124 Sentences With "saphenous" | Random Sentence Generator

Opening the sciatic vein relieved podagra and elephantiasis; menstrual problems were alleviated by cutting the saphenous vein.

The small saphenous vein (also short saphenous vein or lesser saphenous vein), is a relatively large superficial vein of the posterior leg.

The saphenous nerve is a branch of the femoral nerve that runs with the great saphenous vein and can be damaged in surgery on the vein.

The genicular vessels supply the knee joint. The other two structures that are associated with the adductor hiatus are the saphenous branch of descending genicular artery and the saphenous nerve. The saphenous nerve does not leave through the adductor hiatus but penetrates superficially halfway through the adductor canal.

The saphenous nerve (long or internal saphenous nerve) is the largest cutaneous branch of the femoral nerve. It is a strictly sensory nerve, and has no motor function.

The dorsal venous arch of the foot is a superficial vein that connects the small saphenous vein and the great saphenous vein. Anatomically, it is defined by where the dorsal veins of the first and fifth digit, respectively, meet the great saphenous vein and small saphenous vein. It is usually fairly easy to palpate and visualize (if the patient is barefoot). It lies superior to the metatarsal bones approximately midway between the ankle joint and metatarsal phalangeal joints.

Procedures such as saphenous vein cutdown or orthopedic surgery that includes incisions or dissection over the distal tibia or medial malleolus can result in damage to the saphenous nerve, resulting in loss of cutaneous sensation in the medial leg. This is due to the intimate path that the saphenous nerve and the great saphenous vein travel. The saphenous nerve is also often damaged during vein harvest for bypass surgery and during trocar placement during knee arthroscopy. There appears to be occasional meaningful individual variation in the pathway of this nerve, such that the illustration of it done for Gray's Anatomy, for example, likely represents an unusual rather than usual course.

LeMaitre's valvulotome. Removal of the saphenous vein will not hinder normal circulation in the leg. The blood that previously flowed through the saphenous vein will change its course of travel. This is known as collateral circulation.

This is a key distinction between saphenous nerve neuropathy and lower back radiculopathy. Saphenous nerve neuropathy only demonstrates sensory alterations, while lumbar radiculopathy will affect the motor, sensory, and deep tendon reflexes of the lower leg.

A saphena varix, or a saphenous varix is a dilation of the saphenous vein at its junction with the femoral vein in the groin. It is a common surgical problem, and patients may present with groin swelling.

Both saphenous veins are clinically important because of their propensity for becoming varicosed.

The anterior accessory saphenous vein is a special anterior tributary of the great saphenous vein (GSV), draining the antero-lateral face of the thigh. It becomes very often insufficient, causing important varicose veins with an autonomous course and often is the only insufficient vein present on a patient.

In anatomy, the saphenous opening (saphenous hiatus, also fossa ovalis) is an oval opening in the upper mid part of the fascia lata of the thigh. It lies 3–4 cm below and lateral to the pubic tubercle and is about 3 cm long and 1.5 cm wide.

Perforator veins drain superficial veins into the deep veins. Three anatomic compartments are described (as networks), (N1) containing the deep veins, (N2) containing the perforator veins, and (N3) containing the superficial veins, known as the saphenous compartment. This compartmentalisation makes it easier for the examiner to systematize and map. The GSV can be located in the saphenous compartment where together with the Giacomini vein and the accessory saphenous vein (ASV) an image resembling an eye, known as the 'eye sign' can be seen.

When it occurs in the leg, the great saphenous vein is usually involved, although other locations are possible.

The great saphenous vein (GSV, alternately "long saphenous vein"; ) is a large, subcutaneous, superficial vein of the leg. It is the longest vein in the body, running along the length of the lower limb, returning blood from the foot, leg and thigh to the deep femoral vein at the femoral triangle.

"Veins & Lymphatics," in Lange's Current Surgical Diagnosis & Treatment, 11th ed., McGraw-Hill. Sclerotherapy can also be performed using foamed sclerosants under ultrasound guidance to treat larger varicose veins, including the great saphenous and small saphenous veins.Thibault, Paul (2007) Sclerotherapy and Ultrasound-Guided Sclerotherapy, The Vein Book, John J. Bergan (ed.).

In any case, a dilated varicosed saphenous vein would not likely be a good candidate for a bypass graft.

The external pudendal veins (deep pudendal & superficial pudendal) are veins of the pelvis which drain into the great saphenous vein.

Usually it joins GSV very near the saphenous-femoral junction at the saphenous arch or can drain directly in the femoral vein. It can drain below the saphenous arch or in a GSV tributary. Sometimes it can drain in the external pudendal vein (which can communicate with an ovarian vein) and be the reason of a varicose disease of the thigh secondary to pelvic varicose disease. At the superior 1/3 of the thigh it is located under the superficial fascia, like the GSV, but becomes very superficial below this level.

The Giacomini vein is a communicant vein between the great saphenous vein (GSV) and the small saphenous vein (SSV). It is named after the Italian anatomist Carlo Giacomini (1840–1898). The Giacomini vein courses the posterior thigh as either a trunk projection, or tributary of the SSV. In one study it was found in over two-thirds of limbs.

The sapheno-femoral junction (SFJ) is located at the saphenous opening within the groin and formed by the meeting of the great saphenous vein (GSV), common femoral vein and the superficial inguinal veins (confluens venosus subinguinalis). It is one of the distinctive points where a superficial vein meets a deep vein and at which incompetent valves may occur.

Communicating veins are veins that communicate two different points of the venous system. They can communicate the great saphenous vein with the small saphenous vein, (for example the Giacomini vein) or the superficial venous system with the deep one. In this case they are called perforator veins and have a very important role in the venous system hemodynamics.

It is about long. Along the side of the muscle, and superficial to it, is the small saphenous vein. The sural nerve accompanies the small saphenous vein as it descends in the posterior leg, traveling inferolateral to it as it crosses the lateral border of the Achilles tendon. The tendon is the thickest tendon in the human body.

By closing the great saphenous vein, the twisted and varicosed branch veins which are close to the skin shrink and improve in appearance.

