ORIGINAL ARTICLE The ‘‘T’’ Vein of the Leg P. ZAMBONI , MD, M. D E PALMA , MD, S. C ARANDINA , MD, L. F OGATO , MD, P. F ORTINI , MD, A. L EGNARO , MD, P. M AZZA , MD, AND S. R ICCI , MD Department of Surgery, University of Ferrara–Day Surgery Unit, Master in Compression Therapy and Wound He St. Anna Hospital, Ferrara, Italy BACKGROUND. We frequentlyobservea tributary of the saphenous vein with the origin in the saphenous compartment of the medialaspectof the upperthird of the leg.It runs transversally in the interfascial compartment toward the lateral aspect of the leg. Constantly it feeds by reflux varicose veins clinically visible in the paratibial region and/or in the lateral aspect of the leg. For the peculiarity of its anatomical shape as well as duplex appearance, we defined it as the ‘‘T’’ vein. OBJECTIVES. To assess how frequently the ‘‘T’’ vein of the leg is involved in varicose networks. METHODS. A total of 218 consecutivepatientsaffected by primary varicose veins have been evaluated by the means of duplex scanning. We assessed both the presence of the above- mentioned tributary and the frequency of its hemodynamic involvement in the varicose network. RESULTS. In 15 of 218 cases (7%) we demonstrated the above- mentioned tributary with an interfascial length ranging betwee 5 and 12 cm involved in varicose networks. CONCLUSIONS. The anterior tributary of the saphenous vein of the anterolateral aspect of the leg is a neglected clinical entity whose existence is importantto know for the treatment of varicose veins of the lateral aspect of the leg. P. ZAMBONI, MD, M. DE PALMA, MD, S. CARANDINA, MD, L. FOGATO, MD, P. FORTINI, MD, A. LEGNARO, MD, P. MAZZA, MD, AND S. RICCI, MD HAVE INDICATED NO SIGNIFICANT INTEREST WITH COMMERCIAL SUPPORTERS. A RECENT interdisciplinary anatomicalconsensus defined the saphenous compartment as an interfascial compartment encircling the saphenous veins in the lower extremities,even containingthe saphenous nerve. 1 Consequently, owing to such an anatomical relationship between thesaphenousvein and the fascia,high-resolution B-mode investigation leads, in the transversal access, to a peculiar image defined in literatureas the ‘‘saphenouseye’’ image. 2,3 The saphenous eye is constantly obtainable in the trans- versalduplex access of the medial aspect both of the thigh and of the leg for the great saphenous vein, as well as in the posterior aspect for the short saphenous vein. The image is due to the ultrasonic combination of the black ellipse of the saphenous vein encircled by the fascia 2–14 (Figure 1). Furthermore, a never-described interfascial tributary of the great saphenous vein has been frequently observed by our group by the means of the color-flow duplex scanning (Technos 7.5/10-MHz probe, Esaote,Genoa, Italy). Such a vein is situated in the upper third of the medial aspect of the leg. It runs transversally along the interfascial compartment and often transfers a great saphenousvein reflux in an anterolateral direction, overcomingthe tibia, and usually appearson the cutaneoussurfaceat this level through a varicose cluster. The aim of this study was therefore to define the anatomic and the hemodynamic details of this vein, to assesshow frequently it is involved in varicose networks,and finally,to describe the surgical treat- mentto be used,in a perspective ofa conservative sparing great saphenous vein surgery. Methods and Materials We performed 218 consecutive preoperative duplex venous mappings in patients (72 men, 146 women) aged between23 and 81 (averageage 53). We employed an Esaote Technos scanner with a 7.5/10- MHz probe. Patients signed an informed consent and the study conformed to the 1975 Declaration of Helsinki. Patients were examined in standing position accord ing to a methodology previously described. 11–13 In addition to the preoperative mapping purposes, we investigatedthe presenceof the above-described interfascial tributary and described the hemodynamic patterns 11–13 when it was involved in a varicose network (Figure 2). We considered a positive investi- gation when the interfasciallength of the great saphenous vein tributary was at least 5 cm. r 2004 by the American Society for Dermatologic Surgery, Inc. Published by Blackwell Publishing, Inc. ISSN:1076-0512/04/$15.00/0 Dermatol Surg 2004;30:750–753 Address correspondence and reprint requests to: Paolo Zamboni, MD, Program Director, Department of Surgery, University of Ferrara, 44100 Ferrara, Italy, or e-mail: zmp@unife.it.