The accessory saphenous vein (ASV) is a tributary of the great saphenous vein (GSV) that runs within the anterior compartment of the thigh, superior to the popliteal fossa. It is located behind the sartorius muscle and deep to the skin, and it extends from the junction of the great saphenous vein with the superficial femoral vein. The ASV primarily drains the skin and superficial fatty tissues of the anteromedial aspect of the thigh.
Anatomy
The ASV arises from the posteromedial aspect of the thigh, near the adductor magnus tendon. It emerges from a smaller communicating vein that connects it to the lower arm and forearm, forming the communicating vein plexus that bathes a significant portion of the anteromedial aspect of the extremity. The ASV travels distally in the retrograde manner, along with the deep inguinal lymphatic system and the greater saphenous vein, until it empties into the distalsaphenous vein within the popliteal fossa. The ASV has three distinct layers: an inner endothelial layer, a middle adventitial layer, and an outer perivenous layer.
Variations
The ASV may not always be present, and sometimes accessory tributaries from the great saphenous vein, such as the short saphenous vein (SSV) or the sural communicating veins, join the ASV. In the absence of accessory tributaries, the ASV assumes the course of the great saphenous vein, from the inguinal region to the popliteal fossa.
Function and Histology
The ASV serves as a channel for blood drainage from the superficial areas of the anteromedial thigh, which receives a significant amount of cutaneous and adipose tissues (approximately 500 cm2). Blood enters the ASV through the communicating veins and subsequently from the deep inguinal lymphatic system. Microscopically, the ASV endothelium appears to be similar to that of the GSV, with several layers of cells with characteristic cytoplasmic vacuolation. These vacuoles vary in size and shape among individuals, but they are most pronounced in regions of stasis such as the sartorius insertion points.
Clinical Significance
The accessory saphenous vein is important for its potential contribution to recurrent varicose veins. Recurrence after varicose veinectomy can occur for many reasons, including the development or progression of neovascularization within the triangle of Valsalva (the triangle enclosed by the great saphenous vein, the posterior wall of the inferior vena cava, and the sartorius muscle). In such cases, the ASV provides a potential pathway for blood to traverse across the suture line into the popliteal fossa, which can prevent healing and lead to a varicose recurrence. Furthermore, the ASV can become dilated and tortuous due to increased pressure from varicose veins and reduced function of the superficial system, causing further varicosities and potentially leading to skin changes such as hyperpigmentation and ecchymosis.
Imaging
Imaging of the accessory saphenous vein is important for the evaluation of varicose veins and the planning of surgical management. Duplex ultrasonography (DUS) is the primary imaging modality used to assess the anatomy and function of the ASV. By evaluating the direction of flow, the presence of valvular insufficiency, and the diameter of the ASV, physicians can determine the potential risks for varicose vein recurrence after surgery.
Treatment
Treatment for accessory saphenous vein abnormalities typically involves endoscopic or open surgical techniques to remove or repair the affected vein. Conservative measures such as compression, elevation, and support stockings are generally not effective for accessory saphenous vein problems. However, in cases where the ASV is significantly dilated or congested, drainage procedures may be necessary to alleviate symptoms or prevent complications from varicose veins.
History and Background
The concept of accessory saphenous veins was first described in the early 1970s, with studies by Mironescu-Florin and associates providing early accounts of the venous system's tributaries and tributaries in the popliteal fossa and leg. The ASV was recognized as a distinct anatomical entity in 1983, and its clinical relevance has since been increasingly recognized.s
The accessory saphenous vein is an important tributary of the great saphenous vein, located in the anterior compartment of the thigh. It plays a role in the circulation of blood from the anteromedial aspect of the leg, and its abnormalities can contribute to recurrent varicose veins after varicose veinectomy. Understanding the anatomy, function, and potential variations of the ASV is crucial for the proper management of varicose veins, particularly in cases where conservative measures are not sufficient and surgical intervention is required.