The infrapatellar branch of saphenous nerve is a nerve of the lower limb. The saphenous nerve, located about the middle of the thigh, gives off a branch which joins the subsartorial plexus. It pierces the sartorius and fascia lata, and is distributed to the skin in front of the patella. This nerve communicates above the knee with the anterior cutaneous branches of the femoral nerve; below the knee, with other branches of the saphenous; and, on the lateral side of the joint, with branches of the lateral femoral cutaneous nerve, forming a plexiform net-work, the plexus patellae.

The great saphenous vein originates from where the dorsal vein of the big toe (the hallux) merges with the dorsal venous arch of the foot. After passing in front of the medial malleolus (where it often can be visualized and palpated), it runs up the medial side of the leg. At the knee, it runs over the posterior border of the medial epicondyle of the femur bone. In the proximal anterior thigh 3-4 centimeters inferolateral to the pubic tubercle, the great saphenous vein dives down deep through the cribriform fascia of the saphenous opening to join the femoral vein.

The canal contains the subsartorial artery (superficial femoral artery), subsartorial vein (superficial femoral vein), and branches of the femoral nerve (specifically, the saphenous nerve, and the nerve to the vastus medialis). The femoral artery with its vein and the saphenous nerve enter this canal through the superior foramen. Then, the saphenous nerve and artery and vein of genus descendens exit through the anterior foramen, piercing the vastoadductor intermuscular septum. Finally, the femoral artery and vein exit via the inferior foramen (usually called the hiatus) through the inferior space between the oblique and medial heads of adductor magnus.

Schwartz's test is a clinical test used for confirming the diagnosis of long standing varicose veins. The clinician exposes the lower limb. A tap is made on the lower part of the leg on the long saphenous varicose vein with one hand. If an impulse can be felt at the saphenous opening with the other hand, Schwartz's test is positive.

Stripping consists of removal of all or part the saphenous vein (great/long or lesser/short) main trunk. The complications include deep vein thrombosis (5.3%), pulmonary embolism (0.06%), and wound complications including infection (2.2%). There is evidence for the great saphenous vein regrowing after stripping. For traditional surgery, reported recurrence rates, which have been tracked for 10 years, range from 5% to 60%.

The medial marginal vein is a continuation of the Dorsal venous arch of the foot and is the origin of the long saphenous vein.

The lateral marginal vein is a continuation of the Dorsal venous arch of the foot and is the origin of the short saphenous vein.

When emergency resuscitation with fluids is necessary, and standard intravenous access cannot be achieved due to venous collapse, saphenous vein cutdown may be utilized.

The superficial epigastric vein is a vein which travels with the superficial epigastric artery. It joins the accessory saphenous vein near the fossa ovalis.

It forms an arch, the saphenous arch, to join the common femoral vein in the region of the femoral triangle at the sapheno-femoral junction.

It has become the reference standard for examining the condition and hemodynamics of the lower limb veins. Particular veins of the deep venous system (DVS), and the superficial venous system (SVS) are looked at. The great saphenous vein (GSV), and the small saphenous vein (SSV) are superficial veins which drain into respectively, the common femoral vein and the popliteal vein. These veins are deep veins.

Radiofrequency ablation is a minimally invasive procedure used in the treatment of varicose veins. It is an alternative to the traditional stripping operation. Under ultrasound guidance, a radiofrequency catheter is inserted into the abnormal vein and the vessel treated with radio-energy, resulting in closure of the involved vein. Radiofrequency ablation is used to treat the great saphenous vein, the small saphenous vein, and the perforator veins.

The cribriform fascia has been proposed for use in preventing new vascularization when surgery is performed at the join between the great saphenous vein and the femoral vein.

In addition, since stripping removes the saphenous main trunks, they are no longer available for use as venous bypass grafts in the future (coronary or leg artery vital disease).

It is done above the knee on the posterior leg where the sciatic nerve starts splitting into the common peroneal and tibial nerves. The saphenous nerve block is often done in combination with the popliteal block for surgeries below the knee. The saphenous nerve is numbed at the medial part of the lower thigh under the sartorius muscle. The lumbar plexus block is an advanced technique indicated for hip, anterior thigh, and knee surgery.

A study by Kanter and Thibault in 1996 reported a 76% success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3% solution. Padbury and Benveniste found that ultrasound guided sclerotherapy was effective in controlling reflux in the small saphenous vein. Barrett et al. found that microfoam ultrasound guided sclerotherapy was "effective in treating all sizes of varicose veins with high patient satisfaction and improvement in quality of life".

The subsartorial plexus is a plexus of nerves that is located under the sartorius muscle. It is formed by: # the medial cutaneous nerve of the thigh (a branch of the femoral nerve) # the saphenous nerve (a branch from femoral nerve) # the cutaneous branch of anterior division of the obturator nerve At the lower border of the adductor brevis muscle the cutaneous branch of anterior division of the obturator nerve communicates with the anterior (medial), cutaneous and saphenous branches of the femoral nerve, forming a kind of plexus. It then descends upon the femoral artery, to which it is finally distributed. Occasionally the communicating branch to the anterior (medial), cutaneous and saphenous branches of the femoral is continued down, as a cutaneous branch, to the thigh and leg.

Zamboni has conducted research on lower extremity Chronic venous insufficiency, testing a minimally invasive and conservative treatment of the saphenous vein: the CHIVA method. On this topic he conducted several randomized clinical trials and published books. In 2015 the Cochrane Review published an article that recognizes the CHIVA method is much more effective than ablative treatments with saphenous removal/obstruction. Cell therapies for the treatment of severe vascular ulcerations of the lower limbs are another Zamboni field of study.

Complications of venous cutdown include cellulitis, hematoma, phlebitis, perforation of the posterior wall of the vein, venous thrombosis and nerve and arterial transection. This procedure can result in damage to the saphenous nerve due to its intimate path with the great saphenous vein, resulting in loss of cutaneous sensation in the medial leg. Over the years, the venous cutdown procedure has become outdated by the introduction and recent prehospital developments of intraosseous infusion in trauma/hypovolemic shock patients.

