The saphenous veins are located in the leg and ensure the return of venous blood. These two veins of the lower limb have the function of ensuring the circulation of the blood flow in one direction, in an ascending path which must fight against gravity. 

The main pathology that affects these veins is the appearance of varicose veins. However, treatments exist, surgical treatment is also possible.

The great saphenous vein and the small saphenous vein are part of the so-called peripheral venous network. It is thanks to the venous valves that the blood manages to circulate only in one direction: towards the heart.

The term is etymologically derived from the Arabic safina, saphenous, itself probably derived from a Greek term meaning “visible, apparent”. Thus, the two large longitudinal venous blood collectors located in the leg are made up of:

• the great saphenous vein (also called the internal saphenous vein);
• the small saphenous vein (also called the external saphenous vein). 

Both are part of the superficial venous network. The great saphenous vein therefore goes up to the groin, to join the deep network. As for the small saphenous vein, it also flows into the deep network, but behind the knee.

Two networks constitute, in fact, the veins of the lower limb: one is deep, the other superficial, and both are anastomosed to each other at several levels. In addition, these veins of the lower limb are provided with valves. The valves are membranous folds inside a canal, here the vein, which prevent the backflow of liquid.

The physiological function of the saphenous veins is to bring the venous blood flow from the bottom to the top of the body, so that it can then reach the heart. The great saphenous vein and the lesser saphenous vein are involved in the blood circulation. 

The blood path is ascending at the level of the two saphenous veins: it must therefore fight against the effect of gravity. The venous valves thus force the blood to flow in only one direction: towards the heart. The function of the valves is therefore to split the blood flow in the vein, and thus ensure a one-way circulation. 

The major pathologies that can affect the internal and external saphenous veins are varicose veins. In fact, these anomalies affect, in the majority of cases, these two superficial veins which go up along the leg. Varicose veins are caused by leaking venous valves.

What are varicose veins? 

When the venous valves of the saphenous veins leak, this causes dilation of the veins, which then become tortuous: they are called varicose veins, or varicose veins. Varicose veins can occur anywhere in the body. But in fact, they mainly affect the superficial veins of the lower limbs (they are also more frequent also in the esophagus and the anal canal).

Varicose veins of the saphenous veins can cause a simple cosmetic inconvenience, or cause serious medical problems. When the valves leak, blood therefore flows back from the deep veins to the superficial veins, which perform less well and blood accumulates there. 

The causes of valve insufficiency can be as follows:

• a congenital origin;
• mechanical stress (prolonged standing or pregnancy), certain professions are more at risk (for example hairdressers or salespeople);
• aging.

There are several types of treatments to treat varicose veins of the saphenous veins:

• Compression stockings: wearing varicose veins (or compression stockings) is sometimes suggested for patients with mild symptoms, or for whom other treatments are not recommended;
• Sclerosis: it is carried out by injecting varicose veins with a solution that causes inflammation with a blood clot. When the area heals, it then forms a scar which will block the vein;
• Radiofrequency: endovenous occlusion by radiofrequency consists in using the energy of radiofrequencies in order to heat the varicose veins and to close them;
• Laser: laser occlusion consists of using this laser to close the veins;
• Stripping: this is a surgical operation. It involves inserting a flexible rod into the varicose vein, then removing it by removing the vein. It therefore aims to directly remove varicose veins, as well as diseased peripheral veins.

Chronic venous insufficiency affects between 11 and 24% of the population in industrialized countries against only 5% in Africa and 1% in India. In addition, it should be noted that it affects three women for one man. The patient generally consults his general practitioner, because of a functional symptom, an aesthetic desire or a varicose vein, more rarely an edema. In fact, it turns out that 70% of patients who consult for the first time on the grounds of venous insufficiency first suffer from heaviness in their legs (according to a French study carried out on more than 3 patients on average aged 500 years).

A precise medical examination

This questioning will make it possible to find out in the patient his possible treatments, allergies, his medical history and especially surgical, or fractures and plasters, and finally the history of thromboembolic disease, in him or in his family.

In addition, the general practitioner will assess the risk factors for superficial venous insufficiency, including:

• heredity;
• age;
• gender;
• the number of pregnancies for a woman;
• weight and height;
• physical inactivity ;
• physical activity.

The in-depth clinical examination

It consists of observing the patient who is standing on a phlebology stepladder. His lower limbs are bare to the groin, without bandage or restraint.

How is the exam going ?

The examination is done from the bottom up, from the toes to the waist, one limb after another in muscle relaxation. The patient should turn around. This examination is then continued with the patient lying down, this time on the examination table (the lighting must be of good quality). It is indeed necessary to visualize the vessels. The observation is insistent at the top of the leg and at the bottom of the thigh because the first visible varicose veins are, for the most part, present first at the level of the knee. Then an ultrasound may be deemed necessary.

It is also necessary that the doctor be aware that it is advisable, in front of important varicose veins, to look for risk factors for the appearance of a venous ulcer.

These risk factors are:

• obesity;
• limited ankle dorsiflexion;
• the tobacco ;
• an episode of deep vein thrombosis;
• a corona phlebectatica (or dilation of the small subcutaneous veins on the inner edge of the foot);
• a change in the skin of the leg (such as the presence of eczema).

The history of blood circulation owes a lot to the XNUMXth century scientist^e century William Harvey, who indeed discovered and described it. But, like any scientific discovery, it is based on knowledge acquired, questioned, accumulated over the ages.

The very first representation discovered of the heart is thus a rock painting dating from the Magdalenian era (approximately – 18 to – 000 years BC), in the cave of El Pindal (Asturias): indeed, the heart is there. painted on a mammoth like a red patch in the shape of a playing card heart. Years later, the Assyrians will attribute intelligence and memory to the heart. Then, in 12 BC, in ancient Egypt, the pulse was common. The heart is then described as the center of the vessels.

Hippocrates (460 – 377 BC) correctly described the heart. His physiological conception was, however, wrong: for him, the atria attract air, the right ventricle pushes blood into the pulmonary artery to nourish the lung, the left ventricle contains only air. After several successive theories, it will be necessary to wait for the XVI^e century, in Italy, for André Césalpin to be the first to recognize the blood circuit. Until that time, blood movement was thought of as ebb and flow. It is Césalpin who theorizes the concept of circulation, of which he is moreover the first to use the term.

Finally, William Harvey (1578-1657) and his work Anatomical study of the movement of the heart and blood in animals will revolutionize the theory of blood circulation. Thus, he writes: “Wherever there is blood, its course always remains the same, either in the veins or in the arteries. From the arterioles, the fluid passes into the veinlets of the parenchyma, and the strength of the heart is sufficient to effect this transition.»

In addition, Harvey demonstrates that the valves of the veins have the function of facilitating the return of blood to the heart. This revolutionary theory is opposed to fierce opponents. However, Louis XIV succeeded in imposing it in particular through the intermediary of his surgeon Dionis.