Segmental Hypoplasia of the Great Saphenous Vein and Varicose Disease

Abstract

Saphenous hypoplasia occurs in varicose limbs more frequently than in healthy ones (p= >0.001). It greatly influences the path of the reflux and the anatomy of the varicose veins. GSV segmental hypoplasia can be detected preoperatively by duplex ultrasonography. Its occurrence may influence surgical management for two main reasons: in about 68% of varicose limbs with segmental hypoplasia, the distal GSV is competent. If the distal GSV is varicose, its size and flow direction is normalised by treating the accessory vein that bypasses the hypoplastic segment.

Sonographic anatomy of the lower extremity superficial veins

“…If there is no connection between the two segments of the GSV, then only one segment may develop incompetence. Segmental hypoplasia is present in 25% of limbs with GSV reflux due to SFJ incompetency and in 12% of limbs in normal subjects (P < 0.01) (15). Another study also showed that the incidence of a segmental hypoplasia of the GSV was higher in patients with varices than in normal subjects (43% versus 30%; statistical significance is not defined) (13).…”

“…Another study also showed that the incidence of a segmental hypoplasia of the GSV was higher in patients with varices than in normal subjects (43% versus 30%; statistical significance is not defined) (13). The higher incidence of segmental GSV hypoplasia in patients with clinically apparent varicose veins may play a causative role in the pathogenesis of varices (13,15). Despite the high incidence of hypoplasia of the GSV, it has been mentioned rarely in the literature.…”

“…However, the GSV may be diminished in caliber or not visualized at all in some segments along the saphenous compartment and is called segmental hypoplasia of the GSV (14,15). The etiology of GSV hypoplasia is unknown but could be secondary to a primitive defect occurring during development.…”

“…5). The vein that connects the proximal and distal parts of the saphenous vein acts as a bridging vein, which was called the saphenous accessory vein (15). However, the term saphenous accessory for the bridging vein may not be appropriate according to recent terminology for accessory veins.…”

“…However, the term saphenous accessory for the bridging vein may not be appropriate according to recent terminology for accessory veins. The distal normal GSV may sometimes terminate by directly draining into a perforator just distal to the hypoplastic segment (15). The proximal normal GSV in the saphenous compartment may be a continuation of a tributary, which means that sometimes no connection exists between the lower and upper parts of the GSV in its compartment.…”