Myers wrote that open surgery for small saphenous vein reflux is obsolete. Myers said these veins should be treated with endovenous techniques, citing high recurrence rates after surgical management, and risk of nerve damage up to 15%. By comparison ERA has been shown to control 80% of cases of small saphenous vein reflux at 4 years, said Myers. Complications for ERA include burns, paraesthesia, clinical phlebitis and slightly higher rates of deep vein thrombosis (0.57%) and pulmonary embolism (0.17%).

Padbury A, Benveniste G L, Foam echosclerotherapy of the small saphenous vein, Australian and New Zealand Journal of Phlebology Vol 8, Number 1 (Dec 2004) However, some authors believe that sclerotherapy is not suitable for veins with reflux from the greater or lesser saphenous junction, or for veins with axial reflux. This is due to the emergence of more effective technologies, including laser ablation and radiofrequency, which have demonstrated superior efficacy to sclerotherapy for treatment of these veins.

René Gerónimo Favaloro (July 12, 1923 – July 29, 2000) was an Argentine cardiac surgeon and educator best known for his pioneering work on coronary artery bypass surgery using the great saphenous vein.

The impulse is felt at the saphenous opening because of the incompetence of the valves in the superficial venous system.Butie, A. (1995). Clinical Examination of Varicose Veins. Dermatologic Surgery, 21(1), 52-56.

Beneath the fascia lata, at the lower border of the adductor longus, it joins to form a plexiform net-work (subsartorial plexus) with branches of the saphenous and obturator nerves. When the communicating branch from the obturator nerve is large and continued to the integument of the leg, the posterior branch of the medial cutaneous is small, and terminates in the plexus, occasionally giving off a few cutaneous filaments. The medial cutaneous nerve, before dividing, gives off a few filaments, which pierce the fascia lata, to supply the integument of the medial side of the thigh, accompanying the long saphenous vein. One of these filaments passes through the saphenous opening; a second becomes subcutaneous about the middle of the thigh; a third pierces the fascia at its lower third.

SEMS are also sometimes used in the vascular system, usually in the aorta and peripheral vascular system. In the past they have been used for saphenous vein graft and native coronary artery percutaneous coronary interventions.

The 810 nm laser is the original laser fiber wavelength as pioneered by Dr. Robert Min of New York, USA. Subsequently, various other fibers with different wavelengths have become available. The varying wavelength each aim to maximize local damage to a component of the varicose vein or the blood contained in it while minimizing damage to adjacent tissues. During the procedure, a catheter bearing a laser fiber is inserted under ultrasound guidance into the great saphenous vein (GSV) or small saphenous vein (SSV) through a small puncture.

The terms "saphaina" (Greek, meaning "manifest", "to be clearly seen") and "safoon" (Hebrew, "שָׂפוּן" meaning "hidden/covered") as well as "safin" (Arabic, "صَافِن" meaning "deep/embedded") have been claimed as the origin for the word "saphenous".

Active treatments can be divided into surgical and non-surgical treatments. Newer methods including endovenous laser treatment, radiofrequency ablation and foam sclerotherapy appear to work as well as surgery for varices of the greater saphenous vein.

In contrast with other tributaries, its wall is histologically saphenous-type with a thick media, running parallel and external to the GSV. The vein can be identified near the saphenous ostium by a typical ultrasonographic image the so-called Mickey mouse sign (the 2 ears will be the GSV and the ASV, the head is the common femoral vein). When the ultrasonography is performed, we can see it running across the anterior face of the thigh in a plan outside the femoral vessels, the GSV being at the inside of those vessels.

Occasionally the communicating branch to the anterior cutaneous and saphenous branches of the femoral is continued down, as a cutaneous branch, to the thigh and leg, as the cutaneous branch of the obturator nerve. When this is so, it emerges from beneath the lower border of the Adductor longus, descends along the posterior margin of the sartorius to the medial side of the knee, where it pierces the deep fascia, communicates with the saphenous nerve, and is distributed to the skin of the tibial side of the leg as low down as its middle.

The saphenous nerve, about the middle of the thigh, gives off a branch which joins the subsartorial plexus. At the medial side of the knee it gives off a large infrapatellar branch, which pierces the sartorius and fascia lata, and is distributed to the skin in front of the patella. Below the knee, the branches of the saphenous nerve (medial crural cutaneous branches) are distributed to the skin of the front and medial side of the leg, communicating with the cutaneous branches of the femoral, or with filaments from the obturator nerve.

A valvulotome is a medical device used to destroy the venous valves in especially the great saphenous vein to allow for arterial flow. Since the leg veins usually contain a number of valves that direct flow towards the heart, they cannot directly be used as graft, but if vein valves are removed the arterial blood can flow via the GSV to the lower leg - this is called an in situ graft procedure, a type of vascular bypass. Donaldson MC1, Mannick JA, Whittemore AD. Femoral-distal bypass with in situ greater saphenous vein. Long-term results using the Mills valvulotome. Ann. Surg.

A synthetic graft remains open in 33 to 50 out of 100 people 5 years after Popliteal bypass surgery was carried out, whereas using veins, the bypass remains unobstructed in 66 out of 100 people. Moreover, the particular vein, great saphenous vein was shown to be more durable over the years after surgery. Also, when comparing the efficacy of using PTFE or the great saphenous vein in people with claudication and critical limb ischemia, the latter showed better long term results. A second bypass may be required if a blockage forms in the bypass graft later on.

Endovenous thermal ablation (EVTA) by radiofrequency or laser is a safe and effective treatment of refluxing great saphenous veins (GSVs) and has replaced traditional high ligation and stripping in official recommendations of various leading Vascular Societies in the United States and the United Kingdom.

Just inferolateral to the pubic tubercle the fascia extends downwards forming an arched (falciform) margin of the lateral boundary of the opening. It is covered by a thin perforated part of the superficial fascia called the fascia cribrosa which is pierced by the great saphenous vein, the 3 superficial branches of the femoral artery, and lymphatics. It transmits the great saphenous vein and other smaller vessels including the superficial epigastric artery and superficial external pudendal artery, as well as the femoral branch of the genitofemoral nerve. The fascia cribrosa, which is pierced by the structures passing through the opening, closes the aperture and must be removed to expose it.

