Cercetri Experimentale & Medico-Chirurgicale Anul XIVl Nr.1/2007 Pag.

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Cercetari
e x p e r i m e n ta le & m edico-chirurgicale

ANATOMICAL CONSIDERATIONS CONCERNING THE SCARPA FEMORAL TRIANGLE VEINS

C. Cebzan, 1 V. Niculescu, M. Niculescu, Alina iu, Codrua Petrescu

ABSTRACT: The femoral Scarpa triangle contains the saphenofemoral junction, the accessories saphenous veins terminations, individually represented by the anterior accessory )saphenous vein (AASV), the posterior accessory saphenous vein (PASV) or the Cruveilhier vein or the accessory satellite saphenous vein and also by the superior tributaries of the great saphenous vein represented by the anterior and posterior superficial femoral veins of Giacomini (A,P SFV), perforates perinea veins and suprapubian veins. For this anatomical study we made dissections on 15 human adult formolised bodies (bilaterally) at the femoral triangle place. The material was from the anatomy lab since 2001 to 2006. The measured distances (in centimeters) between the draining great saphenous vein place and the inguinal ligament are variable. In aboard the saphenofemoral junction , is good to consider the possibility of the individual venous morphological variations. KEY WORDS: great saphenous vein, inguinal ligament, femoral vein. REZUMAT: Trigonul femural Scarpa conine att jonciunea safenofemural, terminaiile venelor safene accesorii, reprezentate individual de vena safen accesorie anterioar (VSAA), vena safen accesorie posterioar sau vena lui Cruveilhier (VSAP) sau vena safen satelit accesorie, precum i tributarele superioare ale venei safene mari reprezentate de venele femurale superficiale anterioar i posterioare (ale lui Giacomini)(VFSA,P), vene perineale perforante i vene suprapubiene Pentru realizarea prezentului studiu anatomic am practicat disecii pe 15 cadavre umane adulte formolizate (bilateral) la nivelul trigonului femural al lui Scarpa, provenite din cadrul Laboratorului de Anatomie al U.M.F. din Timioara, ntre anii 2001-2006. Distanele msurate (n centimetri) ntre locul de vrsare a venei safene mari i ligamentul inghinal sunt destul de variabile. n abordul jonciunii safenofemurale trebuie s se aib n vedere posibilitatea variaiilor morfologice venoase individuale.

Received for publication: 10.06.2006 Revised: 25.09.2006

1- Department of Anatomy and Embryology, University of Medicine and Pharmacy Victor Babe Timioara 2 - Eftimie Murgu Square, 300 041 Timioara, Romania,

INTRODUCTION
The femoral Scarpa triangle contains the saphenofemoral junction, the accessories saphenous veins terminations, individually represented by the anterior accessory) saphenous vein (AASV), the posterior accessory saphenous vein (PASV) or the

Cruveilhier vein or the accessory satellite saphenous vein and also by the superior tributaries of the great saphenous vein represented by the anterior and posterior superficial femoral veins of Giacomini (A,P SFV), perforates perinea veins and suprapubian veins (1,2,7). The saphenofemoral junction effluents are: the external pudenda veins (EPV), the superficial iliac

Correspondence to: C. CEBZAN : Assistant, PhD, Department of Anatomy and Embryology, University of Medicine and Pharmacy Victor Babe Timioara, 2 Eftimie Murgu Square, 300 041 Timioara, Romania, 0742532674, cipicebzan@yahoo.com; codruta.petrescu@gmail.com; alinasisu@gmail.com

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circumflex vein (SICV), the superficial epigastric vein (SEV), the penis and clitoris dorsal superficial veins which are draining in EPV or directly in the femoral vein. The scrotal or labial veins are draining in the EPV or in the femoral vein. The accessory saphenous vein is described like a vein which connected the great saphenous vein and the little saphenous vein and received the posterior superficial veins of the thigh and certain regions has a parallel trajectory with the great saphenous vein, before the draining in it (3,4).

