Delis Konstantinos T, Knaggs Alison L, Khodabakhsh Pourandokht
Department of Vascular Surgery, Imperial College School of Medicine, London, United Kingdom.
J Vasc Surg. 2004 Dec;40(6):1174-83. doi: 10.1016/j.jvs.2004.09.019.
Coursing the posterior thigh as a tributary or trunk projection of the small saphenous vein (SSV), the Giacomini vein's clinical significance in chronic venous disease (CVD) remains undetermined. This cross-sectional controlled study examined the prevalence, anatomy, competency status, and clinical significance of the Giacomini vein across the clinical spectrum of CVD in relation to the SSV termination.
One hundred eighty-nine consecutive subjects (301 limbs) with suspected CVD (109 men, 80 women; age, 18-87 years [median, 61 years]) underwent examination, clinical class (CEAP) stratification, and duplex ultrasound determination of the sites and extent of reflux >0.5 sec) and Giacomini vein's anatomy.
A Giacomini vein was found in 70.4% of limbs (212 of 301; 95% confidence interval, 65%-75.6%). Extent, pattern, and sites of reflux in all named superficial and deep veins were evenly distributed in limbs with and without a Giacomini vein; perforator vein incompetence in thigh and calf was also balanced (all, P > .2). Giacomini vein had no effect ( P > .2) on SSV termination anatomy, displaying a similar prevalence in classes C(0-6) . In 212 limbs, either as a tributary or trunk projection of the SSV, the Giacomini vein ascended subfascially (n = 210) to the lower (8%; n = 17), middle (47.6%; n = 101), or upper (44.3%; n = 94) thigh, and terminated at the deep system (45.3%; n = 96) and/or perforated the fascia (64.2%; n = 136), to join the superficial system. Giacomini vein morphology was not affected by the SSV termination anatomy and CEAP clinical class. Incompetence was detected less often (P < .001) in the Giacomini vein (4.7%; n = 10 of 212) than in the saphenous trunks cumulatively (53.3%; n = 113 of 212). Yet the odds ratio of Giacomini incompetence was 11.94 (7 of 33 over 3 of 169) in the presence of SSV reflux, and 11.67 (6 of 23 over 4 of 179) when both the great saphenous vein (proximal, proximal plus distal) and SSV were incompetent.
Found in more than two thirds of limbs, the Giacomini vein has a complex anatomy that is linked vastly to the deep or superficial veins of the posteromedial thigh, but is unaffected by the anatomy of SSV termination and CEAP clinical class. Its presence proved insignificant to the extent, pattern, sites, and clinical severity of venous incompetence, yet the Giacomini vein was far less often susceptible to reflux than the saphenous trunks were. Routine Giacomini vein investigation is not justified in view of these findings. Investigation could be considered selectively in limbs with SSV incompetence, with or without great saphenous vein incompetence, supported by the high odds of concomitant Giacomini vein reflux.
Giacomini静脉作为小隐静脉（SSV）的分支或主干走行于大腿后侧，其在慢性静脉疾病（CVD）中的临床意义尚不确定。这项横断面对照研究考察了Giacomini静脉在CVD临床谱中的患病率、解剖结构、功能状态以及与SSV终止相关的临床意义。
189例连续的疑似CVD患者（301条肢体）（109例男性，80例女性；年龄18 - 87岁[中位数61岁]）接受了检查、临床分级（CEAP）分层以及双功超声检查，以确定反流部位和程度（>0.5秒）以及Giacomini静脉的解剖结构。
在70.4%的肢体（301条中的212条；95%置信区间，65% - 75.6%）中发现了Giacomini静脉。所有命名的浅静脉和深静脉的反流范围、模式和部位在有和没有Giacomini静脉的肢体中分布均匀；大腿和小腿的穿静脉功能不全情况也平衡（所有P > 0.2）。Giacomini静脉对SSV终止解剖结构没有影响（P > 0.2），在C（0 - 6）级中患病率相似。在212条肢体中，Giacomini静脉作为SSV的分支或主干，在筋膜下上升（n = 210）至大腿下部（8%；n = 17）、中部（47.6%；n = 101）或上部（44.3%；n = 94），并在深静脉系统终止（45.3%；n = 96）和/或穿透筋膜（64.2%；n = 136），以汇入浅静脉系统。Giacomini静脉形态不受SSV终止解剖结构和CEAP临床分级的影响。Giacomini静脉功能不全的检出率（P < 0.001）低于大隐静脉累计功能不全的检出率（4.7%；212条中的10条）（53.3%；212条中的113条）。然而，在存在SSV反流时，Giacomini静脉功能不全的比值比为11.94（33条中的7条比169条中的3条），当大隐静脉（近端、近端加远端）和SSV均功能不全时，比值比为11.67（23条中的6条比179条中的4条）。
在超过三分之二的肢体中发现了Giacomini静脉，其解剖结构复杂，与大腿后内侧的深静脉或浅静脉广泛相连，但不受SSV终止解剖结构和CEAP临床分级的影响。其存在对静脉功能不全的范围、模式、部位和临床严重程度无显著影响，然而Giacomini静脉比大隐静脉主干更不易发生反流。鉴于这些发现，常规检查Giacomini静脉并无必要。对于有SSV功能不全的肢体，无论有无大隐静脉功能不全，鉴于同时存在Giacomini静脉反流的高可能性，可考虑选择性检查。
