Presentations/abstracts about Giacomini varicose veins originating from the Popliteal Fossa
Clinical Significance of Giacomini varicose veins originating from the popliteal fossa.
Stefano Ermini M.D
This study analyzes the patterns where Giacomini varicose veins originate from escape points placed below visible varicose veins, and aims to provide better hemodynamic solutions.
Among a total of 1669 incompetent GSV and 311 incompetent SSV, 50 Giacomini veins with upward flow during calf muscle contraction were evaluated. DUS check-ups were performed using dynamic tests to better evaluate flow events during calf muscle contraction. Surgery was performed on 20 patients. Follow up evaluation was done between 3 months and 3 years.
Venous flow in the GV can demonstrate different hemodynamic patterns in relation to calf muscle contraction and relaxation flow patterns and to the escape and re-entry points disposition. The disconnection of an incompetent tributary leads to the disappearance in the GV of the flow with muscle relaxation in some cases and sometimes interrupts also the upwards flow previously detectable during the calf muscle contraction. If the treatment of Giacomini varicose veins interrupts this muscle contraction flow, recurrences are 20%, while recurrences of the entire group are 10%.
The hemodynamic study of Giacomini vein flow patterns to assess the muscle contractive upward flow and the flow during muscle relaxation, thus leading to a better treatment choice. Strategy treatment must address both flow patterns, preserving the upward flow in the GV during calf muscle contraction.
Sapheno-popliteal junction (SPJ) recurrences and outward flow in the popliteal fossa during the calf muscle contraction.
Stefano Ermini M.D.*
- Professor of Venous Hemodynamic at Camerino University, Italy
An SPJ recurrence can occur even after correctly executed ligation/surgery. The objective of this study is to check the hemodynamic aspects of these recurrences.
From January 2007 to January 2014 18 SPJ recurrences have been checked with ultrasonography using a dynamic test. An outward flow (towards the skin) was observed during muscle contraction in 30% of the cases. This study checked this outward contractive flow, with particular attention paid to that which gives origin to an upward flow (towards the heart) in the Giacomini vein.
A venous stump was present in 6 SPJ (30.0%); a muscle contractive upward flow in 8 cases (44%); a cavernoma in 6 cases (30%). All cavernoma (abnormal vein cluster) in the SPJ were associated with a contractive outward flow and not with a stump only.
A contractive outward/upward flow in the popliteal fossa can originate in 2 situations:
– With deep vein obstruction/stenosis in the thigh. In this case the Giacomini flow is a compensative flow.
– Without deep vein obstruction, thanks to a functional or anatomical situation.
Surgical treatment of a muscle contractive refluxing SPJ recurs frequently and leads to a popliteal cavernoma. Re-treatment is complicated and frequently leads to another recurrence. If attention is paid to muscle contractive outward flow, SPJ recurrences can be reduced.
The Giacomini Vein and its pathological flows.
Stefano Ermini M.D.*
The Giacomini vein(GV) has been found to have different hemodynamic reflux patterns of the escape point location. Therefore, the GV is mandated for redefinition of its different reflux patterns.
158 US check-up of pathological GV has been performed between 2007 and 2014 . Doppler analisys has been performed using Valsalva test, squeezing test and dynamic tests.
The GV accompanies two different types of reflux:
- Type 1(68%) : A downward flow during (calf) muscle relaxation that originates from an escape point located higher (i.e. a pelvic escape point) and drains into a re-entry point located lower(i.e. a calf perforator)..
- Type 2 (32%): An upward flow during (calf) muscle contraction that originates from an escape point located lower (i.e. the SPJ) and drains into a re-entry point located higher (i.e. the SFJ)
Type 2 Reflux is unusual. Occurs because the blood flow changes its normal direction through the SPJ during muscle contraction.
Reflux in the GV can originate from atypical situations. Type 2 reflux is a compensation of a deep anatomical or functional stenosis and is the result of an ambulatory pressure gradient whose origin is in the popliteal fossa. A tributary that feeds visible varicose veins can originate from the GV. This tributary venous flow returns downwards to a perforator situated lower than SPJ.