Double Femoral Vein: A Case Report

Abstract

Turkish Abstract

Introduction

The femoral vein (FV) accompanies  the femoral artery. FV begins at  the adductor canal is a continuation of the popliteal vein. It ends at the level of inguinal ligament, where it becomes the external iliac vein. FV is posterolateral to the femoral artery in the lower portion of the adductor canal, and behind the artery in the upper portion of the adductor canal and in the lower portion of the femoral triangle. It is medial to the artery at the base of the femoral triangle. The femoral vein has multiplexed muscular tributaries. The deep femoral vein joins from posterior to the femoral vein in 4?12 cm distal of the inguinal ligament, and the great saphenous vein joins it anteriorly. Lateral and medial circumflex femoral veins are generally tributaries of the femoral vein ¹.

Vascular sheath in the femoral region is utilized for various clinical procedures, both open and closed, particularly with respect to arterial and venous cannulations ². Anatomical variations of the femoral vein are of great clinical significance particularly in cases of deep vein trombosis (DVT) ³. The venous anatomy is extremely variable due to venous malformations occurring during the late development of the embryo ⁴.   In our case, we have identified variations in the FV and its components. 

Case Report

FV dublication  was  observed in the left femoral triangle of a 55 year old male embalmed cadaver during routine dissection of the lower limb in Suleyman Demirel University, Faculty of Medicine, Anatomy Laboratory (Figure 1, 2).

This case has been detected during routine dissection for the training of undergraduate medical students. Femoral vein was 9 mm diameter in this case, and separated into two veins as superficial and deep constituent in the adductor canal (Figure 1, 2). The diameters of double femoral veins were measured as 7 mm and 6 mm,  respectively. The diameter of femoral artery was 9 mm, and passed  between these two veins. Double femoral veins are  connected to eachother by a small connection branch  near the apex of the femoral triangle and a superficial vein drained to this connection branch (Figure 1, 2).  These veins were reunited after 9.7 cm from the cleavage site. The diameter of the femoral vein just after the junction was 10 mm.

Figure 1 FV; Femoral vein, FA; Femoral artery, SV; Superficial vein, CB; Common branch, DFV; Deep constituent of femoral vein, SFV; Superficial constituent of femoral vein, VMM; Vastus medialis muscle, RFM; Rectus femoris muscle

Figure 2 FV; Femoral vein, FA; Femoral artery, SV; Superficial vein, CB; Common branch, DFV; Deep constituent of femoral vein, SFV; Superficial constituent of femoral vein, VMM; Vastus medialis muscle, RFM; Rectus femoris muscle

Discussion

The presence of FV duplication is usually reported as being approximately 20?25% of the cases, but these values may be higher if partial duplications are considered ⁵. The frequency of duplicated FV?s is variable,  ranging  from 12% to 46%, according to  the technique used: ultrasound, venography, or anatomical study ⁴.

Dona et al. reported a statistically high prevalence of duplications of the FV. They confirmed that changes in flow rate increased the formation of DVT secondary. Dona et al. also found 15% duplicated VF?s on  ultrasound  ⁶. The incidence of duplication of FV is quite variable and may reach as high as 46% ⁷. Quinlan et al. found the prevalence of duplicated superficial FV in 253 (31%) of extremities in their review of 404 bilateral (808 extremities) lower extremity venograms. Quinlan et al. also found that the duplicated vein started in the adductor region in only 80 extremities ⁷. Duplication of the FV was reported in 25% of investigated cases in a previous study ⁵. Liu et al detected multiple FV?s in 31% of  all the extremities ⁸. More recently, Sharma and Salwan reported a more or less similar type of case of duplication of the FV ⁹. Kerr et al. reported that duplication of the superficial FV is the most common anomaly of venous system in the lower extremities diagnosed by duplex scanning ¹⁰.

Dublication of the FV  is  not rare. But in our case, it is significant due to the existence of a connection branch. Double FV?s are important in the  researches of  the lower extremity venous network, particularly in the  deep vein transfer on the opposed extremity and the mapping of cardiovascular diseases. Furthermore, it is significant to refrain from incorrect diagnosis of DVT in the femoropopliteal veins.

References

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Information Presentation

7. International Symposium of Clinical and Applied Anatomy (ISCAA 2015), 17-20 Eylül 2015, Bratislava, SLOVAKYA