Types of outlet of the major saphenous vein tributaries in patients with chronic vein insufficiency of the lower limbs

Abstract

Chronic vein insufficiency (CVI) is a disease which, when it develops, leads to varicose veins of the lower limbs. As approximately 25% to 50% of people suffer from it, it should be recognised as a public disease. The treatment of chronic vein insufficiency is based on a surgical approach. The aim of the operation is to remove (strip) the insufficient major saphenous vein (MSV), the main cause of the disease. The major saphenous vein drains into the femoral vein and forms the sapheno-femoral junction, which is located in the hiatus saphenous within the femoral triangle. We conducted 94 varicose vein operations by the Babcock method on patients suffering from chronic vein insufficiency. This surgical treatment was performed in "Therapy", a private clinic for peripheral vessel disease. We operated on 52 left lower limbs and 42 right lower limbs. The patients were qualified for the operation procedure after physical examination and Doppler ultrasonography imaging. We identified 5 types of major saphenous vein tributary drainage. The most common was Type I, in which there were 3 tributaries draining directly into the major saphenous vein. This type consisted of 45 cases (47.87%). We distinguished here 3 modifications. In Type II, however, there were 4 direct tributaries that drained into the major saphenous vein in 23 cases (24.46%). In this group of patients also 3 modifications were distinguished. Type III occurred in 14 cases (14.89%). We identified here 2 direct tributaries that drained into the saphenous vein and divided this type into 2 modifications. Type IV occurred in 8 cases (8.51%). Here we found 5 or 6 direct tributaries depending on the number of the external pudendal veins. Type V turned out to be very rare, occurring in only 4 cases (4.25%). Among all the types mentioned a thin tributary 1–2 mm wide was found in 10 cases (10.63%). This ran from under the fascia cribrosa into the saphenofemoral junction in the hiatus saphenous. This may be one of the causes of the recurrences of chronic vein insufficiency. There is also the possibility that a tributary will be overlooked or ignored during the operation, particularly when Type IV appears with 5 or 6 direct collaterals.