The vascular architecture. Phlebosomes do they exist?

The angiosome is a 3D structure which is perfused by a single perforating artery (arteriosome) and drained by a perforating vein (venosome). The concept of arteriosome is applied in plastic surgery and in the revascularization of ischemic limbs. Each venosome is also drained by longitudinal veins running in the subcutaneous layer. Accordingly, the concept of venosome cannot be applied in the field of the venous disorders of the limbs. The concept of phlebosome consider both paths of venous drainage

The nomenclature of the veins of the lower limbs, based on their planar anatomy and fascial relationships

Spiegazione della nuova terminologia anatomica delle vene degli arti inferiori

Venous obstruction of the thigh

A case of femoral vein thrombosis is described by 3D spiral CT

Cartilaginous metaplasia of varicose veins: a case report

Cartilaginous metaplasia of superficial veins was found in a 64-year-old woman who underwent surgery for varicose veins. At operation, some varicose veins of the medial thigh were semi-rigid and fibroelastic to the touch. Histology revealed that half the lumen was occupied by chondroid tissue. The other half was obliterated by fibrous tissue, typical of post-thrombotic involution. Possible causes of cartilaginous metaplasia are briefly discussed

Fascial relationships of the short saphenous vein

AbstractObjectives: The purpose of this study was to define the relationships between the short saphenous vein (SSV) and the fasciae of the leg, including the muscular fascia (MF) and the membranous layer (ML) of the subcutaneous tissue. Methods: Fascial relationships of the SSV were evaluated by means of dissection in 30 cadaveric limbs and by means of duplex sonography in 270 healthy limbs from living subjects. Results: All along the leg, the SSV courses in a flat compartment delimited by the MF and the ML. Neither results from dissection nor results from sonographic examination demonstrated piercing of the MF by the SSV. A hyperechoic lamina similar to a ligament connects the SSV to the fasciae by which it is encased. An SSV tributary and collateral vessels course out of this space and are devoid of any fascial wrapping. Conclusions: The SSV does not correspond to the classical description of a “superficial” vein. In fact, from the anatomical point of view, the SSV is an interfascial vein, because it is encased by two connective fasciae, just like the greater saphenous vein. Fascial relationships of the SSV suggest that muscular contraction potentially influences the caliber and hemodynamics of the SSV. In addition, the ML is arranged as a sort of mechanical shield that could counteract dilative pathologic conditions in varicose limbs. (J Vasc Surg 2001;34:241-6.

Three-dimensional phlebography of the saphenous venous system

This is the first study reporting the technique for the 3D visualization of the saphenous veins obtained by CT in living subjects

Confluence of the right internal iliac vein into a compressed left common iliac vein

The authors describe the abnormal confluence of the right internal iliac vein into a left common iliac vein compressed by the overlying right common iliac artery. The prevalence of this combination of abnormalities, evaluated in cadavers and in living subjects by CT, was 0.9%. The possible obstacle to venous pelvic return by these anomalies is pointed out

Frank Bernard Cockett 1916-2014

La vita di Frank Cockett viene ricordata in occasione della sua mort

Skin erythrodiapedesis during chronic venous disorders

Background: Extravasation of erythrocytes (erythrodiapedesis [ED]) is currently included among causes of skin damage in legs with chronic venous disorders (CVD) and ascribed to venular hypertension. ED is followed by erythrocyte disruption, degradation of hemoglobin, and storing of ferric iron into hemosiderin. The aim of this study was to evaluate the occurrence of ED in the skin of legs with different clinical stages of CVD. Methods: One hundred eighteen skin biopsies from legs with CVD underwent histologic evaluation for ED and hemosiderin deposition (HD). Results: ED was found in only 21/118 specimens. In particular, it was found in ulcer samples, in tissues surrounding varicophlebitis and, finally, in acute eczematous skin. ED was found in only 15/30 samples showing HD. Conclusion: Our findings confirm the occurrence of ED during CVD. However, it was found only in concomitance of severe dermal inflammation. Hemosiderin deposition in the absence of actual ED could be explained with previous healed episodes of skin inflammation. However, ED is not likely the only cause of skin iron overload, which could also occur by a molecular mechanism. Further studies are needed to define the mechanism of iron deposition in the skin of legs afflicted with CVD. (J Vase Surg 2011;53:1649-53.

Cutaneous changes in varicose legs with normal skin appearance

Background: In most of Western and European countries, reimbursement for the treatment of vein disorders depends upon the severity of the disease. This is currently evaluated according only to skin appearance (normal skin, edema, cutaneous changes and finally ulceration). Aim: In this study, the occurrence of skin damaging was evaluated by ultrasonography in varicose legs with apparently normal skin (excluded from reimbursement in many countries). Methods : Only legs with extensive varicose veins were considered (reflux originating from the saphenofemoral junction and descending along the great saphenous vein down to the lower leg). US findings fom the varicose leg were compared to those from the contra lateral healthy limb. Results: In 13/18 varicose legs, skin changes related to inflammation were observed: dermal edema, subcutaneous edema, dermal or subcutaneous infiltration. In these legs, scoring for venous symptoms resulted higher than in the remaining 5 legs. Discussion: Sonography demonstrated the occurrence of cutaneous and/or subcutaneous inflammation in varicose legs with apparently normal skin. These objective signs correlate to heavier symptoms and greater limitation in working, domestic and social activities. Possible forensic and insurance implications are finally discussed