ORIGINAL ARTICLE Assessment of posterior accessory great saphenous vein of the leg using ultrasonography: a preliminary study Ihsan Yuce 1 • Levent Oguzkurt 2 • Suat Eren 1 • Akin Levent 1 • Mecit Kantarci 1 • Ahmet Yalcin 3 • Alberto Caggiati 4 Received: 25 March 2015 / Accepted: 18 July 2015 Ó Springer-Verlag France 2015 Abstract Purpose To assess the frequency and anatomic distribu- tions of the posterior accessory great saphenous vein of the leg (PAGSVL) and its insufficiency rate using ultra- sonography (US) in patients who presented with clinical, etiologic, anatomic, and pathophysiologic (CEAP) scores of 1 and above. Methods A prospective US study on 200 limbs of 100 consecutive patients with CEAP scores of 1 and above. Results Right PAGSVL was seen in 45 % (45 cases), whereas left PAGSVL was seen in 54 % (54 cases) of the patients [49.5 % (99 limbs) in total] (p \ 0.05). PAGSVL insufficiency was present in 6 % (6 cases) of the patients [6 limbs in total (6.06 %)]. The type of PAGSVL joining to the great saphenous vein (GSV) was above the knee level in 4 % (4 limbs), at the knee level in 14 % (14 limbs), and below the knee level in 74 % of patients (74 limbs). The relationship between posterior tibial perforators and PAGSVL was seen in 3.03 % of cases (3 limbs). There was no statistically significant relationship between PAGSVL insufficiency and the presence of posterior tibial perfora- tors (p = 0.55) or between the presence of PAGSVL and the GSV insufficiency. Conclusion PAGSVL was seen in half of the limbs with CEAP scores of 1 and above. The frequency of PAGSVL was more common in the left limbs than the right limbs. There was no statistically significant relationship between the presence of PAGSVL, GSV insufficiency, and different CEAP scores. The PAGSVL often joined to the GVS below the knee, but could also join above the knee. Keywords Posterior accessory great saphenous vein Á Ultrasonography Á Insufficiency Introduction The great saphenous vein (GSV) takes its origin from the medial marginal vein of the foot and ends at the saphe- nofemoral junction. The GSV is located between situated muscular fascia and saphenous fascia. The space is called the ‘saphenous compartment’, which goes from the thigh to the leg [2]. Tributary veins to the GSV are defined as veins that run obliquely or beside the tract of the associated saphenous vein, but these are not situated within the saphenous compartment [4]. The term posterior accessory great saphenous vein (PAGSV) indicates any venous seg- ment that ascends parallel to the GSV and is located pos- teriorly in both the leg and the thigh [2, 13]. PAGSVL corresponds to the so-called Leonardo’s vein (about new nomenclature, see article [2, 10]) present in 27 % of cases [1]. PAGSVL begins behind the medial malleolus and joins the GSV just distal to the knee. This vessel is very important due to its connection to the ‘posterior tibial perforators’, which then empties into the posterior tibial veins [9]. The purpose of this study is to assess the fre- quency, anatomic distribution, and insufficiency of the PAGSVL using US. & Ihsan Yuce drihsany@gmail.com 1 Department of Radiology, School of Medicine, Ataturk University, Erzurum, Turkey 2 Department of Interventional Radiology, Medical Park Hospital, Istanbul, Turkey 3 Department of Radiology, Regional Training and Research Hospital, Erzurum, Turkey 4 Department of Anatomy, University of Rome ‘‘La Sapienza’’, Rome, Italy 123 Surg Radiol Anat DOI 10.1007/s00276-015-1523-7