Therapeutic procedures for Giacomini anastomosis.

Therapeutic modalities of the Giacomini anastomosis.

Giacomini’s vein is a venous anastomosis between the great saphenous vein (GSV) and the lesser saphenous vein (LSV). It extends from the PVS on the posterior aspect of the thigh and travels medially to join the posterior circumflex vein of the thigh before draining into the GVS. It was first described by Giacomini in 1873 and is present in 2.5 to 86% of the population [1]. It is thought to be involved in varicose disease in only 5% of cases in a series of 212 members [2]. However, the identification of the incontinent LV and its reflux pattern is crucial. Indeed, treatment focused only on GVS and PVS, which often leads to the removal of healthy veins, would not always be effective. On the other hand, the anatomical variability of the Giacomini vein and its difficult and non-consensual exploration leads the practitioner to misunderstand it and underestimate its involvement in the origin of varicose veins. Thus, we perceive the appearance of other therapeutic methods, based on the knowledge of the singular physiopathology of the venous insufficiency of the Giacomini anastomosis, all the more so as its distal location, in the saphenous compartment, satellite of the posterior femoral-cutaneous nerve of the thigh, also requires other therapeutic constraints. Currently, there is no clear therapeutic consensus on venous insufficiency related to Giacomini insufficiency. Thus, we have chosen to review the different articles that deal with the therapeutic indications of Giacomini insufficiency, with the objective of identifying a simple diagram, which takes into consideration the anatomical, hemodynamic and pathophysiological singularity of this vein.