A rare anatomical variation of great saphenous vein at the level of saphenofemoral junction

Abstract

The saphenofemoral junction is one of the major connections between the superficial and deep venous system in the leg. It is important to understand the anatomic variations in the lower extremity for treatment of venous disorders. There are many variations of the superficial system, most of them are with the great saphenous vein. A rare anatomic variant where the great saphenous vein is located between the superficial femoral and profunda arteries at the level of saphenofemoral junction is discussed in our case report.

Introduction

The saphenofemoral junction is a proximal connection between the superficial and deep veins in the lower limb. Great saphenous vein (GSV) is one of the main superficial veins which runs from the ankle to the groin at the medical aspect of the leg. Normally the GSV drains medially into the common femoral vein (CFV). On the other hand, the common femoral artery or the junction of superficial femoral artery (SFA) and profunda artery join laterally to CFV. There are many anatomic variation of the GSV especially in the thigh. In our case, we observe a very rare variant where the GSV was located between SFA and profunda artery at the junction of SFJ.

Case report

A 23-year-old male was evaluated for lower extremity venous insufficiency using B-mode, Color and Doppler ultrasound. The left GSV was located between the SFA and profunda artery at the SFJ. There was a narrowing effect in the GSV at the level of the SFJ due to the compression by both the SFA and profunda artery, the reduction of GSV diameter was 50%. The GSV was insufficient in both locations. There were many varicose veins connecting to GSV all over the thigh and calf up to 9 mm diameter with some incompetent perforators. A treatment with endovenous laser therapy was performed and patient showed improvement in symptoms.

Discussion

The GSV and SSV are the 2 main superficial veins in the lower limb. They join the deep system via SFJ and saphenopopliteal junction, respectively. Both GSV and SSV have normal anatomic variants in their drainage with deep system, connecting between each other, duplication and aplasia or hypoplasia.

There are many anatomic variants of the GSV around the level of the thigh, calf, and knee. At the level of SFJ usually there are few variants where the GSV connect to CFV (Fig. 1). In our case report GSV was located between the SFA and PROF A at the level of SFJ (Fig. 2)-type 2 variation.

Fig. 1.

Variation at the sapheno-femoral junction (SFJ). (1) GSV crossing posterior to the CFA. (2) GSV passing through between profunda femoris artery and SFA. (3) GSV running lateral, along the SFA. (4) Inversion of femoral artery and vein. (5) Duplication of the SFJ. GSV, great saphenous vein; CFA, common femoral artery; PFA, profunda femoris artery; SFA, superficial femoral artery; FV, femoral vein.

Fig. 2.

Ultrasound representation a normal variant where the right GSV join the SFJ on the lateral aspect between the SFA and profunda artery. GSV, great saphenous vein, CFV, common femoral vein; SFJ, saphenofemoral junction; SFA, superficial femoral artery; PROF A, profunda artery.

There are modern ways to diagnose and treat venous insufficiency of lower limb. Diagnosis options are venography, CTV, MRV, and ultrasound using B-mode, color, and Doppler. Treatment options include thermal, mechanical ablation, sclerotherapy, and surgical ligation with or without stripping.

Finally, identification of normal variants plays an important role in increasing the success and efficiency of surgical treatment in the lower limb veins.