The Giacomini vein – so small and inconspicuous?

Abstract

In Giacomini’s first description (1873), a vein was reported that runs via the popliteal fossa (without entering the popliteal vein) to the dorsal thigh and then passed to join the great saphenous vein. Since then, numerous other types of termination (including those that lead into the popliteal vein) have been published. In clinical practice, however, this vein receives little attention. The probability of detecting an insufficiency of the Giacomini vein is almost 12 times higher, especially in the presence of an insufficiency of the small saphenous vein. There are two reflux types of Giacomini’s vein. In retrograde reflux, venous blood enters the small saphenous vein via the great saphenous vein, the iliac veins or the perforating veins of the thigh. In the much rarer antegrade reflux, a paradoxical (ascending) reflux occurs in the Giacomini’s vein during muscular diastole. Surgical therapy focused exclusively on the saphenous vein without consideration of the reflux types may possibly result in overtreatment of the patient and should be avoided in an age of therapeutic diversity and a vein-preserving approach.

Due to the anatomical narrowing of the popliteal fossa and the increasing popularity of endoluminal-thermal procedures in the past, knowledge of the topographical anatomy is essential, especially to avoid neurological complications.

Key words

giacomini vein - femoropopliteal vein - small saphenous vein - paradoxical reflux

Schlüsselwörter

Vena giacomini - V. femoropoplitea - V. saphena parva - paradoxer Reflux

Publication History

Article published online:
18 January 2021

• Literatur

• 1 Giacomini C. Osservazioni anatomiche per servire allo studio della circolazione venosa delle estremità inferiori. 1873
• 2 Georgiev M, Myers KA, Belcaro G. et al Giacomini’s observations on the superficial veins of the abdominal limb and principally the external saphenous. Int Angiol 2001; 20: 225-233 . Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/11573057
• 3 Georgiev M, Myers KA, Belcaro G. The thigh extension of the lesser saphenous vein: From Giacomini’s observations to ultrasound scan imaging. J Vasc Surg 2003; 37: 558-563 . Im Internet: http://linkinghub.elsevier.com/retrieve/pii/S074152140275218X
• 4 Gillot C. Les veines superficielles du membre inferieur. Ann Chir 1997; 51: 713-727
• 5 Hyrtl J. Über normale und ahnorniale Verhältnisse der Schlagadern des Unterschenkels. In: Vorgelegt an der Sitzung der mathematisch-naturwissenschaftlichen Classe der KaiserlichenAkademie der Wissenschaften am 8.03.1864
• 6 Stolic E. La veine sous-aponévrotique postérieure de la cuisse. Comptes rendus l'Association des Anat 1970; 55: 1016-1026
• 7 van Limbourgh J. L’Anatomie du systeme veineux de l’extremite inferieure relation avec la pathologie variqueuse. Folia angiol (Pisa) 1631; 8: 3
• 8 Schobinger RA. Bedeutung einer persistierenden V. femoropoplitea. In: Brunner U. (Hrsg) Die Kniekehle. Bern: Hans Huber; 1975: 106-110
• 9 Staubesand J. Angiologische Aspekte zur Anatomie der Kniekehle. In: Brunner U. (Hrsg) Die Kniekehle. Bern: Hans Huber; 1975: 11
• 10 Raivio E. Untersuchungen über die Venen der unteren Extremität mit besonderer Berücksichtigung der gegenseitigen Verbindungen zwischen den oberflächlichen und tiefen Venen. Ann Med exp Fenn 1948; 26: 4
• 11 Nissl R, Flora G. Röntgenstudien zur Anatomie der Vena semicircularis und der Giacominivene. RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der Bildgeb Verfahren 1978; 128: 334-338
• 12 Gillot C. La veine décrite par Giacomini: Essai de systématisation et approche de la terminologie des veines fondée sur l’embryologie et la fonction. Phlebologie 2001; 54: 423-429
• 13 Giacomini C. Osservazioni anatomiche per servire allo studio della circolazione venosa delle estremita inferiori. G della R Accad di Med di Torino 1873; 14: 109-215
• 14 Caggiati A, Mendoza E, Murena-Schmidt R. Anatomie des oberflächlichen Venensystems. In: Duplexsonographie der oberflächlichen Beinvenen. Berlin Heidelberg: Springer; 2020: 21-48 . Im Internet: https://link.springer.com/chapter/10.1007/978-3-662-58982-3_2
• 15 Brenner E. Anatomie des oberflächlichen Venensystems des Beines. Phlebologie 2018; 47: 352-362
• 16 Delis KT, Knaggs AL, Khodabakhsh P. Prevalence, anatomic patterns, valvular competence, and clinical significance of the Giacomini vein. J Vasc Surg 2004; 40: 1174-1183
• 17 Schweighofer G, Mühlberger D, Brenner E. The anatomy of the small saphenous vein: Fascial and neural relations, saphenofemoral junction and valves. J Vasc Surg 2010; 51: 982-989
