The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation Anton L.A. Kerver, MSc, Arie C. van der.

Slides:

Advertisements

Similar presentations

Lower Limb CONTENTS OF THE ANTERIOR FASCIAL COMPARTMENT OF THE LEG

Advertisements

Patterns of saphenous reflux in women with primary varicose veins

The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation Anton L.A. Kerver, MSc, Arie C. van der.

Ultrasound Observation of the Sciatic Nerve and its Branches at the Popliteal Fossa: Always Visible, Never Seen S. Ricci European Journal of Vascular.

Muscles and other essential Anatomy of the anterior leg

Geza Mozes, MD, Peter Gloviczki, MD, Sunil S. Menawat, MD, Dean R

Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation Laura van Groenendael, MD, J.

Sanjeev Sarin, FRCS, John H. Scurr, FRCS, Philip D

Alfred Obermayer, MD, Katharina Garzon, MSc

Treatment of recurrent varicose veins of the great saphenous vein by conventional surgery and endovenous laser ablation Laura van Groenendael, MD, J.

Amos Z. Dai, B. S. , Michael Zacchilli, M. D. , Neha Jejurikar, B. S

Unusual surgical exposures to avoid scarred or infected standard access routes to the common femoral, deep femoral, and popliteal arteries Frank J. Veith,

Greater saphenous vein evaluation from computed tomography angiography as a potential alternative to conventional ultrasonography William F. Johnston,

Kathleen D. Gibson, MD, Brian L

Failure of microvenous valves in small superficial veins is a key to the skin changes of venous insufficiency Jordan R. Vincent, Gregory Thomas Jones,

Fascial relationships of the short saphenous vein

Bypass to the perigeniculate collateral vesselsA useful technique for limb salvage: Preliminary report on 22 patients Xavier Barral, MD, Gholam R. Salari,

The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation Anton L.A. Kerver, MSc, Arie C. van der.

Mohammed Al-Omran, MD, MSc Journal of Vascular Surgery

The anatomy of the small saphenous vein: Fascial and neural relations, saphenofemoral junction, and valves Gregor Schweighofer, MD, Dominic Mühlberger,

Todd M. Gerkin, MD, Hugh G. Beebe, MD, David M. Williams, MD, Jess R

Patterns of saphenous reflux in women with primary varicose veins

Neovascularization and recurrent varicose veins: more histologic and ultrasound evidence André M van Rij, MD, FRACS, Gregory T Jones, PhD, Gerry B Hill,

Treatment of the incompetent great saphenous vein by endovenous radiofrequency powered segmental thermal ablation: First clinical experience Thomas Michael.

The thigh extension of the lesser saphenous vein: From Giacomini's observations to ultrasound scan imaging Mihael Georgiev, MDa, Kenneth A Myers, FRACSb,

Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency Robert F. Merchant,

Nicos Labropoulos, PhD, DIC, RVT, Angela A

The nonsaphenous vein of the popliteal fossa: Prevalence, patterns of reflux, hemodynamic quantification, and clinical significance Konstantinos T. Delis,

The importance of deep venous reflux velocity as a determinant of outcome in patients with combined superficial and deep venous reflux treated with endovenous.

Anatomical variations of the femoral vein

Classification of proximal endovenous closure levels and treatment algorithm Peter F. Lawrence, MD, Ankur Chandra, MD, Michael Wu, David Rigberg, MD,

Compression syndromes of the popliteal neurovascular bundle due to Baker cyst Jorge E. Sanchez, BS, Nicole Conkling, BA, BS, Nicos Labropoulos, PhD, DIC,

Bernhard Partsch, MD, Hugo Partsch, MD Journal of Vascular Surgery

Fascial relationships of the short saphenous vein

A Limb Saving, Intra-medullary Crural Bypass

Symptomatic popliteal venous aneurysm causing a footdrop

Lowell S. Kabnick, MD Journal of Vascular Surgery

Alfred Obermayer, MD, Katharina Garzon, MSc

Endovenous 980-nm laser treatment of saphenous veins in a series of 500 patients Jacques Desmyttère, MD, Christophe Grard, MD, Benjamin Wassmer, MSc,

Management of endovenous heat-induced thrombus using a classification system and treatment algorithm following segmental thermal ablation of the small.