Edlich helped to quantitate the perfusion of a saphenous vein graft implanted in canine ischemic myocardium using tissue blood flow measurements. When his studies failed to show revascularization of the heart, he suggested that the revascularization of the heart could be improved by a coronary artery bypass graft.

The vein is often removed by cardiac surgeons and used for autotransplantation in coronary artery bypass operations, when arterial grafts are not available or many grafts are required, such as in a triple bypass or quadruple bypass. The great saphenous vein is the conduit of choice for vascular surgeons, when available, for doing peripheral arterial bypass operations [ see vascular bypass ]. The saphenous vein may undergo vein graft failure after engraftment, but still it has superior long-term patency compared to synthetic grafts (PTFE, PETE (Dacron)), human umbilical vein grafts or biosynthetic grafts [Omniflow]. Often, it is used in situ (in place), after tying off smaller tributaries and destruction of the venous valves with a device called valvulotome, e.g.

The origin of the small saphenous vein, (SSV) is where the dorsal vein from the fifth digit (smallest toe) merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein (GSV). It is a superficial vein being subcutaneous, (just under the skin). From its origin, it courses around the lateral aspect of the foot (inferior and posterior to the lateral malleolus) and runs along the posterior aspect of the leg (with the sural nerve), where it passes between the heads of the gastrocnemius muscle. This vein presents a number of different draining points: Usually it drains into the popliteal vein, at or above the level of the knee joint.

Its upper portion forms the lateral border of the femoral triangle, and the point where it crosses adductor longus marks the apex of the triangle. Deep to sartorius and its fascia is the adductor canal, through which the saphenous nerve, femoral artery and vein, and nerve to vastus medialis pass.

Follow up after surgery includes the stripping of the drainage device to prevent blockage. A typical hospital stay can be up to two weeks. The site of the surgery is left unbandaged to allow for frequent examination. Complications can be the development of lymphedema though not removing the saphenous vein during the surgery will help prevent this.

The femoral branch passes underneath the inguinal ligament, travelling through the lateral muscular compartment of the femoral canal where it innervates skin of the upper leg. Passing through the cribriform fascia of the saphenous opening of the fascia lata of the thigh, it then supplies the skin of the upper, anterior and medial side of thigh.

When this is so, it emerges from beneath the lower border of the Adductor longus muscle, descends along the posterior margin of the Sartorius to the medial side of the knee, where it pierces the deep fascia, communicates with the saphenous nerve, and is distributed to the skin of the tibial side of the leg as low down as its middle.

These complications may necessitate amputation of the affected foot. Biopsies of severely affected sural nerve (short saphenous nerve) in patients with HSAN I showed evidence of neuronal degeneration. Only a very few myelinated fibers were observed some of which showed a sign of primary (segmental) demyelination. A reasonable number of unmyelinated axons remained, although the presence of stacks of flattened Schwann cell processes suggested unmyelinated axon loss.

The radial artery is used for coronary artery bypass grafting and is growing in popularity among cardiac surgeons. Recently, it has been shown to have a superior peri-operative and post- operative course when compared to saphenous vein grafts. The radial artery is often punctured in a common procedure to obtain an arterial blood gas. Such a procedure may first involve an Allen's test.

If the narrowings in coronary arteries are unsuitable for treatment with a percutaneous coronary intervention, open surgery may be required. A coronary artery bypass graft can be performed, whereby a blood vessel from another part of the body (the saphenous vein, radial artery, or internal mammary artery) is used to redirect blood from a point before the narrowing (typically the aorta) to a point beyond the obstruction.

The saphenous nerve can experience entrapment syndrome from exercises involving the quadriceps or from prolonged walking or standing. It is characterized by a burning sensation in most patients. Pain often occurs at night, long after the physical exercise which induced it has stopped, and may be aggravated by climbing stairs. Usually, in this case, motor function of the lower leg will not be impaired.

The medial cutaneous nerve (internal cutaneous nerve) passes obliquely across the upper part of the sheath of the femoral artery, and divides in front, or at the medial side of that vessel, into two branches, an anterior and a posterior. The anterior branch runs downward on the sartorius, perforates the fascia lata at the lower third of the thigh, and divides into two branches: one supplies the integument as low down as the medial side of the knee; the other crosses to the lateral side of the patella, communicating in its course with the infrapatellar branch of the saphenous nerve. The posterior branch descends along the medial border of the sartorius to the knee, where it pierces the fascia lata, communicates with the saphenous nerve, and gives off several cutaneous branches. It then passes down to supply the integument of the medial side of the leg.

The modified Allen's test is also performed prior to heart bypass surgery. The radial artery is occasionally used as a conduit for bypass surgery, and its patency lasts longer in comparison to the saphenous veins. Prior to heart bypass surgery, the test is performed to assess the suitability of the radial artery to be used as a conduit. A result of less than 3 seconds is considered as good and suitable.

In the early 1990s, surgeons began to perform off-pump coronary artery bypass, done without cardiopulmonary bypass. In these operations, the heart continues beating during surgery, but is stabilized to provide an almost still work area in which to connect a conduit vessel that bypasses a blockage. The conduit vessel that is often used is the Saphenous vein. This vein is harvested using a technique known as endoscopic vessel harvesting (EVH).

Thin red lines may be observed running along the course of the lymphatic vessels in the affected area, accompanied by painful enlargement of the nearby lymph nodes. When the inferior limbs are affected, the redness of the skin runs over the great saphenous vein location and confusion can be made with a thrombophlebitis. Chronic lymphangitis is a cutaneous condition that is the result of recurrent bouts of acute bacterial lymphangitis.

The medial dorsal cutaneous nerve (internal dorsal cutaneous branch) passes in front of the ankle-joint, and divides into two dorsal digital branches, one of which supplies the medial side of the great toe, the other, the adjacent side of the second and third toes. It also supplies the integument of the medial side of the foot and ankle, and communicates with the saphenous nerve, and with the deep peroneal nerve.

