Patients with primary varicose veins have few venous valves in the proximal femoral vein and great saphenous vein: A cadaveric and ultrasound examination of living subjects

Abstract

Objectives

The pathogenesis of primary varicose veins (PVVs) is multifactorial and remains incompletely understood; however, venous valve dysfunction is recognized as a key factor. Previous studies have suggested racial differences in the prevalence and distribution of venous valves in the proximal femoral vein; however, no data are available for the Japanese population. This study aimed to clarify the prevalence and number of venous valves in the proximal femoral vein and great saphenous vein (GSV) in Japanese individuals and determine whether patients with PVVs have fewer venous valves than healthy individuals.

Methods

A cadaveric study of 59 individuals (median age, 87 years) and an ultrasound study involving 52 healthy volunteers (median age, 26 years) and 106 patients with PVVs (median age, 72 years) were conducted. Venous valves were assessed in segments A (from the confluence of the inferior epigastric vein to the saphenofemoral junction [SFJ]) and B (GSV within 4 cm distal to the SFJ).

Results

In cadavers and volunteers, venous valves were identified in approximately 60% of segment A and nearly all of segment B, with no significant differences between the two groups. Conversely, patients with PVVs had significantly fewer venous valves in both segments A (right, 0.22 vs 0.54, p < .001; left, 0.31 vs 0.56, p = .005) and B (right, 1.29 vs 1.50, p = .034; left, 1.32 vs 1.52, p = .028) than volunteers. In several PVVs, only the venous sinus without valve leaflets was detectable by ultrasonography.

Conclusions

Patients with PVVs had significantly fewer venous valves in the proximal femoral vein and GSV than healthy subjects, suggesting that valve deficiency, possibly including congenital factors, may contribute to PVV development. This study provides the first detailed data on venous valve distribution in Japanese individuals. More studies are needed to confirm these findings and clarify clinical implications.

Keywords

venous valve primary varicose vein femoral vein Japanese ultrasound and anatomy

Get full access to this article

View all access options for this article.

References

Gloviczki

Comerota

Dalsing

, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg 2011; 53: 2S–48S.

Pannucci

Shanks

Moote

, et al. Identifying patients at high risk for venous thromboembolism requiring treatment after outpatient surgery. Ann Surg 2012; 255: 1093–1099.

Carpentier

Maricq

Biro

, et al. Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J Vasc Surg 2004; 40: 650–659.

Jacobs

Andraska

Obi

, et al. Pathophysiology of varicose veins. J Vasc Surg Venous Lymphat Disord 2017; 5: 460–467.

Banjo

. Comparative study of the distribution of venous valves in the lower extremities of Black Africans and Caucasians: pathogenetic correlates of prevalence of primary varicose veins in the two races. Anat Rec 1987; 217: 407–412.

Keiler

Schulze

Claassen

, et al. Human femoral vein diameter and topography of valves and tributaries: a post mortem analysis. Clin Anat 2018; 31: 1065–1076.

Sun

Zhang

. Anatomic and histologic studies on the valves of the venous system in lower extremities. Vasc Surg 1990; 24: 85–90.

Soifer

Weiss

Marom

, et al. The effect of pathologic venous valve on neighboring valves: Fluid–structure interactions modeling. Med Biol Eng Comput 2017; 55: 991–999.

Friedreich

. Ueber das Verhalten der Klappen in den Crural-venen sowie ueber das Vorkommen von Klappen in den grossenVenenstaemmen des Unterleibes. Morph Jahrb 1882; 7: 323–325.

10.

Powell

Lynn

. The valves of the external iliac, femoral and upper third of the popliteal veins. Surg Gynecol Obstet 1951; 92: 453–455.

11.

Eger

Wagner

Jr . Etiology of varicose veins. Postgrad Med J 1949; 6: 234–238.

12.

Basmajian

. The distribution of valves in the femoral, external iliac and common iliac veins and their relationship to varicoseveins. Surg Gynecol Obstet 1952; 95: 537–542.

13.

Mühlberger

Morandini

Brenner

. An anatomical study of femoral vein valves near the saphenofemoral junction. J Vasc Surg 2008; 48: 994–999.

14.

Shinohara

Morisawa

Toshima

, et al. Distribution of valves in the great saphenous vein; its clinical implications. Okajimas Folia Anat Jpn 1990; 67: 219–221.

15.

Leu

Vogt

Pfrunder

. Morphological alterations of non-varicose and varicose veins: a morphological contribution to the discussion on pathogenesis of varicose veins. Basic Res Cardiol 1979; 74: 435–444.

16.

Mühlberger

Morandini

Brenner

. Venous valves and major superficial tributary veins near the saphenofemoral junction. J Vasc Surg 2009; 49: 1562–1569.

17.

Cooper

JR Hobart

Provenza

. Analysis of the number and position of valves in normal and varicose saphenous veins. Vasc Surg 1978; 12: 308–314.

18.

Ortega

Sarmiento

Mompeo

, et al. Morphological study of the valvular distribution in the long saphenous vein. Phlebology 1994; 9: 59–62.

19.

Mühlberger

Morandini

Brenner

. Frequency and exact position of valves in the saphenofemoral junction. Phlebology 2007; 36: 3–7.

20.

Dickson

Hill

Thomson

, et al. The valves and tributary veins of the saphenofemoral junction: ultrasound findings in normal limbs. V&L 2013; 2: e18.

21.

Mendoza

Stücker

. Duplex-ultrasound assessment of the saphenofemoral junction. Phlebol Rev 2015; 3: 78–85.

22.

Cotton

. Varicose veins: gross anatomy and development. Br J Surg 1961; 48: 589–598.

23.

Corcos

De Anna

Dini

, et al. Proximal long saphenous vein valves in primary venous insufficiency. J Mal Vasc 2000; 25: 27–36.