The absence of the great saphenous vein: aplasia or involution? A clinical case

There are different types of great saphenous vein (GSV) anatomy that have been reported in the literature. GSV hypoplasia is frequently observed anatomical type with twice higher incidence than GSV aplasia. Proximal GSV aplasia including sapheno-femoral junction (SFJ) is the rarest anatomical type that is always accompanied by anterior accessory saphenous vein (AASV) acting as the alternative drainage route in such cases. In the case of SFJ absence the AASV connects common femoral vein at the level of typical SFJ location. In this case report we present the situation of complete GSF and AASV absence with the subsartorious perforating vein as the proximal junction between superficial and deep veins. At the same time this perforating vein is the source of pathological venous reflux towards the varicose veins of the thigh and leg. There is no information about phlebectomy of GSV in this case but it is known that the accident of the knee trauma with a subsequent operation and also the operation on the GSV tributaries on the leg (puncture without avulsion according to the patient memories) took place in the past. As such events are associated with the risk of thrombotic complications the postthrombotic involution of GSV could be contemplated in this case as the reason of GSV disappearance. Foam sclerotherapy of the incompetent thigh perforator vein with miniphlebectomy on the thigh was performed. Leg varicose veins were left untreated as their reduction after reflux elimination was expected. 14 days after treatment perforating vein obliteration and leg varicose veins reduction were diagnosed.