Fascial relationships of the short saphenous vein

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Fascial relationships of the short saphenous vein Alberto Caggiati, MD, PhD Journal of Vascular Surgery Volume 34, Issue 2, Pages 241-246 (August 2001) DOI: 10.1067/mva.2001.116972 Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 1 A, Posterior face of leg after removal of superficial layer of fat. At lower leg (E-line ), compartment of SSV appears as a hemicylindrical prominence along Achilles tendon. At upper leg (D-line ), compartment of SSV does not extend past convex margin of gastrocnemius muscle. Lines D and E indicate where sections shown in D and E have been removed. B, SSV is evident only after dissection of the ML. C, Longitudinal ultrasonography scanning of lower margin of the gastrocnemius muscle (gc ). SSV courses parallel to membranous layer (ml ) and muscular fascia (mf ). The latter is not pierced by the vein. D, Transverse section of posterior leg at level of the gastrocnemius muscle (corresponding to D-line traced in A ). Membranous layer (ml ) is easily distinguishable from underlying muscular fascia (mf ). Insert: The corresponding ultrasonography feature. E, Transverse section of leg swollen because of lipedema (corresponding to E-line traced in A ). A greater amount of fat spreads SSV from its fascial wrapping. Insert: The corresponding ultrasonography pattern. Note presence of large collateral veins (asterisk ) in a more superficial plane of subcutaneous tissue. Journal of Vascular Surgery 2001 34, 241-246DOI: (10.1067/mva.2001.116972) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 2 A, At upper leg, MF (thick black line ) lines the groove between two heads of the gastrocnemius muscle. ML (thin black line ) does not extend past convex margin of the gastrocnemius muscle. B, Corresponding ultrasonography pattern. Note two hyperechoic laminae connected to SSV adventitia. C, At lower leg, compartment of SSV shows semilunar profile because it extends past convex margin of Achilles tendon. D, Corresponding ultrasonography pattern. Journal of Vascular Surgery 2001 34, 241-246DOI: (10.1067/mva.2001.116972) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 3 Fascial relationships of SSV at ankle. A, Cross-sectioned specimen showing SSV encased by muscular fascia (mf ) and membranous layer (ml ). pm, Peroneal muscles; tc, tendo calcaneus. B, Corresponding ultrasonography scan from a leg swollen because of lipedema. Note hyperechoic laminae of the “saphenous ligament” (arrows ). Journal of Vascular Surgery 2001 34, 241-246DOI: (10.1067/mva.2001.116972) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 4 A, Schematic drawing representing course of SSV and femoropopliteal vein. Their main connections with perforators (asterisk ) and with the GSV (arrows ) are demonstrated. B, Schematic drawing representing different patterns of SSV termination. Perforating and connecting veins are highlighted as in A. pv, Popliteal vein. Journal of Vascular Surgery 2001 34, 241-246DOI: (10.1067/mva.2001.116972) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions

Fig. 5 A, Transverse ultrasonography section of posterior thigh. Femoropopliteal vein (arrow ) courses between envelopes of the biceps femoris (b ) and semitendinosus (s ) muscles and membranous layer (ml ). B, Two hyperechoic laminae (arrows ) connect adventitia of femoropopliteal vein to fasciae that line its compartment. C, Duplication of SSV. Note that two vessels are connected by hyperechoic lamina (arrow ). D, “External accessory saphenous vein” (arrow ) courses parallel to SSV, above membranous layer (ml ). E, Only terminal segment of SSV tributary vein enters SSV compartment (arrow ), piercing membranous layer (ml ). F, Transverse ultrasonography scan of a limb excluded from anatomical evaluation because of presence of varicose veins in posterior leg. SSV shows a light dilatation and is overlaid by a greatly dilated external accessory saphenous vein (asterisk ). Note hyperechoic laminae of the saphenous ligament (arrows ). Journal of Vascular Surgery 2001 34, 241-246DOI: (10.1067/mva.2001.116972) Copyright © 2001 Society for Vascular Surgery and The American Association for Vascular Surgery Terms and Conditions