![]() ![]() Hydrostatic pressure can be significantly improved by the correction of femoral or popliteal vein incompetence however, the relative importance of proximal versus distal valves has not been established ( 20). Venous valves are also present in the femoro-popliteal segment, at the common femoral vein (CFV) near the inguinal ligament, superficial femoral vein (SFV) just distal to the deep femoral vein (DFV) tributary, and in the popliteal vein (PV) near the adductor hiatus ( 19). Valves are most densely distributed in the infrapopliteal segment which implies their critical functional importance in this area. The valves also divide the hydrostatic column of blood into segments and prevent the full pressure of the fluid column from exerting force on the distal veins ( 17, 18). Venous valves play a crucial role in preventing pathologic reflux and maintaining net vertically directed flow by preventing reflux. During muscle relaxation, the pressure gradient is reversed and causes physiological reflux, lasting approximately 200 to 300 milliseconds in veins with competent valves. Calf muscle contraction elevates the pressure of the deep venous compartment of leg to approximately 140 mmHg, propelling venous blood into the popliteal and femoral veins ( 10, 12). It works in both vertical and horizontal directions-across the central and perforating veins-and generates an ambulatory pressure gradient across the knee. Pressure provided by calf muscle squeeze is the primary force for venous return against gravity from the lower extremity in an upright position. Venous return in the lower extremity involves a complex interplay of the calf muscle pump, venous valves, and perforating veins. The saphenous fascia also restricts venous dilation and prevents the development of varicose veins ( 11). This fascial tissue has been implicated in providing the muscular squeeze during muscle contraction to enhance blood flow within them ( 10). A similar fascial covering has been described in relation with the short saphenous vein ( 9). This fascia has been termed the “saphenous fascia” ( 4, 10). The great saphenous vein courses in a deep plane of the hypodermis just outside the muscular fascia, covered by a connective tissue lamina extending from the inguinal ligament to the ankle. The mid-portion of the SSV may be duplicated in as many 4% of individuals ( 9). A standard SPJ may co-exist in many of these cases. In the remaining one-third of patients, its course is variable: it may drain into a posterior medial tributary of the GSV, directly into the GSV as the thigh extension of the SSV, or into a perforator ( Figure 1) ( 7, 8). In approximately two-thirds of patients, the SSV terminates at popliteal fossa by forming the saphenopopliteal junction (SPJ). It travels posterior to the lateral malleolus and ascends along the posterior midline superficial to the deep muscular fascia. The short saphenous vein (SSV) is the other major truncal superficial vein, which begins on the lateral aspect of the foot. GSV, great saphenous vein SSV, short saphenous vein. Prop up your legs above the level of your heart when lying down.Anatomy of GSV and SSV with common variants of SSV. Do not sit with your legs crossed at the knee. ![]() Avoid long periods of standing or sitting. Home care may help relieve your symptoms and improve blood flow. Procedures can close the vein, remove the vein, or improve blood flow. Medicine or a procedure can also be treatment options. Your doctor may also suggest other steps to try at home, such as getting regular exercise. Your doctor may recommend wearing compression stockings to help relieve symptoms. Your doctor can diagnose venous insufficiency by examining your legs and by using a type of ultrasound test (duplex Doppler) to find out how well blood is flowing in your legs. You may also have skin problems like itching, sores, or changes in skin color. Symptoms may include swelling (often in the ankles), cramping, aching, a heavy feeling in the legs, or varicose veins. Symptoms of venous insufficiency affect the legs. So are people who smoke or stand for long periods of time. People who are pregnant, older, overweight, or have a family history of varicose veins are more likely to get it. Venous insufficiency is sometimes caused by deep vein thrombosis and high blood pressure inside leg veins. This may result in tissue breakdown and venous skin ulcers. Fluid seeps out of the engorged veins into surrounding tissues. This causes the veins to become overfilled. But damaged valves allow some blood to leak backward. These valves normally keep blood flowing toward the heart. In venous insufficiency, the valves in the veins have become damaged. It can lead to problems that include varicose veins. The veins of the legs might not work as they should. Venous insufficiency is a problem with the flow of blood from the veins of the legs back to the heart. Condition Basics What is venous insufficiency? ![]()
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