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Giacomini varicose veins originating from
the Popliteal Fossa
Stefano Ermini MD
Firenze
Giacomini varicose veins originating from the Popliteal Fossa
This pattern only occurs in the case of a contractive centri...
If the flow that originates from the popliteal fossa, passes through the
Giacomini vein and re-enters into the deep vein t...
Deepveins
LSV
Re-entry
point A
Re-entry
point B
SSV
Escape point
If a re-entry point is placed
below the escape point, a
c...
Deepveins
LSV
Re-entry
point A
Re-entry
point B
SSV
Escape point
Deepveins
LSV
Re-entry
point A
Re-entry
point B
SSV
Escap...
The siphon effect explains the presence of a relaxation centripetal flow in the Giacomini v.
The siphon effect occurs when...
Between January 2007 and January 2014, 50
Giacomini systolic shunts have been checked in a
group of 1669 Incompent GSV and...
Shunt Type 1 Shunt Type 2 Shunt Type 3
Escape Point Classification
SPJ Popliteal Perforator Gastrocnemious Perforator
34 c...
Systolic Flow
Diastolic Flow
Shunt Type A
Re-entry point disposition
classification
5 casi su 50
10%
Systolic Flow
Diastolic Flow
Shunt Type A + II
Without GVS involvement With GVS involvement
4 casi su 50
8%
Systolic Flow
Diastolic Flow
Shunt Type B
5 casi su 50
10%
= Perforator
Shunt Type B + II
Without GVS involvement With GVS involvement
Nessun caso osservato
Shunt Type C
8 casi su 50
16%
Shunt Type D
12 casi su 50
24%
Shunt Type E
Without GVS involvement With GVS involvement
31 casi su 50
62%
29 casi su 50
58%
With or Without Giacomini Systolic Flow Re-Entry Perforator
The perforator is situated
before the tributary origin :
3 cas...
With or Without Giacomini Systolic Flow Re-Entry Perforator
The perforator is situated after
the tributary origin : 7 case...
Strategy Treatment
Goals:
 To treat the escape point only when it is hemodynamically and anatomically
possible , or in al...
20 Surgical Treatments
15 strategies on the Giacomini v.
4 strategies on the GSV ( 2 shunt type B and 2 type E)
1 Flush li...
Disconnection of the Giacomini vein flush to the saphenous arc
(1 case)
Gastrocnemious
perforator
Surgical treatment
Shunt Type E = 11 cases
Shunt Type D = 2 cases
Shunt Type A = 2 cases
Hemodynamic effects of the Giacom...
The same surgical disconnection obtains different effects:
 In situation A the systolic flow is preserved
 In situation ...
Strategy on
Giacomini v
No perforator
before surgery
Systolic flow 1
week later
No Systolic flow
1 week later
GiacThrombos...
The worst thing that we can
do in a situation like this is to
destroy the saphenous trunk.
Thanks for your attention
Stefano Ermini M.D.
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GIACOMINI VARICOSE VEINS ORIGINATING FROM THE POPLITEAL FOSSA

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GIACOMINI VARICOSE VEINS ORIGINATING FROM THE POPLITEAL FOSSA

  1. 1. Giacomini varicose veins originating from the Popliteal Fossa Stefano Ermini MD Firenze
  2. 2. Giacomini varicose veins originating from the Popliteal Fossa 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
  3. 3. 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
  4. 4. Deepveins LSV Re-entry point A Re-entry point B SSV Escape point If a re-entry point is placed below the escape point, a centripetal flow also exists in the Giacomini vein during muscle relaxation.
  5. 5. Deepveins LSV Re-entry point A Re-entry point B SSV Escape point Deepveins LSV Re-entry point A Re-entry point B SSV Escape point Contraction Relaxation
  6. 6. 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 B The Siphon Effect Tank A Tank B
  7. 7. Between January 2007 and January 2014, 50 Giacomini systolic shunts have been checked in a group of 1669 Incompent GSV and 311 Incompetent SSV ( 2.5 % of all checked saphenous varicose veins)
  8. 8. Shunt Type 1 Shunt Type 2 Shunt Type 3 Escape Point Classification SPJ Popliteal Perforator Gastrocnemious Perforator 34 casi su 50 68% 14 casi su 50 28% 2 casi su 50 4%
  9. 9. Systolic Flow Diastolic Flow Shunt Type A Re-entry point disposition classification 5 casi su 50 10%
  10. 10. Systolic Flow Diastolic Flow Shunt Type A + II Without GVS involvement With GVS involvement 4 casi su 50 8%
  11. 11. Systolic Flow Diastolic Flow Shunt Type B 5 casi su 50 10%
  12. 12. = Perforator Shunt Type B + II Without GVS involvement With GVS involvement Nessun caso osservato
  13. 13. Shunt Type C 8 casi su 50 16%
  14. 14. Shunt Type D 12 casi su 50 24%
  15. 15. Shunt Type E Without GVS involvement With GVS involvement 31 casi su 50 62% 29 casi su 50 58%
  16. 16. With or Without Giacomini Systolic Flow Re-Entry Perforator The perforator is situated before the tributary origin : 3 cases 31 shunt type E 21 without perforator 10 with perforator 2 shunt type D 2 without perforator 0 with perforator Zero shunt with perforator observed
  17. 17. With or Without Giacomini Systolic Flow Re-Entry Perforator The perforator is situated after the tributary origin : 7 cases 31 shunt type E 21 without perforator 10 with perforator Zero shunt with perforator observed
  18. 18. Strategy Treatment 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. 20 Surgical Treatments 15 strategies on the Giacomini v. 4 strategies on the GSV ( 2 shunt type B and 2 type E) 1 Flush ligation of the Giacomini v. Surgery has been performed in 20 patients ( Follow up minimum 3 months , maximum 3 years)
  20. 20. Disconnection of the Giacomini vein flush to the saphenous arc (1 case) Gastrocnemious perforator
  21. 21. Surgical treatment Shunt Type E = 11 cases Shunt Type D = 2 cases Shunt Type A = 2 cases Hemodynamic effects of the Giacomini tributary disconnection are different depending on the presence or not of natural destination points of the systolic flow.
  22. 22. The same surgical disconnection obtains different effects:  In situation A the systolic flow is preserved  In situation B the systolic flow is NOT preserved A B
  23. 23. Strategy on Giacomini v No perforator before surgery Systolic flow 1 week later No Systolic flow 1 week later GiacThrombosis 1 week later 15 10 6 4 1 What happens when the systolic flow is interrupted by the tributary disconnection? Zero Deep vein thrombosis 2 recurrences ( new tributary originating from the Giacomini v.) in the first 12 months 2 recurrences = 10 % of the entire group 20% of the cases without systolic flow re-entry perforators
  24. 24. The worst thing that we can do in a situation like this is to destroy the saphenous trunk.
  25. 25. Thanks for your attention Stefano Ermini M.D.

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