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| ORIGINAL ARTICLE |
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| Year : 2021 | Volume
: 8
| Issue : 1 | Page : 55-57 |
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Anatomical variations of the saphenous fascia in the omani population
Sara Samir Hamed Al-Adawi, Ahmed Al-Aufi, Edwin Stephen, Ibrahim Abdelhady, Hanan Al-Mawali, Khalifa Al-Wahaibi
Department of Surgery, Division of Vascular Surgery, Sultan Qaboos University Hospital, Seeb, Oman
| Date of Submission | 27-Apr-2020 |
| Date of Acceptance | 05-May-2020 |
| Date of Web Publication | 20-Feb-2021 |
Correspondence Address:
Edwin Stephen
Department of Surgery, Division of Vascular Surgery, Sultan Qaboos University Hospital, Seeb
Oman
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijves.ijves_47_20
Objectives: The aim of this study is to detect the anatomical variations of the saphenous fascia (SF) around the great saphenous vein (GSV) in the Omani population and compare it to published studies in other populations. The extent of the SF has been documented to vary between certain populations. There are no such studies from the Arabian Gulf population. Methods: Following ethical approval, bilateral lower limbs of 100 consecutive consenting volunteers at our tertiary care university hospital were scanned using an ultrasound scan. The GSV was traced from the groin to ankle, and the point of exit from the SF was noted. Results: The results showed that the majority of the Omani population had a SF ending at the upper thigh (39.5%). The next most common location was at the mid-thigh (26.5%). Conclusions: This study found that the course of the GSV within the SF can differ between populations. This has important implications in the pathophysiology and endovenous treatment options offered to Omani patients seeking treatment for varicose veins.
Keywords: Egyptian eye, saphenous eye, endovenous, varicose, Oman, Middle East, saphenous fascia, the great saphenous vein
How to cite this article:
Al-Adawi SS, Al-Aufi A, Stephen E, Abdelhady I, Al-Mawali H, Al-Wahaibi K. Anatomical variations of the saphenous fascia in the omani population. Indian J Vasc Endovasc Surg 2021;8:55-7 |
How to cite this URL:
Al-Adawi SS, Al-Aufi A, Stephen E, Abdelhady I, Al-Mawali H, Al-Wahaibi K. Anatomical variations of the saphenous fascia in the omani population. Indian J Vasc Endovasc Surg [serial online] 2021 [cited 2021 Feb 25];8:55-7. Available from: https://www.indjvascsurg.org/text.asp?2021/8/1/55/309714 |
| Introduction | |  |
Anatomical variations of the venous system are more common compared to the arterial system.[1] While the anatomy of the great saphenous vein (GSV) has been well documented, the saphenous fascia (SF) in comparison is less known. It is said to be derived from the deep fascia of the leg, and covers the GSV for variable lengths.[2] This fascia can be seen on ultrasound, and its appearance is referred to as the “saphenous eye” (SE) or “Egyptian eye,” and has been used to identify the GSV by radiographers, radiologists, and vascular surgeons.[1] In this study, the extent of this fascia was assessed in 100 healthy Omani participants. Although the exact role of the SF is not yet clear, it could have hypothetical implications on the pathophysiology of venous insufficiency and its treatment, particularly endovascular techniques.
| Methods | | |
The descriptive study was approved by the Medical Research Ethical Committee at the Sultan Qaboos University, College of Medicine and Health Sciences. Written consent was obtained from all participants. It included 100 consecutive healthy Omani volunteers above the age of 18 from the outpatient department at the Sultan Qaboos University Hospital in Oman. Pregnant women; amputees; and those with lower limb injuries, skin lesions, or previous surgeries were excluded from the study.