RESULTS AND DISCUSIONS

The Scarpa femoral triangle is delimited superior by the inguinal ligament, laterally by the sartorius muscle and medially by the longus adductor muscle (table I). In table I are presented the tributaries veins of dissected saphenofemoral junction, and grouping them in superiors and inferiors. Superior tributaries are represented by the superficial epigastric vein (SEV), the superficial iliac circumflex vein (SICV), the suprapubian vein (SPV) and the external pudendal veins (EPV). Inferior tributaries are represented by the anterolateral femoral vein (ALFV), the posterior femoral vein (PFV) or Giacomini vein and the accessories saphenous veins (ASV) (5). The great saphenous vein are going through the saphenous hiatus and is opening on the medial anterior face of the femoral vein, inferior from the inguinal ligament. The media of these distances was 4,0 cm, in according with the conventional describes (6), but individually the variations of this distance were in same cases important (3,1-4,3 cm) (table II). Two recent studies realized by macroscopically dissection at the 68 inguinofemoral regions are correlated with our results and shows that the Paturet venous star does not represented the most frequently venous configurations at the saphenofemoral junction level (2,4). The saphenofemoral junction resection is one of the essential techniques from the varicous disease surgery with implication in dissection of following anatomical levels: skin, superficial fatty tissues, the cribriforme fascia crossed by the great saphenous vein and its tributaries, corresponding to a particular region of the fascia lata. Despite the popularity of the internal

MATERIAL AND METHOD

For this anatomical study we made dissections on 15 human adult formolised bodies (bilaterally) at the femoral triangle place. The material was from Department of Anatomy and Embryology, University of Medicine and Pharmacy Victor Babe Timioara since 2001 until 2006. For the macroscopic dissection method we made an incision between the following two marks: the anterosuperior iliac spine and the pubic tubercle and from the middle of this incision we descended with another incision, vertically, at the anterior region of the thigh till 5 cm superior the patellar region. From the inferior extremity of the vertical incision we had continued with two transversal incisions, one medial and another lateral, which permitted to realize and remote the skin fascias. Superficially of the cribriforme fascia we made detailed dissections of the veins, with the progressive remote of the superficial tissues and the superficial inguinal lymph nodes. The measured distances (in centimeters) between the draining great saphenous vein place and the inguinal ligament are variable.

TABLE I: The femoral venous affluents SPECIMENS

SEV SICV SPV PV ALFV FPV

NUMBER
30 26 14 26 17 14

%
100% 82,5% 46,6% 82,5% 56,6% 46,6%

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TABLE II The measured distances (in cm) between

the draining place of the great saphenous vein and the inguinal ligament

TABLE II (continued): SPECIMEN

24 25 26 27 28 29 30

DISTANCE (cm)
3,5 3,6 3,3 4,3 4,0 3,9 4,1

SPECIMEN
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23

DISTANCE (cm)
3,8 3,7 3,3 4,1 3,5 4,3 3,8 4,2 3,3 3,9 4,0 4,1 3,1 3,5 3,8 4,0 3,9 3,1 3,3 3,6 3,2 4,3 3,7

torachal artery for the revascularization of the myocardium, the great saphenous vein remains an excellent material for the aortocoronary grafts and also for the lower limb too. Because the longer incisions have a lot of negative effects is preferring the endoscopical prelevations with fill in the endoscope after the great saphenous vein opened dissection at the saphenofemoral junction level, presuming the junction affluent ligature (2).

CONCLUSIONS
The measured distances (in cm) between the draining place of the great saphenous vein and the inguinal ligament are quite variable. In abording the saphenofemoral junction must have in count the possibility of the individual venous morphological variations. A large exposure of the junction will permit a morphological evaluation in the plague and the application the fair procedures to prevent the recurrences in case of surgical treatment of the varicose disease.

References:
1. 2. 3. 4. 5. Blanchemaison P, Camponovo J, Greney P Atlas of anatomy of the superficial veins of the lower limbs, la http://www.phlebologia.com/en/main.asp Carrizo GJ, Livesay JJ, Luy L. Endoscopic harvesting of the greater saphenous vein for aortocoronary bypass grafting. Tex Heart Inst J. 1999; 26(2): 120123. Feneis H, Dauber W. Pocket atlas of human anatomy. 2000, 4th ed., Georg Thieme Verlag. Miranda RLS, Liberato CC, Miguel Neto C, Michaelis W, Mesquita Junior N, Lacerda Filho A, Stroparo FFC. Surgical anatomy of the saphenofemoral junction. Rev. Md. Paran, Curitiba, 2003; 61(2):9-11. Ndiaye A, Ndiaye A, Ndoye JM, Diarra O, Diop M, Dia A, Ndiaye M, Sow ML. The arch of the great saphenous vein: anatomical bases for failures and recurrences after surgical treatment of varices in the pelvic limb. About 54 dissections. Surg Radiol Anat. 2006 Mar;28(1):18-24. Epub 2005 Niculescu, V, Matusz, PL Vasele i nervii membrelor, Ed.II, Ed.Mirton, Timioara, 1992, 118 - 127 Schneider Fr., Siska I., Avram J. - Clinical physiology of the venous system, .Kluwer Academic Publishers (Boston/ Dordrecht/ London) 2003

6. 7.

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