An oblique incision is made in the groin, over the femoral artery and extending 4 cm medially. The great saphenous vein is exposed and the common femoral and superficial femoral vein are identified before dividing. The vein is ligated close to the junction with of the femoral vein. If the ligation is distal from the saphenofemoral junction, it will leave out small tributaries which may later cause recurrence of varicosities.

Although clearly indicating a selectivity of synephrine for α1 receptors, its potency at this receptor sub-class is still relatively low, in comparison with that of phenylephrine (pD2 at α1 = 6.32). Brown and co-workers examined the effects of the individual enantiomers of synephrine on α1 receptors in rat aorta, and on α2 receptors in rabbit saphenous vein. In the aorta preparation, l-synephrine gave a pD2 = 5.38 (potency relative to norepinephrine = 1/1000), while d-synephrine had a pD2 = 3.50 (potency relative to norepinephrine = 1/50000); in comparison, l-phenylephrine had pD2 = 7.50 (potency relative to norepinephrine ≃ 1/6). No antagonism of norepinephrine was produced by concentrations of l-synephrine up to 10−6 M. In the rabbit saphenous assay, the pD2 of l-synephrine was 4.36 (potency relative to norepinephrine ≃ 1/1700), and that of d-synephrine was < 3.00; in comparison, l-phenylephrine had pD2 = 5.45 (potency relative to norepinephrine ≃ 1/140).

The superficial dorsal vein of the penis drains the prepuce and skin of the penis, and, running backward in the subcutaneous tissue, inclines to the right or left, and opens into the corresponding superficial external pudendal vein, a tributary of the great saphenous vein. In contrast to the deep dorsal vein, it lies outside Buck's fascia. It is possible for the vein to rupture, which presents in a manner similar to penile fracture.

ELA is performed as an outpatient procedure and does not require an operating theatre, nor does the patient need a general anaesthetic. Doctors use high-frequency ultrasound during the procedure to visualize the anatomical relationships between the saphenous structures. Some practitioners also perform phlebectomy or ultrasound guided sclerotherapy at the time of endovenous treatment. Follow-up treatment to smaller branch varicose veins is often needed in the weeks or months after the initial procedure.

Therefore, it can be coapted directly to the normal functioning facial nerve. The one stage CFNG, implies an end-to-side coaptation of the sural or saphenous nerve to the distal end of the affected facial nerve. In the two- stage procedure, an incision in front of the ear is made on the non-paralysed side. Upon electrical stimulation, the nerve which produces the best contraction of the zygomatic muscles (and so the appearance of a smile) is selected.

The internal thoracic artery is the cardiac surgeon's blood vessel of choice for coronary artery bypass grafting. The left ITA has a superior long-term patency to saphenous vein grafts and other arterial grafts (e.g. radial artery, gastroepiploic artery) when grafted to the left anterior descending coronary artery, generally the most important vessel, clinically, to revascularize. Plastic surgeons may use either the left or right internal thoracic arteries for autologous free flap reconstruction of the breast after mastectomy.

The Batson Venous plexus, or simply Batson's Plexus, runs through the inner vertebral column connecting the thoracic and pelvic veins. These veins get their notoriety from the fact that they are valveless, which is believed to be the reason for metastasis of certain cancers. The great saphenous vein is the most important superficial vein of the lower limb. First described by the Persian physician Avicenna, this vein derives its name from the word safina, meaning "hidden".

Jacobson previously described the common problems to medial knee surgery. It was stressed that adequate diagnosis is imperative and all possible injuries should be evaluated and addressed intraoperatively. Damage to the saphenous nerve and its infrapatellar branch is possible during medial knee surgery, potentially causing numbness or pain over the medial knee and leg. As with all surgeries, there is a risk of bleeding, wound problems, deep vein thrombosis, and infection that can complicate the outcome and rehabilitation process.

Furthermore, the pectoralis minor muscle is not a parallel-fibered muscle, and it is oversized in adults. During a one-stage or two-stage CFNG procedure, one or more non-affected facial nerve branches are used for reinnervation of the paralysed side. In the one stage procedure a free muscle transplant with a latissimus dorsi graft or a nerve graft (using the sural nerve or saphenous nerve) can be used. The latissimus dorsi graft is used because of its long thoracodorsal nerve.

Vein stripping is a surgical procedure done under general or local anaesthetic to aid in the treatment of varicose veins and other manifestations of chronic venous disease. The vein "stripped" (pulled out from under the skin using minimal incisions) is usually the great saphenous vein. The surgery involves making incisions (usually the groin and medial thigh), followed by insertion of a special metal or plastic wire into the vein. The vein is attached to the wire and then pulled out from the body.

Several arteries and veins can be used, however internal mammary artery grafts have demonstrated significantly better long- term patency rates than great saphenous vein grafts. In patients with two or more coronary arteries affected, bypass surgery is associated with higher long-term survival rates compared to percutaneous interventions. In patients with single vessel disease, surgery is comparably safe and effective, and may be a treatment option in selected cases. Bypass surgery has higher costs initially, but becomes cost-effective in the long term.

Goldman, M., Sclerotherapy Treatment of varicose and telangiectatic leg vein, Hardcover Text, 2nd Ed, 1995 Both Debout and Cassaignaic reported success in treating varicose veins by injecting perchlorate of iron in 1853.Sharmi S, Cheatle T. Fegan's Compression Sclerotherapy of Varicose Veins, Hardcover Text, 2003. Desgranges in 1854 cured 16 cases of varicose veins by injecting iodine and tannin into the veins. This was approximately 12 years after the probable advent of great saphenous vein stripping in 1844 by Madelung.

The patient's leg is then compressed with either stockings or bandages that they wear usually for one week after treatment. Patients are also encouraged to walk regularly during that time. It is common practice for the patient to require at least two treatment sessions separated by several weeks to significantly improve the appearance of their leg veins. Sclerotherapy can also be performed using microfoam sclerosants under ultrasound guidance to treat larger varicose veins, including the great and small saphenous veins.