• 18 Caggiati A. Fascial relationships of the short saphenous vein. J Vasc Surg 2001; 34: 241-246
• 19 Kosinski C. Observations on the Superficial Venous System of the Lower Extremity. J Anat 1926; 60: 131-142 . Im Internet: http://www.ncbi.nlm.nih.gov/pubmed/17104088
• 20 Hach W. Venenchirurgie. Stuttgart: Schattauer; 2006
• 21 Shahid KR, Dellon AL, Amrami KK. et al Sciatic and peroneal nerve injuries after endovascular ablation of lower extremity varicosities: Case reports and review of the literature. Ann Plast Surg 2015; 74: 64-68
• 22 Uhl JF, Gillot C. Anatomy and embryology of the small saphenous vein: Nerve relationships and implications for treatment. Phlebology 2013; 28: 4-15
• 23 Chang KV, Mezian K, Naňka O. et al Ultrasound Imaging for the Cutaneous Nerves of the Extremities and Relevant Entrapment Syndromes: From Anatomy to Clinical Implications. J Clin Med 2018; 7: 457 . Im Internet: www.mdpi.com/journal/jcm
• 24 Labropoulos N, Tassiopoulos AK, Gasparis AP. et al Veins along the course of the sciatic nerve. J Vasc Surg 2009; 49: 690-696 . Im Internet: https://pubmed.ncbi.nlm.nih.gov/19135832/
• 25 Oǧuzkurt L. Ultrasonographic anatomy of the lower extremity superficial veins. Diagnostic Interv Radiol 2012; 18: 423-430
• 26 Caggiati A, Bergan JJ, Gloviczki P. et al Nomenclature of the veins of the lower limbs: An international interdisciplinary consensus statement. J Vasc Surg 2002; 36: 416-422
• 27 Broman I. Organogenie oder Organentwicklung. In: Broman I. (Hrsg) Normale und Abnorme Entwicklung des Menschen: Ein Hand- und Lehrbuch der Ontogenie und Teratologie. Berlin, Heidelberg: Springer; 1911: 133-794
• 28 Trigaux JPF, Vanbeers BE, Delchambre FE. et al Sciatic venous drainage demonstrated by varicography in patients with a patent deep venous system. Cardiovasc Intervent Radiol 1989; 12: 103-106
• 29 Cherry KJ, Gloviczki P, Stanson AW. Persistent sciatic vein: Diagnosis and treatment of a rare condition. J Vasc Surg 1996; 23: 490-497
• 30 Burbelko M, Kalinowski M, Wagner HJ. Seltene Ursache chronisch rezidivierender Lungen-Embolien und pulmonal-arterieller Hypertonie. Dtsch Medizinische Wochenschrift 2006; 131: 811-814
• 31 Ricci S, Moro L, Antonelli Incalzi R. Ultrasound Imaging of the Sural Nerve: Ultrasound Anatomy and Rationale for Investigation. Eur J Vasc Endovasc Surg 2010; 39: 636-641 . Im Internet: https://pubmed.ncbi.nlm.nih.gov/20018530/
• 32 Kerver ALA, Van Der Ham AC, Theeuwes HP. et al The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation. J Vasc Surg 2012; 56: 181-188 . Im Internet: https://pubmed.ncbi.nlm.nih.gov/22503186/
• 33 Kowalska B, Sudoł-Szopińska I. Normal and sonographic anatomy of selected peripheral nerves. Part III: Peripheral nerves of the lower limb. J Ultrason 2012; 12: 148-163 . Im Internet: /pmc/articles/PMC4579744/?report=abstract
• 34 Mendoza E. Stadieneinteilung der Varikose. In: Duplexsonographie der oberflächlichen Beinvenen. Berlin, Heidelberg: Springer; 2020: 79-103 . Im Internet: http://link.springer.com/10.1007/978-3-662-58982-3_4
• 35 Escribano JM, Juan J, Bofill R. et al Haemodynamic strategy for treatment of diastolic anterograde giacomini varicose veins. Eur J Vasc Endovasc Surg 2005; 30: 96-101
• 36 Gianesini S, Sisini F, Di Domenico G. et al Lower limbs venous kinetics and consequent impact on drainage direction. Phlebology 2018; 33: 107-114 . Im Internet: https://pubmed.ncbi.nlm.nih.gov/28084901/
• 37 Sagoo KS, Vari R, Helmdach M. et al Chirurgie der Vena giacomini. Phlebologie 2004; 33: 1-7
• 38 Zierau UT, Küllmer A, Künkel HP. Stripping der Giacominivene – Pathophysiologische Notwendigkeit oder phlebochirurgische Spielerei?. Vasa – J Vasc Dis 1996; 25: 142-147 . Im Internet: https://pubmed.ncbi.nlm.nih.gov/8659216/
• 39 Theivacumar NS, Dellagrammaticas D, Mavor AI. et al Endovenous laser ablation (EVLA) of great saphenous vein to abolish “paradoxical reflux” in the Giacomini vein: a short report12. Eur J Vasc Endovasc Surg 2007; 34: 229-231
• 40 Park SW, Lee SA, Hwang JJ. et al Early Results of Endovenous Ablation with a 980-nm Diode Laser for an Incompetent Vein of Giacomini. Korean J Radiol 2011; 12: 481-486
• 41 Guzelmansur I, Oguzkurt L, Koca N. et al Endovenous laser ablation and sclerotherapy for incompetent vein of Giacomini. Phlebology 2014; 29: 511-516
• 42 Bush RG, Hammond K. Treatment of Incompetent Vein of Giacomini (Thigh Extension Branch). Ann Vasc Surg 2007; 21: 245-248 . Im Internet: https://linkinghub.elsevier.com/retrieve/pii/S0890509607000805