Treatment of incompetent vein of Giacomini (thigh extension branch)

Most varices secondary to truncal insufficiency arise from the greater saphenous vein (GSV), short saphenous vein (SSV), or accessory saphenous branch. However, an important etiology for varices that arise on the posterior thigh or calf is often overlooked. The thigh extension (TE) branch, also known as the vein of Giacomini in many patients, may also contribute to venous pathology. Patients were assigned to one of three categories depending on the anatomical findings. All patients were treated with a combination of endovenous ablation using a 940 nm Skin Pulse S laser and foam sclerotherapy. Eighteen patients were treated and followed for at least 2 years. There were no complications. All patients had successful ablation of the TE branch with successful obliteration of any perforators or collateral vessels. Varices secondary to TE branch insufficiency are common when coexisting SSV insufficiency is present. The incidence increases when both SSV insufficiency and GSV insufficiency exist. This study groups the pattern of TE branch pathology into three anatomical patterns. Combination therapy based on the prevalent anatomical group being treated was done. There was successful ablation in all groups with no complications. As experience in venous disease and expertise by the surgeon increases, more examples of this pattern of pathology will become evident.