The right gastroepiploic artery was first used as a coronary artery bypass graft (CABG) in 1984 by Dr. John Pym and colleagues at Queen's University. It has become an accepted alternative conduit, and is particularly useful in patients who do not have suitable saphenous veins to harvest for grafts. The right gastroepiploic artery is typically used as a graft to coronary arteries on the posterior wall of the heart such as the right coronary artery and the posterior descending branch.

ASV at sapheno-femoral junction, the "Mickey Mouse sign" The accessory saphenous vein (ASV), either anterior or posterior, is an important GSV collateral frequently responsible for varicose veins located on the anterior and lateral aspect of the thigh. The anterior ASV is more anterior than the ASV and is outside the femoral vessels plan. The two veins terminate in a common trunk near the groin, the sapheno-femoral junction. Here, the ASV can be located aligned with the femoral vessels at the "alignment sign".

In surgeries, the principle superficial neurovascular bundles at risk are, medially, the great saphenous vein and its accompanying nerve, and, laterally, the superficial peroneal nerve. The superficial peroneal nerve originates from the common peroneal nerve near the neck of the fibula and passes between the peroneus longus and brevis muscles, supplying motor branches to these muscles. The superficial branch then continues onto the dorsum of the foot to supply sensory fibers to the skin there. The main deep neurovascular bundle at risk is the posterior tibial.

It lies on the posterior aspect of the tibialis posterior and flexor digitorum longus muscles, and medial to the belly of flexor hallucis longus. It also gives rise to medial plantar artery and lateral plantar artery. During surgery, these neurovascular bundles, both superficial and deep, should be protected in order to prevent neurological damage. A common anatomically informed, surgical technique to avoid damaging neurovascular bundles is to undermine anteriorly to the posterior tibial margin after reaching the fascia, in order to avoid the saphenous vein and nerve.

The four plantar metatarsal veins run backward in the metatarsal spaces, communicate, by means of perforating veins, with the veins on the dorsum of the foot, and unite to form the plantar venous arch (or deep plantar venous arch) which lies alongside the plantar arterial arch. From the deep plantar venous arch the medial and lateral plantar veins run backward close to the corresponding arteries and, after communicating with the great and small saphenous veins, unite behind the medial malleolus to form the posterior tibial veins.

This branch is then sectioned. The sural or saphenous nerve as cross facial nerve graft is coapted to this unaffected branch of the facial nerve and tunnelled across the face to the paralysed side through a subcutaneous tunnel. The end of the graft is positioned in front of the tragus (cartilage in front of the ear) on the paralysed side. Nine to twelve months is needed for axonal regeneration in the cross facial nerve graft, because the result of damaged nerve tissue is loss of structure and axonal function.

Proximal shunts, such as the Quackel's, are more involved and entail operative dissection in the perineum where the corpora meet the spongiosum while making an incision in both and suturing both openings together. Shunts created between the corpora cavernosa and great saphenous vein called a Grayhack shunt can be done though this technique is rarely used. As the complication rates with prolonged priapism are high, early penile prosthesis implantation may be considered. As well as allowing early resumption of sexual activity, early implantation can avoid the formation of dense fibrosis and, hence, a shortened penis.

Urapidil is a sympatholytic antihypertensive drug. It acts as an α1-adrenoceptor antagonist and as an 5-HT1A receptor agonist. Although an initial report suggested that urapidil was also an α2-adrenoceptor agonist, this was not substantiated in later studies that demonstrated it was devoid of agonist actions in the dog saphenous vein and the guinea-pig ileum. Unlike some other α1-adrenoceptor antagonists, urapidil does not elicit reflex tachycardia, and this may be related to its weak β1-adrenoceptor antagonist activity, as well as its effect on cardiac vagal drive.

The skin is cleaned, draped, and anesthetized if time allows. The greater saphenous vein is identified on the surface above the medial malleolus, a full-thickness transverse skin incision is made, and 2 cm of the vein is freed from the surrounding structures. The vessel is tied closed distally, the proximal portion is transected (venotomy) and gently dilated, and a cannula is introduced through the venotomy and secured in place with a more proximal ligature around the vein and cannula. An intravenous line is connected to the cannula to complete the procedure.

In this method, the artery is "pedicled" which means it is not detached from the origin. In the other, a great saphenous vein is removed from a leg; one end is attached to the aorta or one of its major branches, and the other end is attached to the obstructed artery immediately after the obstruction to restore blood flow. CABG is performed to relieve angina unsatisfactorily controlled by maximum tolerated anti-ischemic medication, prevent or relieve left ventricular dysfunction, and/or reduce the risk of death. CABG does not prevent myocardial infarction (heart attack).

The arterial supply is by the femoral artery and the obturator artery. The lymphatic drainage closely follows the arterial supply and drains to the lumbar lymphatic trunks on the corresponding side, which in turn drains to the cisterna chyli. The deep venous system of the thigh consists of the femoral vein, the proximal part of the popliteal vein, and various smaller vessels; these are the site of proximal deep venous thrombosis. The venae perfortantes connect the deep and the superficial system, which consists of the saphenous veins (the site of varicose veins).

Since it is a rare disease, it remains a diagnosis of exclusion of other conditions with similar symptoms. The diagnosis is supported by the results of imaging studies such as computed tomography or magnetic resonance imaging, ultrasound of the abdomen (with or without doppler imaging) or intravenous urography. Specialist vascular ultrasonographers should routinely look for left ovarian vein reflux in patients with lower limb varices especially if not associated with long or short saphenous reflux. The clinical pattern of varices differs between the two types of lower limb varices.

In early 1967, Favaloro began to consider the possibility of using the saphenous vein in coronary surgery. He put his ideas into practice for the first time in May of that year. The basic principle was to bypass a diseased (obstructed) segment of a coronary artery in order to deliver blood flow distally. The standardization of this technique, called coronary artery bypass surgery, was the fundamental work of his career, and ensured that his prestige would transcend the limits of his country, as the procedure radically changed the treatment of coronary disease.

The pectineus is in relation by its anterior surface with the pubic portion of the fascia lata, which separates it from the femoral artery and vein and internal saphenous vein, and lower down with the profunda artery. By its posterior surface with the capsule of the hip joint, and with the obturator externus and adductor brevis, the obturator artery and vein being interposed. By its external border with the psoas major, the femoral artery resting upon the line of interval. By its internal border with the outer edge of the adductor longus.