Manuel Caceres, MD, Natalia O. Glebova, MD, PhD

Amos Z. Dai, B. S. , Michael Zacchilli, M. D. , Neha Jejurikar, B. S

Venous valves and major superficial tributary veins near the saphenofemoral junction Dominic Mühlberger, MD, Luca Morandini, MD, Erich Brenner, MD, PhD,

Geza Mozes, MD, Peter Gloviczki, MD, Sunil S. Menawat, MD, Dean R

Regarding “The anatomy of the small saphenous vein: Fascial and neural relations, saphenofemoral junction, and valves” Alberto Caggiati, MD Journal.

Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: Analysis of early efficacy and complications Alessandra Puggioni, MD,

Rectus femoris muscle flap based on proximal insertion mobilization to cover a groin infected vascular graft Luís Silvestre, MD, Luís Mendes Pedro, MD,

Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of.

Stroke following endovenous laser treatment of varicose veins

Balloon angioplasty for revision of failing lower extremity bypass grafts Haitham Ali, MD, Ahmed Elbadawy, MD, Mahmoud Saleh, MD, Ayman Hasaballah, MD

Recurrence of a popliteal venous aneurysm

Robert A. McCready, MD, M. Ann Bryant, MSN, RN, BC, ACNP, Janet L

Jim H. Geselschap, MD, Wijnand B. van Gent, MD, Cees H. A

Volume 20, Issue 4, Pages e30-e31 (October 2010)

Harshal Broker, MD, G. Patrick Clagett, MD Journal of Vascular Surgery

Ruptured mycotic infrapopliteal aneurysm

ANATOMY OF THE KNEE AND LEG

Regarding “Endovenous laser treatment of the short saphenous vein: Efficacy and complications” Seung Joon Park, MD, Su Bin Yim, MD, Dae Won Cha, MD,

Hemodynamic and clinical impact of ultrasound-derived venous reflux parameters Peter Neglén, MD, PhD, John F Egger, BA, Jake Olivier, PhD, Seshadri Raju,

The Giacomini vein as an autologous conduit in infrainguinal arterial reconstruction Konstantinos T. Delis, MD, PhD, FRCSI, EBSQvasc, Mark Swan, MRCS,

Regarding “Venous ulcers and the superficial venous system”

Regarding “Ultrasound findings after radiofrequency ablation of the great saphenous vein: Descriptive analysis” Olivier Pichot, MD, Denis Creton, MD

Ioannis Prionidis, MD, Tom F. Browne Journal of Vascular Surgery

Homologous veins as an arterial substitute: Long-term results

Signs and symptoms of saphenous nerve injury after greater saphenous vein stripping: prevalence, severity, and relevance for modern practice Charles.

Preferential use of basilic vein for surgical repair of popliteal aneurysms via the posterior approach Ronit Tal, MD, Yefim Rabinovich, MD, Laslo Zelmanovich,

Taco M. A. L. Klem, MD, J. Marco Schnater, MD, PhD, P

Popliteal entrapment syndrome: A report of tibial nerve entrapment

Superficial venous aneurysms of the small saphenous vein

The posterior approach to popliteal-crural bypass

Presentation transcript:

The surgical anatomy of the small saphenous vein and adjacent nerves in relation to endovenous thermal ablation Anton L.A. Kerver, MSc, Arie C. van der Ham, MD, Hilco P. Theeuwes, MD, Paul H.C. Eilers, MD, Alex R. Poublon, MSc, Albertus J.H. Kerver, MD, Gert-Jan Kleinrensink, MD Journal of Vascular Surgery Volume 56, Issue 1, Pages 181-188 (July 2012) DOI: 10.1016/j.jvs.2011.11.127 Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 1 Bony and nonbony landmarks used for computer-assisted surgical anatomy mapping (CASAM). Bony ultrasound landmarks commonly used in endovenous thermal ablation (EVA) of the small saphenous vein (SSV): the tibia plateau (1) and (2) and the lateral malleolus (3) and (5). Yellow: bony landmarks; the most lateral (1) and most medial (2) part of the tibia plateau, the proximal (3) and distal (5) border of the lateral malleolus, the proximal border of the medial malleolus (4), the insertion of the Achilles tendon (6), the tuberosity of the fifth metatarsal (7), and the tuberosity of the first metatarsal (8). Green: nonbony landmarks, halfway between landmarks 1 and 2, at one-third (9) and two-thirds (10) between landmarks 1 and 3, and at one-third (11) and two-thirds (12) between landmarks 2 and 4. Distance X was used to create the upper lateral landmarks (13, 14). Distance Y was used to create the upper medial landmarks (15, 16). Distance X = one-third of the distance between landmark 1 and 3. Distance Y = one-third of the distance between landmark 2 and 4. Journal of Vascular Surgery 2012 56, 181-188DOI: (10.1016/j.jvs.2011.11.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 2 Measurements. Yellow line: lateral and medial sural cutaneous nerve sural nerve (LSCN, MSCN). Blue line: small saphenous vein (SSV). Black arrows: measurements taken with a 5-mm interval from the most distal saphenopopliteal junction (SPJ) to the most proximal part of the lateral malleolus: the absolute distance between the SSV and the closest branch of the sural nerve (MSCN, LSCN, or combined sural nerve [CSN]); the presence of a fascia layer between the SSV and the SN. Journal of Vascular Surgery 2012 56, 181-188DOI: (10.1016/j.jvs.2011.11.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 3 Areas of distribution for the (A) small saphenous vein (SSV), (B) sural nerve (SN), and (C) overlap in area of distribution shown on a computer-assisted surgical anatomy mapping (CASAM)-generated image depicting an average leg in which the SSV and the SN of all 20 legs were warped. Yellow dots: landmarks used for CASAM. A, Purple dots: most distal saphenopopliteal junction (SPJ) of each specimen. Blue: area of distribution of the SSV. Yellow: area of distribution of the SN. Orange: overlap between both distribution areas. Journal of Vascular Surgery 2012 56, 181-188DOI: (10.1016/j.jvs.2011.11.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 4 Small saphenous vein (SSV) and sural nerve (SN) are shown in relation to the fascia layers, with computer-assisted surgical anatomy mapping (CASAM)-generated image depicting an average leg in which relevant areas regarding the deep (crural) and superficial fascia (of all 20 legs) were warped. A, Area in which both the SSV and SN run superficial. B, Area in which the SN runs beneath the deep (crural) fascia. Yellow dots: landmarks used for CASAM. Blue area: progressive percentage of legs in which both the SSV and SN run superficial. Green area: digressive percentage of legs in which the SN runs beneath the deep crural fascia. Journal of Vascular Surgery 2012 56, 181-188DOI: (10.1016/j.jvs.2011.11.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 5 Standardized distance between small saphenous vein (SSV) and sural nerve (SN) and interlaying fascia. X axis: 0.0 = start measurements, 1.0 = stop measurements (proximal part of the lateral malleolus) standardized for the length of the SSV. Y axis: percentage of legs; blue line: percentage of legs in which the distance between the SSV and the SN is more than 5 mm; green line: percentage of legs with a fascia present between the SSV and the SN. Journal of Vascular Surgery 2012 56, 181-188DOI: (10.1016/j.jvs.2011.11.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 6 Distance between the small saphenous vein (SSV) and sural nerve (SN) and the interlaying fascia. The X axis: 10 = 100 mm proximal to the tibia plateau, 0.0 = tibia plateau, and 50 = 500 mm distal from the tibial plateau. Y axis: percentage of legs. Blue line: percentage of legs in which the distance between the SSV and the SN is >5 mm. Green line: percentage of legs with a fascia present between the SSV and the SN. Journal of Vascular Surgery 2012 56, 181-188DOI: (10.1016/j.jvs.2011.11.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 7 Schematic transverse drawing of the general course of the small saphenous vein (SSV) and the sural nerve (SN) in relation to the fascia layers. A, Proximal part of the lower leg until the saphenopopliteal junction (SPJ). The SSV runs an interfascial course. The medial sural cutaneous nerve (MSCN) runs under the deep fascia layer (DFL) above the medial or lateral gastrocnemius muscle. The lateral sural cutaneous nerve (LSCN) runs a superficial course. B, The SSV and the MSCN both run an interfascial course under the superficial fascia layer (SFL) and above the DFL. The LSCN runs a superficial course. C, In the distal part of the lower leg, the SSV and the SN both run a superficial course. Journal of Vascular Surgery 2012 56, 181-188DOI: (10.1016/j.jvs.2011.11.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions

Fig 8 An original photograph was enhanced with Photoshop CS-4 to highlight the relevant anatomy of the saphenopopliteal fossa. The small saphenous vein (SSV) actually curls under the tibial nerve (TN) to conjoin in the popliteal vein. Journal of Vascular Surgery 2012 56, 181-188DOI: (10.1016/j.jvs.2011.11.127) Copyright © 2012 Society for Vascular Surgery Terms and Conditions