Variations in Lower Limb Venous Anatomy: Implications for US Diagnosis of Deep Vein Thrombosis

Abstract

To retrospectively review bilateral venograms free of thrombus to evaluate the frequency and types of variations seen in venous anatomy. A retrospective review of 404 bilateral (808 limbs) lower limb venograms obtained from medical patients participating in a thromboprophylaxis clinical trial and found to be free of thrombus was performed. Venograms were evaluated according to predetermined criteria for the presence of duplication of vessels and inter- and intraindividual variations in venous anatomy. Variations were assessed with analysis of variance and chi2 tests. Two vessels were seen in the popliteal fossa on 337 (42%) of 808 venograms, and 41 (5%) were true duplicated popliteal veins. There were 253 (31%) duplicated superficial femoral veins (SFVs), with 12 (1.5%) being complex duplicated systems. Of 265 duplicated SFVs, 138 (52%) began in the midthigh region and 80 (30%), in the adductor canal region. The duplicated vessel was medial to the main SFV in 122 (46%), lateral in 131 (49%), and both (ie, triplications) in 12 (4.5%). The length of the duplicated SFV ranged from 1 to 35 cm; 6-15 cm was the most common length in 162 (62%) SFVs. There was no significant association between the incidence of anatomic variations and age or sex (P >.1). The presence of multiple vessels in one leg was strongly correlated with the probability of occurrence in the other leg (P <.001). Variations in lower limb venous anatomy are common and have important implications for the US diagnosis of deep vein thrombosis.