric dissection for undergraduate medical students, we observed a case of double GSV on the right lower limb in a male cadaver aged about 60 years. The origin of the main GSV was normal from the dorsal venous arch of the foot, whereas its duplicate vessel was found to be formed by the union of medial end of dorsal venous arch with the dorsal metatarsal vein which was draining the great and second toes [Figure 1]a. Main GSV had a normal course as it ran upward in front of the medial malleolus, along the medial side of the leg. The duplicate GSV was accompanying the main GSV laterally and had a similar course as that of the main GSV. Main GSV received the superficial external pudendal and superficial epigastric veins and united with the duplicated GSV, which received the superficial circumflex iliac vein before its union with the main GSV [Figure 1]b and both of them drained into the femoral vein after passing through the saphenous opening.
Figure 1: (a) Dissection of dorsum of the right foot and medial side of the leg showing the origin of main and duplicate great saphenous veins. (b) Dissection of front of the thigh showing termination of main and duplicate great saphenous vein into femoral vein. SA = Sartorius, RF = Rectus femoris, AL = Adductor longus muscles

Click here to view



  Discussion Top


The venous system is considered to be more variable than the arterial system. The arrangement of venous drainage of the lower limb may vary from subject to subject and even from limb to limb. [3]

The GSV, a clinically significant superficial vein of the lower limb, is a readily accessible vein. Due to the presence of enough distance between its tributaries and perforating veins, usable length of it can be harvested for vascular implantation purposes. Since its wall contains a significant amount of muscular and elastic fiber content than any other superficial vein, it is commonly used for coronary arterial bypass. [4]

Variant form in its formation, course, and tributary pattern is widely reported. However, reports on duplicate GSV are very uncommon as its occurrence rate is estimated to be 1%. Moreover, when duplication persists, it is reported that both GSVs lie in the same plane. [5]

GSV, with its variant formation, reported as a continuation of the dorsal venous arch at the proximal part of metatarsal bones in 70% of cases and in the remaining cases, it arises as a continuation of the first common metatarsal vein of the medial side of the great toe. [6]

Based on its relation with the femoral vein, duplication of GSV can be categorized into 3 types. They are duplication with a common junction, duplication with separate junctions, and insular duplication with a common junction. [7]

Duplicated GSV can be found below or above the knee. A case of duplicated GSV with the same origin and course as that of main GSV and with multiple intercommunications at mid-calf and mid-thigh levels has been reported by Waseem and Roger. [8]

Nakhate et al. [9] reported a unilateral duplicated GSV below the knee at the level of medial condyle of tibia with the eventual reunion of both to form a single saphenous vein with eventual termination into femoral vein.

GSV has a great clinical importance, as it is a vein of choice for the grafts in peripheric vascular surgery in the treatment of cerebrovascular diseases. [10],[11] Recurrent incompetence of the GSV is the most common predisposing factor of the persistence of duplicated GSV. [12]

Conservative approach, ultrasound-guided sclerotherapy, and junction ligation with or without vein stripping are the treatment options for varicose veins. [13] Expertize in venous anatomy and its atypical variant forms are necessary for interventional treatment modalities. Surgical or lesser invasive procedures might result in incomplete sephanofemoral junction surgery if important anatomical variations are not recognized. [13],[14]


  Conclusion Top


Presence of rare and clinically essential variant form of GSV and its duplication should be known to clinicians, radiologists, and phlebotomists. Varicosity is one of the most significant clinical pose of superficial veins of the lower limb, its recurrence even after stripping or sclerotherapy procedure warrants the need of a meticulous look for the presence of double GSV.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Standring S. In Gray′s Anatomy. 39 th ed. London: Elsevier Churchill Livingstone; 2005. p. 1452-3.  Back to cited text no. 1
    
2.
Mozzon L, Venier E,Gonano N, BiasiG. Sur un cas de double crosse saphenienne. In: Davy A, Stemmer R, eds. Phlebologie 89. 1989: 14-5.  Back to cited text no. 2
    
3.
Palastanga N, Field D, Soamas R. Anatomy and Human Movement Structure and Function. 3 rd ed. Oxford: Butter Worth & Heineman; 2000. p. 574.  Back to cited text no. 3
    
4.
Moore KL, Dalley AF. Clinically Oriented Anatomy. 5 th ed. Baltimore: Lippincott Williams & Wilkins; 2006. p. 580-4.  Back to cited text no. 4
    
5.
Ricci S, Caggiati A. Echo-anatomical patterns of the long saphenous vein in patients with primary varices and in healthy subjects. Phlebology 1999;14:54-8.  Back to cited text no. 5
    
6.
Al-Sayigh HA. The incidence of double great saphenous vein among Iraqi people: Case series study. Med J Babylon 2014;6(2) doi: 1812-156X-6-2.  Back to cited text no. 6
    
7.
Hsin CS, Kumar PS. Long saphenous vein and its anatomical variations. AJUM 2009;12:28-31.  Back to cited text no. 7
    
8.
Waseem AL, Roger S. A duplicated great saphenous vein and clinical significance for varicosity. Rev Argent Anat Clin 2014;6: 43-6.  Back to cited text no. 8
    
9.
Nakhate MS, Ghoshal J, Sawant VG. A rare variation of great saphenous vein. J Evol Med Dent Sci 2014;3:13625-7.  Back to cited text no. 9
    
10.
Tuncer I, Buyukmumcu M, Cicekcibasi AE, Salbacak A. A duplication of great saphenous vein. Genel Týp Derg 2002;12:105-7.  Back to cited text no. 10
    
11.
Karabulut AK, Ustun ME, Uysal II, Salbacak A. Saphenous vein graft for bypass of the maxillary to supraclinoid internal carotid artery: An anatomical short study. Ann Vasc Surg 2001; 15:548-52.  Back to cited text no. 11
    
12.
Michael K, Kees-Peter DR, Lucas VD, Tamar N, Martino AK, Yeliz A, et al. A rare anatomical variation of the greater saphenous vein: Case report. Med Ultrason 2014;16:60.  Back to cited text no. 12
    
13.
Tavlasoglu M, Guler A, Gurbuz HA, Tanrýseven M, Kurkluoglu M, Yesil FG. Anatomical variations of saphenofemoral junction encountered during venous surgery. J Cardiovasc Surg 2013;1:5-7.  Back to cited text no. 13
    
14.
Donnelly M, Tierney S, Feeley TM. Anatomical variation at the saphenofemoral junction. Br J Surg 2005;92:322-5.  Back to cited text no. 14
    


    Figures

  [Figure 1]


This article has been cited by
1 Systematic review and meta-analysis of the anatomic variants of the saphenofemoral junction
Roberto Cirocchi,Brandon Michael Henry,Massimo Rambotti,Krzysztof A. Tomaszewski,Massimo Cappelli,Gianfranco Vettorello,Alessandra Pistilli,Vito DćAndrea,Bruno Amato,Justus Randolph
Journal of Vascular Surgery: Venous and Lymphatic Disorders. 2018;
[Pubmed] | [DOI]
2 Bifurcated great saphenous vein: A report on its therapeutic and diagnostic perspectives
Naveen Kumar,AshwiniP Aithal,RavindraS Swamy,SatheeshaB Nayak,MohandasK. G Rao,P Abhinitha
Journal of Cardiovascular Echography. 2017; 27(3): 107
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed2663    
    Printed76    
    Emailed0    
    PDF Downloaded72    
    Comments [Add]    
    Cited by others 2    

Recommend this journal


[TAG2]
[TAG3]
[TAG4]