The catheter is then advanced, also under ultrasound guidance, to the level of the groin or knee crease. Dilute local anesthesia is injected around and along the vein (perivascular infiltration) using ultrasound imaging to place the local anesthetic solution around the vein, mostly in a sub-facial location. This technique derives from the tumescent local anesthesia (TLA) method long used and proven safe and effective for some methods of liposuction. The laser is activated whilst the catheter or laser fiber is slowly withdrawn, resulting in obliteration of the saphenous vein along its entire length.

The saphenous nerve from the femoral nerve provides sensory innervation to the medial side of the foot as well as the medial side of the leg. Likewise, the sural nerve provides sensory innervation to the skin on the lateral side of the foot as well as the skin on the posterior aspect of the lower leg. The tibial nerve from the sciatic nerve provides sensory innervation to the skin of the sole and toes, and the dorsal aspect of the toes. It provides motor innervation to plantaris, tibialis posterior, flexor hallucis longus, flexor digitorum longus as well as posterior muscles in the leg.

The diagnosis is largely a clinical one, generally done by physical examination of the groin. However, in obese patients, imaging in the form of ultrasound, CT, or MRI may aid in the diagnosis. For example, an abdominal X-ray showing small bowel obstruction in a female patient with a painful groin lump needs no further investigation. Several other conditions have a similar presentation and must be considered when forming the diagnosis: inguinal hernia, an enlarged femoral lymph node, aneurysm of the femoral artery, dilation of the saphenous vein, athletic pubalgia, and an abscess of the psoas.

The intermediate cutaneous nerve (middle cutaneous nerve) pierces the fascia lata (and generally the sartorius) about 7.5 cm below the inguinal ligament, and divides into two branches which descend in immediate proximity along the forepart of the thigh, to supply the skin as low as the front of the knee. Here they communicate with the anterior division of lateral cutaneous nerve, the anterior division of medial cutaneous nerve and the infrapatellar branch of the saphenous, to form the patellar plexus. In the upper part of the thigh the lateral branch of the intermediate cutaneous communicates with the lumboinguinal branch of the genitofemoral nerve.

The anterior branch of the obturator nerve is a branch of the obturator nerve found in the pelvis and leg. It leaves the pelvis in front of the obturator externus and descends anterior to the adductor brevis, and posterior to the pectineus and adductor longus; at the lower border of the latter muscle it communicates with the anterior cutaneous and saphenous branches of the femoral nerve, forming a kind of plexus. It then descends upon the femoral artery, to which it is finally distributed. Near the obturator foramen the nerve gives off an articular branch to the hip joint.

While there are reports of this type of instrument being used in humans, it is more likely that these were reserved for veterinary use, while the common thumb lancet was the instrument of choice for use in people. A survey of 100 fleams found thumb lancets in 6%. These instruments with their triangular-shaped blades were designed to be placed over the vein (most commonly the jugular or saphenous) and struck with a fleam stick. This would ideally result in rapid penetration of the vein with minimal risk to the operator and minimal dissection of the subcutaneous tissues.

B-flow ultrasonograph over a valve of the great saphenous vein, showing a venous reflux (flow toward right in the image). History and examination by a clinician for characteristic signs and symptoms are sufficient in many cases in ruling out systemic causes of venous hypertension such as hypervolemia and heart failure. Topic last updated: Dec 04, 2017. A duplex ultrasound (doppler ultrasonography and b-mode) can detect venous obstruction or valvular incompetence as the cause, and is used for planning venous ablation procedures, but it is not necessary in suspected venous insufficiency where surgical intervention is not indicated.

In emergency situations when peripheral access cannot be easily achieved, such as in arrest scenarios, intraosseus methods can be used to gain rapid access to the venous system. These methods usually involve inserting an access device into the tibia or femur bones in the legs, humerus in the upper arm, or sometimes the sternum in the chest. Venous cutdown can also be done to gain immediate emergency access to the venous system. Venous cutdown procedures most commonly target the great saphenous vein in the leg because it is superficial, easily accessible, and consistently in the same anatomical location.

Venous cutdown is an emergency procedure in which the vein is exposed surgically and then a cannula is inserted into the vein under direct vision. It is used to get vascular access in trauma and hypovolemic shock patients when peripheral cannulation is difficult or impossible. The saphenous vein is most commonly used. This procedure has fallen out of favor with the development of safer techniques for central venous catheterization such as the Seldinger technique, the modified Seldinger technique,Seldinger SI: Catheter replacement of the needle in percutaneous arteriography. Acta Radiol 1953; 39:368-376McGee WT, Mallory DL: Cannulation of the internal and external jugular veins.

A 1996 study reported a 76% success rate at 24 months in treating saphenofemoral junction and great saphenous vein incompetence with STS 3% solution. A Cochrane Collaboration review concluded sclerotherapy was better than surgery in the short term (1 year) for its treatment success, complication rate and cost, but surgery was better after 5 years, although the research is weak. A Health Technology Assessment found that sclerotherapy provided less benefit than surgery, but is likely to provide a small benefit in varicose veins without reflux. This Health Technology Assessment monograph included reviews of epidemiology, assessment, and treatment, as well as a study on clinical and cost effectiveness of surgery and sclerotherapy.

The treatment, which is performed without sedation, usually takes between 1 and two hours, and the patient walks out under his or her own power. The leg is bandaged and/or placed in a stocking that the patient wears for up to three weeks afterwards. Foam sclerotherapy or ambulatory phlebectomy is often performed at the time of the procedure or within the first 1–2 weeks to treat branch varicose veins. However, some physicians do not perform these procedures at the time of the ELT because the varicose veins can improve on their own as a result of reduced reflux from the great saphenous vein.

