Duplex Ultrasound Investigation of the Veins in Chronic Venous Disease of the Lower Limbs—UIP Consensus Document. Part II. Anatomy

Abstract

The authors and a large group of experts have agreed a methodology for the investigation of the lower limbs venous system by duplex ultrasonography, with specific reference to the anatomy of the main superficial veins and perforators of the lower limbs in healthy and varicose subjects.

Duplex ultrasound in the assessment of lower extremity venous insufficiency

“…No two patients are ever exactly alike in terms of the exact location and branching (more precisely convergence) pattern of the venous tree of the limbs 14 , 15 , 16 . Some general observations can be made:

The location of the SFJ is relatively constant at the groin crease.

The GSV and its tributaries are found within a well formed fascial envelope termed the “Saphenous eye, “Egyptian eye” or “Cleopatra's eye” (Fig.

…”

“…Detailed diagram of the most common superficial veins and their accepted international nomenclature 14 , 15 is provided in Fig. 12.…”

Clinical and duplex ultrasound evaluation of lower extremities varicose veins – a practical guideline

“…Lateral varicose veins in the thigh may originate from posterolateral perforator veins or an insuffi cient anterior accessory saphenous vein, although in the latter case varicose veins usually show a ventrolateral course (Figure 4). Alternatively, the origin may be the remnant of the embryonic lateral marginal vein (Albanese system) [7] and if associated with limb hypertrophy, lymphedema, and / or port wine stain, a Klippel-Trenaunay Syndrome can be suspected [34]. However, the most frequent clinical pattern is to fi nd varicose veins related to an incompetence of the GSV or SSV.…”

“…In the past years, an international agreement on the LEVV anatomic terminology and duplex anatomy was reached [5][6][7][8]. This section describes this anatomy, focusing on sonographic criteria.…”

“…Table II. Nomenclature of the perforating veins (PV) (7). The medial leg PV can further be divided in paratibial and posterior tibial PV, the posterior leg PV in medial and lateral gastrocnemius PV, intergemellar PV and para-achillean PV, the medial thigh PV in PV of the femoral canal and inguinal PV and the posterior thigh PV in posteromedial, sciatic and posterolateral PV.…”