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Hemodynamic Assessment and Strategy
Treatment of Giacomini Varicose Veins

Stefano Ermini M.D.
Florence
Giacomini Vein
It is an N2 vein, like the LSV and the SSV
It is a transversal vein that goes from the SPJ to the SFJ and d...
Valve Orientation in the Giacomini Vein
Origin from an escape point placed above

Flow in the Giacomini vein occurs
during the relaxation phase of the
muscle pump
Origin from an escape point placed above

The varicose vein can originate from the Giacomini above or
below the perineal i...
By the interposition of the Giacomini v. , the
perineal reflux can give origin to GSV varicose
veins

In relation to the r...
Pelvic escape point

Giacomini Vein

Visible varicose Veins
Pelvic escape point

Giacomini Vein

Gluteal perforator
Deep veins

LSV

SSV
Giacomini varicose veins originate from an escape point placed below
This pattern only occurs in the case of a contractive...
If the flow that originates from the popliteal fossa, passes through
the Giacomini vein and re-enters into the deep vein t...
Re-entry
point A

Deep veins

If a re-entry point is placed
below the escape point, a
centripetal flow also exists
in the ...
Contraction

Relaxation

Deep veins

Re-entry
point A

Deep veins

Re-entry
point A

Escape
point

Escape
point

LSV

LSV
...
The Siphon Effect
The siphon effect explains the presence of a relaxation centripetal flow in the
Giacomini v. The siphon ...
Hemodynamic patterns of relaxation centrifugal flow

= Perforator
Strategy treatment
Pelvic escape point

Risk of escape point
recurrence for anatomical
reasons

Popliteal fossa escape poi...
Strategy treatment of Giacomini varicose veins originating from a
perineal escape point
Goals:
 To reduce the centrifugal...
Strategy treatment of Giacomini varicose veins originating from
the popliteal fossa
Goals:
 To treat the escape point onl...
The tributary disconnection leads to:
1) The maintenance of the contractive centripetal flow
in the SFJ

or in

in a Giaco...
Giacomini varicose veins, hemodynamic patterns and strategy terapy
Giacomini varicose veins, hemodynamic patterns and strategy terapy
Giacomini varicose veins, hemodynamic patterns and strategy terapy
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Giacomini varicose veins, hemodynamic patterns and strategy terapy

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Describes all venous hemodynamics patterns of Giacomini varicose veins and introduces the principles of hemodynamic treatment. Clearly explains that no classical demolitive treatment is possible in these situations.

Giacomini varicose veins, hemodynamic patterns and strategy terapy

  1. 1. Hemodynamic Assessment and Strategy Treatment of Giacomini Varicose Veins Stefano Ermini M.D. Florence
  2. 2. Giacomini Vein It is an N2 vein, like the LSV and the SSV It is a transversal vein that goes from the SPJ to the SFJ and drains the perineal veins
  3. 3. Valve Orientation in the Giacomini Vein
  4. 4. Origin from an escape point placed above Flow in the Giacomini vein occurs during the relaxation phase of the muscle pump
  5. 5. Origin from an escape point placed above The varicose vein can originate from the Giacomini above or below the perineal intersection
  6. 6. By the interposition of the Giacomini v. , the perineal reflux can give origin to GSV varicose veins In relation to the re-entry point disposition different patterns are possible
  7. 7. Pelvic escape point Giacomini Vein Visible varicose Veins
  8. 8. Pelvic escape point Giacomini Vein Gluteal perforator
  9. 9. Deep veins LSV SSV
  10. 10. Giacomini varicose veins originate from an escape point placed below This pattern only occurs in the case of a contractive centripetal flow in the popliteal fossa , in absence of deep vein obstruction Various hemodynamic patterns and the presence or not of varicose veins are possible in relation to the re-entry point’s disposition
  11. 11. If the flow that originates from the popliteal fossa, passes through the Giacomini vein and re-enters into the deep vein through the SFJ , the patient is completely asymptomatic and no varicose vein is visible In this situation the re-entry point is placed above the escape point and the flow goes upwards into the Giacomini vein thanks to an hypertensive pressure gradient
  12. 12. Re-entry point A Deep veins If a re-entry point is placed below the escape point, a centripetal flow also exists in the Giacomini vein during muscle relaxation. Escape point LSV SSV Re-entry point B
  13. 13. Contraction Relaxation Deep veins Re-entry point A Deep veins Re-entry point A Escape point Escape point LSV LSV SSV Re-entry point B SSV Re-entry point B
  14. 14. The Siphon Effect The siphon effect explains the presence of a relaxation centripetal flow in the Giacomini v. The siphon effect occurs when a tube in an inverted U shape causes a liquid to flow upwards, above the surface of the reservoir, without pumps, powered by the fall of the liquid as it flows down the tube under the pull of gravity, and discharges at a level lower than the surface of the reservoire it comes from ( http://en.wikipedia.org/wiki/Siphon ).The real siphon effect works in a open circuit. In the venous system the circuit is closed and the effect of gravity’s potential energy is charged by muscle pump activity. Tank A Tank A Tank B Tank B
  15. 15. Hemodynamic patterns of relaxation centrifugal flow = Perforator
  16. 16. Strategy treatment Pelvic escape point Risk of escape point recurrence for anatomical reasons Popliteal fossa escape point Impossibility to perform an efficient treatment of an escape point submitted to the pressure of the muscle pump and with anatomical difficulties Common solution Preservation of the N2 Network to drain the pathogenic flow directly in the deep system using the N2 perforators
  17. 17. Strategy treatment of Giacomini varicose veins originating from a perineal escape point Goals:  To reduce the centrifugal flow rate treating the escape point  To preserve all N2 systems, competent or incompetent, to avoid varicose vein recurrence in case of escape point treatment failure.  To reach a good cosmetic and functional result 1 2 1 = escape point treatment 2 = tributary disconnection
  18. 18. Strategy treatment of Giacomini varicose veins originating from the popliteal fossa Goals:  To treat the escape point only when it is hemodynamically and anatomically possible , or in alternative  To preserve the contractive centripetal flow in the Giacomini, draining it directly into the deep system  To only treat the vicious recirculation ( private circulation) that originates during relaxation without interrupting the contractive centripetal flow  To reach a good cosmetic and functional result
  19. 19. The tributary disconnection leads to: 1) The maintenance of the contractive centripetal flow in the SFJ or in in a Giacomini perforator 2) The interruption of the vicious recirculation (venous shunt)

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