Anatomy of the Superficial Venous System

Lowell S. Kabnick, MD, FACS Clinical Assistant Professor of Surgery UMDNJ Director of the Vein Institute of New Jersey

13th Annual MIIT Interventional Radiology and Endovascular Therapy Seminar

Faculty Disclosure Lowell S. Kabnick, M.D.

I hereby disclose that I: 1. Serve as a consultant for VNUS Medical, Angiodynamics, Inc., Johnson & Johnson, Vascular Insights and Biolitec

5 Levels of Veins
Deep Veins
Common Femoral, Femoral, Popliteal,and Tibial Veins

Superficial Veins
Small Saphenous Vein (Lesser Saphenous Vein) Great Saphenous Vein (Greater Saphenous Vein)

Perforators (connectors of the deep veins to the superficial veins) Reticular Veins (tributaries to the saphenous vein connecting branch veins to deep, superficial or perforators) Capillaries
Vein Institute of New Jersey

CHANGING TERMINOLOGY
Greater saphenous Smaller or short saphenous Accessory saphenous
Anterior accessory great saphenous Posterior accessory great saphenous

Great saphenous Small saphenous

Vein Institute of New Jersey

Vein Institute of New Jersey

Varicose Veins
Anatomy and Physiology
Dominant superficial collecting veins Great Saphenous Vein Small Saphenous Vein Vein of Giacomini Lateral subdermic venous plexus Communicating vein connects veins in the same fascial plane AKA tributaries, branches Perforator vein connects a superficial vein to a deep vein (crossing fascial plane)

Vein Institute of New Jersey

Varicose Veins Anatomy

Thorough knowledge of venous anatomy is important for diagnosing the source of varicosities Varicose patterns on the leg often indicate the source of the problem Determining the source of the varicosities is important for treatment

Varicose Veins
Superficial Venous Anatomy
Great Saphenous Vein dorsum of the foot medial thigh femoral vein Lies in the superficial fascia own compartment are often the site of varicosities

Junctional tributaries Saphenous nerve

close contact with the GSV below the knee

Tributaries at the SFJ

Tributary Legend AL Anterolateral PM Posteromedial SEP Superficial external pudendal SE Superficial epigastric SCI Superficial circumflex iliac

Anterolateral branch often demonstrates reflux alone Posteromedial branch when dilated is called the vein of Giacomini Superficial Epigastric vein is an important land mark for minimally invasive procedures

Vein Institute of New Jersey

Varicose Veins
Zone of Influence of GSV
Terminal and subterminal valves at the SFJ
Leaks cause VV Often causes varicosities in the tributaries

Zone of influence GSV medial aspect

Varicose Veins
GSV Reflux

Varicose Veins
Anterior Circumflex(ATL) Reflux

Varicose Veins
Pudendal Reflux

Varicose Veins
Superficial Venous Anatomy
Small Saphenous vein runs along the
posterolateral aspect of the calf Starts along the the posterolateral aspect of the ankle The vein of Giacomini connect the SSV to the GSV SSV is closely associated with the Sural nerve

Varicose Veins
Zone of Influence of SSV and VG
The saphenopoliteal junction is often the origin of reflux in the SSV The excess blood volume entering the SSV from the deep system causes varicosities to form in tributary braches that course along the posterior calf
Reflux in the VG often leads into the GSV and varicosities often occur in the posterior thigh

Varicose Veins
Small Saphenous Reflux

Varicose Veins
Varicosities of the Vein of Giacomini

Varicose Veins
Superficial Venous Anatomy
Lateral Subdermic Venous System is a system of small caliber veins extending above and below the knee on the lateral leg Normal venous flow is paradoxically downward to perforators in the region of the knee

Varicose Veins
Zone of Influence of LSVS
The network of abnormal reticular vein demonstrate reflux A focal source of reflux often can not be found with ultrasound Spider veins often occur along the lateral aspect of the thigh and calf Large varicosities can occur

Varicose Veins Lateral Subdermic Venous System

Varicose Veins
Venous Perforators
Hunterian perforators
Common cause of medial thigh varicosities in patients with competent SFJ

Dodds perforators Boyd perforators

Connect small saph to crural veins Common site for primary varicose veins

Cocketts perforators

Boyds Perforator

Vein Institute of New Jersey

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Vein Institute of New Jersey

Conclusion
Treatment of SVI is entirely based on defining the pathologic anatomy Through knowledge of the superficial and deep venous system of the lower extremity is essential before embarking upon the treatment of SVI Ultrasound evaluation of the extremity is the gold standard way to define the superficial venous anatomy

Welcome to the 13th Annual MIIT Interventional Radiology and Endovascular Therapy Seminar October 28-30, 2004
Chicago Westin River North Hotel Downtown Chicago