Also, at the groin it can be seen at the outside of the great saphenous vein, and together with the common femoral vein (CFV) these three create an image, the so-called "Mickey Mouse sign". Some authors, inspired by this sign (presented for the first time at CHIVA's 2002 meeting in Berlin), described a "Mickey Mouse view" at the groin, an image formed by the common femoral vein, the GSV and the superficial femoral artery. When the ASV is incompetent, its flow becomes retrograde and tries to drain in the superior fibular perforator, at the side of the knee, or sometimes it runs down towards the ankle to drain in the inferior fibular perforator.

Another investigation of stochastic resonance in broadband (or, equivalently, aperiodic) signals was conducted by probing cutaneous mechanoreceptors in the rat. A patch of skin from the thigh and its corresponding section of the saphenous nerve were removed, mounted on a test stand immersed in interstitial fluid. Slowly adapting type 1 (SA1) mechanoreceptors output signals in response to mechanical vibrations below 500 Hz. The skin was mechanically stimulated with a broadband pressure signal with varying amounts of broadband noise using the up-and-down motion of a cylindrical probe. The intensity of the pressure signal was tested without noise and then set at a near sub-threshold intensity that would evoke 10 action potentials over a 60-second stimulation time.

Coronary artery bypass graft surgery has been in practice since the 1960s. Historically, vessels—such as the great saphenous vein in the leg or the radial artery in the arm—were obtained using a traditional "open" procedure that required a single, long incision from groin to ankle, or a "bridging" technique that used three or four smaller incisions. The most minimally invasive technique is known as endoscopic vessel harvesting (EVH), a procedure that requires a single 2 cm incision plus one or two smaller incisions of 2–3 mm in length. Each method involves carefully cutting and sealing off smaller blood vessels that branch off the main vessel conduit prior to removal from the body.

Pringle was the first surgeon in Britain to carry out a free vein graft. He did this using a saphenous vein graft to restore continuity after excision of a syphilitic aneurysm of the popliteal artery and characteristically in this paper he duly acknowledged the "splendid work of Carrel". Alexis Carrel had been the first surgeon to make an arterial anastomosis, work which led to his being awarded the Nobel Prize in Physiology or Medicine in 1912. The technical quality of Pringle's operative technique is demonstrated by the fact that in this pioneering operation "not one drop of blood escaped at either of the lines of suture and distal pulses were instantly restored".

A Health Technology Assessment found that sclerotherapy provided less benefit than surgery, but is likely to provide a small benefit in varicose veins without reflux from the sapheno-femoral or sapheno-popliteal junctions. It did not study the relative benefits of surgery and sclerotherapy in varicose veins with junctional reflux. This Health Technology Assessment monograph includes reviews of the epidemiology, assessment, and treatment of varicose veins, as well as a study on clinical and cost effectiveness of surgery and sclerotherapy The European Consensus Meeting on Foam Sclerotherapy in 2003 concluded that "Foam sclerotherapy allows a skilled practitioner to treat larger veins including saphenous trunks". A second European Consensus Meeting on Foam Sclerotherapy in 2006 has now been published.

Hormones released during pregnancy and the expanding uterus (pressure on the inferior vena cava – the major vein returning blood up to the heart) can affect leg veins. The use of elastic compression stockings can reduce volumetric variations during standing hours. The use of stockings for the entire day is more effective than just half the day or not using compression stockings at all. Many physicians and vein specialists recommend wearing compression stockings after varicose vein stripping, but studies show that wearing an elastic compression stocking has no additional benefit after the application of elastic bandaging for three days in post-operative care following the stripping of the great saphenous vein as assessed by control of limb, edema, pain, complications and return to work.

The choice of is highly dependent upon the particular surgeon and institution. Typically, the left internal thoracic artery (LITA) (previously referred to as left internal mammary artery or LIMA) is grafted to the left anterior descending artery and a combination of other arteries and veins is used for other coronary arteries. The great saphenous vein from the leg is used approximately in 80% of all grafts for CABG. The right internal thoracic (mammary) artery (RITA or RIMA) and the radial artery from the forearm are frequently used as well; in the U.S., these vessels are usually harvested either endoscopically, using a technique known as endoscopic vessel harvesting (EVH), or with the open-bridging technique, employing two or three small incisions.

The anterior branch becomes superficial about 10 cm below the inguinal ligament, and divides into branches which are distributed to the skin of the anterior and lateral parts of the thigh, as far as the knee. The terminal filaments of this nerve frequently communicate with the anterior cutaneous branches of the femoral nerve, and with the infrapatellar branch of the saphenous nerve, forming with them the peripatellar plexus. The posterior branch pierces the fascia lata, and subdivides into filaments which pass backward across the lateral and posterior surfaces of the thigh, supplying the skin from the level of the greater trochanter to the middle of the thigh. Entrapment is caused by compression of the nerve near the ASIS and inguinal ligament and is commonly known as Meralgia paraesthetica or Bernhardt-Roth syndrome.

The small saphenous vein (SSV), runs along the posterior aspect of the leg as far as the popliteal region, in the upper calf. Here it enters the popliteal space which is located between the two heads of the gastrocnemius muscle where it usually drains above the knee joint in the popliteal vein or a little less often in the GSV or other deep muscular veins of the thigh. The use of ultrasonography has allowed a number of variations to be shown at this level; when no contact is made with the popliteal vein it might be seen to drain in the GSV, at a variable level; or, it may merge with the Giacomini vein and drain in the GSV at the superior 1/3 of the thigh. It can also but rarely, drain in the vein of the semimembranosus (thigh muscle) (shown below).

The deep fascia of leg, or crural fascia forms a complete investment to the muscles, and is fused with the periosteum over the subcutaneous surfaces of the bones. The deep fascia of the leg is continuous above with the fascia lata, and is attached around the knee to the patella, the patellar ligament, the tuberosity and condyles of the tibia, and the head of the fibula. Behind, it forms the popliteal fascia, covering in the popliteal fossa; here it is strengthened by transverse fibers, and perforated by the small saphenous vein. It receives an expansion from the tendon of the biceps femoris laterally, and from the tendons of the sartorius, gracilis, semitendinosus, and semimembranosus medially; in front, it blends with the periosteum covering the subcutaneous surface of the tibia, and with that covering the head and malleolus of the fibula; below, it is continuous with the transverse crural and laciniate ligaments.