Jornal Vascular Brasileiro
https://jvascbras.org/article/doi/10.1590/1677-5449.202400581
Jornal Vascular Brasileiro
Artigo Original

O papel da veia de Giacomini no mapeamento pré-operatório das varizes dos membros inferiores

The role of the giacomini vein in preoperative mapping of lower limb varicose veins

Carlos Alberto Engelhorn; Ana Luiza Dias Valiente Engelhorn; Elisa da Silva de Oliveira; Julia Marques de Macedo; Leticia Bressan Anizelli; Maria Luiza Oliveira de Mendonça

Downloads: 1
Views: 122

Resumo

Contexto: A veia de Giacomini (VG) pode transferir refluxo de veias perineais, veias tributárias e veias perfurantes da coxa para a veia safena parva (VSP). A ultrassonografia vascular com Doppler (USVD) é o exame de escolha para detecção do refluxo em veias específicas como a VG.

Objetivos: Identificar a profundidade, o diâmetro e o refluxo na VG e a presença de refluxo na VSP causado pela VG.

Métodos: Estudo transversal e retrospectivo, em mulheres que realizaram mapeamento venoso para cirurgia de varizes de membros inferiores. Nas VGs com refluxo, foram considerados os seguintes parâmetros: refluxo segmentar ou difuso; diâmetro, profundidade; e refluxo na VSP causado pela VG.

Resultados: Das 2.368 mulheres avaliadas, 340 foram incluídas no estudo por apresentarem VG, totalizando 511 veias analisadas, sendo 150 (29,4%) veias com refluxo. Nas 150 VGs com refluxo, o diâmetro variou entre 1,5 e 7,8 mm e a profundidade, entre 4 e 25 mm. O padrão de refluxo na maioria das VGs (91,3%) foi do tipo segmentar. Em relação à drenagem do refluxo das VGs, a maioria (66%) drenou o refluxo para a veia poplítea através da junção safenopoplítea; em 34 veias (22,7%), o refluxo foi transferido para a VSP e, em 15 veias (11,3%), foi escoado por veia tributária na coxa.

Conclusões: Aproximadamente um terço das VGs estudadas apresentou refluxo, majoritariamente segmentar, com calibre médio de 2,7 mm e profundidade média de 11 mm. Refluxo na VSP originado da VG foi detectado em 22% das veias avaliadas.

Palavras-chave

ultrassonografia Doppler; insuficiência venosa; varizes; período pré-operatório

Abstract

Background: The Giacomini vein (GV) can transfer reflux from perineal veins, tributary veins, and perforators of the thigh to the small saphenous vein (SSV). Vascular ultrasound with Doppler (VUD) is the preferred method for detecting reflux in specific veins such as the GV.

Objective: To identify GV depth and diameter, reflux in the GV, and presence of reflux in the SSV caused by the GV.

Methods: A cross-sectional, retrospective study was conducted in women undergoing lower limb venous mapping for varicose vein surgery. The following parameters were analyzed in GVs in which reflux was detected: segmental or diffuse reflux pattern; GV diameter and depth; and reflux in the SSV caused by the GV. 

Results: 340 of the 2368 women evaluated were included in the study because they had a GV, totaling 511 veins analyzed, 150 (29.4%) of which had reflux. The diameters of the 150 GVs with reflux ranged from 1.5 to 7.8 mm and their depth varied from 4 to 25 mm. Most GVs with reflux (91.3%) had a segmental reflux pattern. The majority (66%) of refluxing GVs drained reflux into the popliteal vein through the saphenopopliteal junction, while reflux was transferred to the SSV in 34 veins (22.7%), and was drained by a tributary vein in the thigh in 15 veins (11.3%).

Conclusions: Approximately one-third of the studied GVs had reflux, mostly segmental, mean caliber was 2.7 mm, and mean depth was 11 mm. Reflux in the SSV originating from the GV was detected in 22% of the evaluated veins.

Keywords

ultrasonography; Doppler; venous insufficiency; varicose veins; preoperative period

Referências

1 Labropoulos N, Delis K, Nicolaides NA, Leon M, Ramaswami G, Volteas N. The role of distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency. J Vasc Surg. 1996;23(3):504-10. http://doi.org/10.1016/S0741-5214(96)80018-8. PMid:8601895.

2 Romualdo AP, Bastos RM, Fatio M, et al. Extensão cranial da veia safena parva: quando o fluxo caudal é normal. J Vasc Bras. 2009;8(2):166-1703. http://doi.org/10.1590/S1677-54492009000200011.

3 Gloviczki P, Lawrence PF, Wasan SM, et al. The 2022 Society for Vascular Surgery, American Venous Forum, and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part I. Duplex Scanning and Treatment of Superficial Truncal Reflux: Endorsed by the Society for Vascular Medicine and the International Union of Phlebology. J Vasc Surg Venous Lymphat Disord. 2023;11(2):231-261.e6. http://doi.org/10.1016/j.jvsv.2022.09.004. PMid:36326210.