The volunteers underwent a venous duplex, using a GE Healthcare Medical Systems Logiq (™) ultrasound (Chicago, Illinois) 12 MHz linear probe at seven points: (1) groin; (2) upper thigh; (3) mid-thigh; (4) above knee; (5) below knee; (6) mid-calf; (7) and ankle. The presence of the “saphenous eye” was identified at these seven levels. The volunteers' sex, age, height, weight, groin-to-ankle length, and site where the GSV exits the SF were recorded.
| Results | | |
A total of 100 Omani volunteers (200 limbs) underwent duplex ultrasound scanning of their bilateral lower limbs. Seventy-seven participants were male, while 23 were female. The SF ended most commonly at the upper thigh, with 79 participants (39.5%). The next most common location was the mid-thigh (53, 26.5%), followed by above knee (37, 18.5%). The most distal SF was identified at the mid-leg in 3 (1.5%) participants. None of the participants' fascia extended to the ankle. In four participants (0.2%), the fascia could only be seen at the groin. In ten participants, the level at which the GSV exited the fascia differed between the right and left limbs. The results are summarized in [Table 1]. | Table 1: Results of screening for the sonographic findings of the saphenous fascia around the great saphenous vein at different locations of the lower limb
Click here to view |
| Discussion | | |
The SF was first described by Papadopolous to form a saphenous canal that enclosed the GSV, present in 85% of the thirty cadavers that were examined,[2] and was said to extend from the inguinal ligament to the ankle.[3] This fascia can be identified on ultrasound by the characteristic findings of the “Egyptian eye,” which helps the sonographer distinguish the GSV from tributaries.[1]
In 2015, Samuel and Stephen found that in 72% of Indian participants, the SF extended below the knee, while ending at the mid or distal thigh in 28%.[4]
The current study is a first of its kind in the Middle-East region, where the anatomical variation of the SF is described in Omanis. The results demonstrate that in Omanis, the SF most commonly ends at the upper thigh, and in ten participants, this length differed between the right and left limbs.
The first implication of the results is to explore the relationship between the SF and varicose veins [Figure 1] or chronic venous insufficiency. The SF is thought to aid in the movement of blood up the leg.[3] It can, therefore, be theorized that when the GSV exits the fascia more proximally in the lower limb, the more likely it is to develop dilatation of its walls.
Second is to understand that the SE cannot be used to identify the GSV along the entire limb in populations where the GSV tends to leave the fascia earlier. This has important implications for sonographers, phlebologists, and vascular surgeons.
Finally, in the era of endovenous management of varicose veins, procedures such as laser, radiofrequency, glue, and mechanochemical ablation have become more popular to use. These have documented complications such as hyperpigmentation and pain [Figure 2].[5] Whether the relationship of the GSV to the fascia affects the incidence of such complications should be considered. | Figure 2: Hyperpigmentation after mechanochemical ablation of varicose veins
Click here to view |
This study is not without its limitations. The sample size is small, and there was a discrepancy between the number of females and males.
| Conclusions | | |
While anatomical variations in the saphenous vein have been documented, very little has been studied about its fascia. The characteristic finding of the “Egyptian eye” or “saphenous eye” may not be found along the entire length of the limb in certain populations. In our study, the majority of Omanis were found to have a GSV that exits the fascia at the upper and mid-thigh, knowledge of which should be considered when offering treatment of superficial venous insufficiency.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Chen SS, Prasad SK. Long saphenous vein and its anatomical variations. Australas J Ultrasound Med 2009;12:28-31.  |
| 2. | Papadopoulos NJ, Sherif M?F, Albert EN. A fascial canal for the great saphenous vein: Gross and microanatomical observations. J Anat 1981;132:321-9. |
| 3. | Caggiati A. Fascial relationships of the long saphenous vein. Circulation 1999;100:2547-9. |
| 4. | Samuel V, Stephen E. Anatomical variations of the saphenous fascia in the Indian Population. J Vascular Surg 2015;61:83S. |
| 5. | Holewijn S, van Eekeren RR, Vahl A, de Vries JP, Reijnen MM; MARADONA study group. Two-year results of a multicenter randomized controlled trial comparing Mechanochemical endovenous Ablation to RADiOfrequeNcy Ablation in the treatment of primary great saphenous vein incompetence (MARADONA trial). J Vasc Surg Venous Lymphat Disord 2019;7:364-74. |
[Figure 1], [Figure 2]
[Table 1]
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