Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3825_Библиотеки_им_академика_М_И_Перельмана

are clinically relevant, since in patients presenting with varicose veins they are quite often the main source of pathological reux. Anatomical variants of the small saphenous vein represent another clinical problem related to the treatment of vari­cose veins. Embryologically, this vein develops from the primitive bular vein. The sapheno-popliteal junction, the most proximal part of the small saphenous vein, where it merges with the popliteal vein, is a remnant of the popliteal crossroad found in embryo; consequently, anatomically this area is highly variable. In some individuals, the small saphenous vein is doubled; there are some people presenting with the junction between the small saphenous vein and the popliteal vein located above the level of the knee joint, with continuation of the small saphenous vein located at the posterior aspect of the thigh in the interfascial compartment (this ana­tomic variant, the cranial extension of the small saphenous vein, resembles venous anatomy of an embryo), or with a continuation of the small saphenous vein toward the great saphenous vein (this anatomic variant is referred to as the Giacomini’s vein). Besides, at the level of the knee joint, in some patients there is a connection between supercially located vein and the popliteal vein. Since this supercial vein is not situated in the interfascial compartment, as the small saphenous vein is, this vein is referred to as the perforator of popliteal fossa. Varicose veins associated with this perforator should be managed differently than those resulting from small saphe­nous vein incompetence. Topographically, the deep veins accompany their corre­sponding arteries. Below the knee, deep veins of the lower extremity are usually doubled or tripled; beginning from the popliteal vein there is usually a single vein, although in many individuals paired popliteal or femoral veins are present. The main deep veins of the lower leg comprise the posterior tibial veins that drain the posterior fascial compartment of the lower leg, the anterior tibial veins that drain the anterior fascial compartment, and the bular veins that primarily drain the deep posterior fascial compartment. Besides, the posterior tibial veins receive venous blood from the plantar part of the foot. The anterior tibial veins receive venous out­ow coming from this part of the dorsal aspect of the foot, which is not drained by saphenous veins. The popliteal vein is the main deep vein of the lower leg. This vein is a continuation of the merged posterior and anterior tibial veins. The popliteal vein receives several clinically relevant muscular tributaries, particularly the soleal and gastrocnemius veins. These veins, which drain the triceps surae muscle, constitute the most important component of the so-called calf muscle pump. Morphologically, these muscular veins signicantly differ from each other. While the gastrocnemius veins are paired and are equipped with typical bicuspid valves that are located in the main venous trunks and branches, the soleal veins exhibit very irregular course, with some portions of veins that are not paired, their merging is repeated, there are only a few valves in the main trunks, and their venous valves are incomplete. The soleal veins build up rather a venous plexus, and not typical venous tree. All these features of the soleal veins promote venous stasis inside the soleal muscle, which can result in venous thrombosis. Usually, at the level of the knee joint, the popliteal vein merges with the small saphenous vein that belongs to the interfascial veins. Yet, in some individuals this junction is situated above the knee level or even missing.