4 Labropoulos N, Tiongson J, Pryor L, et al. Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38(4):793-8. http://doi.org/10.1016/S0741-5214(03)00424-5. PMid:14560232.

5 Natsis K, Paraskevas G, Lazaridis N, Sofidis G, Piagkou M. Giacomini vein: thigh extension of the small saphenous vein - report of two cases and review of the literature. Hippokratia. 2015;19(3):263-5. PMid:27418788.

6 Whitmore I, editor. Terminologia Anatomica: International Anatomical Terminology. Stuttgart: Thieme, Federative Committee on Anatomical Terminology; 1998.

7 Caggiati A, Bergan JJ, Gloviczki P, Jantet G, Wendell-Smith CP, Partsch H. Nomenclature of the veins of the lower limbs: an international interdisciplinary consensus statement. J Vasc Surg. 2002;36(2):416-22. http://doi.org/10.1067/mva.2002.125847. PMid:12170230.

8 Zierau UT, Kullmer A, Kunkel HP. Stripping the Giacomini vein--pathophysiologic necessity or phlebosurgical games? Vasa. 1996;25(2):142-7. PMid:8659216.

9 Farrah J, Saharay M, Georgiannos SN, Scurr JH, Smith PD. Variable venous anatomy of the popliteal fossa demonstrated by duplex scanning. Dermatol Surg. 1998;24(8):901-3. http://doi.org/10.1111/j.1524-4725.1998.tb04271.x. PMid:9723058.

10 Georgiev M, Myers KA, Belcaro G, St May’s Society of Vascular Fellows. Giacomini’s observations on the superficial veins of the abdominal limb and principally the external saphenous. Int Angiol. 2001;20(3):225-33. PMid:11573057.

11 Giacomini C. Osservazioni anatomiche per servire allo Studio della circolazione venosa delle estremita inferiori. Parte I: Delle vene superficiali dell’arto addominale e principalmente Dell asaphena esterna. Giornale della Reale Accademia di Medicina di Torino. 1873;14:109-36.

12 Prakash JM, Nishanth R, Kalyani P, Ramya PT, Singh G. A review of literature along with a cadaveric study of the prevalence of the Giacomini vein (the thigh extension of the small saphenous vein) in the Indian population. Rom J Morphol Embryol. 2008;49(4):537-9. PMid:19050803.

13 Stolic E. Posterior subaponeurotic vein of the thigh. C R Assoc Anat. 1970;149:1016-26. PMid:5525227.

14 Delis KT, Knaggs ALI, Khodabakhsh P. Prevalence, anatomic patterns, valvular competence, and clinical significance of the Giacomini vein. J Vasc Surg. 2004;40(6):1174-83. http://doi.org/10.1016/j.jvs.2004.09.019. PMid:15622372.

15 Engelhorn CA, Engelhorn AL, Cassou MF, Salles-Cunha SX. Patterns of saphenous reflux in women with primary varicose veins. J Vasc Surg. 2005;41(4):645-51. http://doi.org/10.1016/j.jvs.2004.12.051. PMid:15874929.

16 Engelhorn AL, Engelhorn CA, de Morais D Fo, Barros FS, Coelho NA. Ultrassonografia vascular na avaliação de varizes dos membros inferiores. In: Engelhorn CA, Engelhorn ALDV, editores. Guia Prático de Ultrassonografia Vascular. 4. ed. Rio de Janeiro: DiLivros Editora; 2019. p. 555-79.

17 Labropoulos N, Leon M, Nicolaides AN, Giannoukas AD, Volteas N, Chan P. Superficial venous insufficiency: correlation of anatomic extent of reflux with clinical symptoms and signs. J Vasc Surg. 1994;20(6):953-8. http://doi.org/10.1016/0741-5214(94)90233-X. PMid:7990191.

18 Labropoulos N, Giannoukas AD, Delis K, et al. The impact of isolated saphenous vein incompetence on clinical signs and symptoms of chronic venous disease. J Vasc Surg. 2000;32(5):954-60. http://doi.org/10.1067/mva.2000.110349. PMid:11054227.

19 Veltman HJ, Zollmann P, Zollmann M, et al. Reflux origin of the insufficient small saphenous vein by duplex ultrasound determination and consequences for therapy considering the saphenopopliteal junction type. J Vasc Surg Venous Lymphat Disord. 2023;11(6):1114-21. http://doi.org/10.1016/j.jvsv.2023.07.004. PMid:37442273.
 


Submetido em:
04/06/2024

Aceito em:
11/08/2024

Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)"> Sociedade Brasileira de Angiologia e Cirurgia Vascular (SBACV)">
674628dfa953957e566f92b3 jvb Articles
Links & Downloads

J Vasc Bras

Share this page
Page Sections