Anatomic Dissection of the Femoral Vein at the Bamako Anatomy Laboratory

Objectives: The purpose of this work was to measure the dimensions of the femoral veins, to describe the affluent and the variations of the femoral veins. Methodology: Twenty-four femoral veins of 12 fresh adult cadavers were dissected and photographed. Results: The diameter of the superficial, deep and common femoral veins was respectively 8.75 mm; 7.60 mm and 13.95 mm. The common femoral vein was 80.70 mm long. At the level of the superficial vein, the modal disposition was noted in 79.17%; as anatomical variations, it was split in 2 cases, the presence of a collateral canal in 1 case and in 2, and it received a quadricipital muscle vein. At the level of the deep femoral vein, the modal disposition was noted in 16.67%, and the anatomical variations were noted in 83.33% where it received no affluent in the femoral trine. The modal disposition was noted in 91.67% at the level of the mode of birth of the common femoral vein, in 16.67% at the level of its tributaries. The anatomical variations were noted in 8.33% in the mode of birth of the femoral vein, in 83.33% in which the common femoral vein received, in addition to the large saphenous vein, other tributaries, the most frequent of which were the quadricipital veins and the circumflex femoral veins. Conclusion: The diameter of the femoral veins is important. The main tributaries of the common femoral vein are GVS, VQ and circumflex femoral veins. The femoral variations are numerous and important to know to avoid a possible misdiagnosis in case of their thrombosis.


Introduction
The femoral veins are 3 in number: the superficial, deep and common femoral veins [1]. The first two will unite to form the last one that ends below the inguinal ligament, continuing through the external iliac vein. They drain almost all the veins of the pelvic limb. Many authors [2] [3] [4] [5] do not distinguish the common femoral vein from the superficial femoral vein. According to these authors, the femoral vein has a main trunk that follows the popliteal vein and ends below the inguinal ligament, continuing through the external iliac vein, and in this case the deep femoral vein is considered a tributary of the femoral vein. In this study, the femoral veins were described as follows: the superficial vein unites with the deep femoral vein to form the common femoral vein.
The non-realization of an anatomic dissection study on the femoral veins; the frequency of their lesion in the trauma of the groin; the frequency of the localization of thrombosis at their level, the realization of the catheterization of the femoral vein in the femoral trigone for various examinations, in particular, a blood sample and the recording of the blood pressure in the cavities of the right heart and/or in the pulmonary artery, or angiography of the right heart, led us to undertake their study with the general objective of to study them by anatomic dissection. The specific objectives were to measure their dimensions, look for their tributaries and describe their anatomical variations.

Methodology
This was a prospective study carried out in the Anatomy Laboratory of the Faculty of Medicine and Ondoto-Stomatology (FMOS) of Bamako from July 26, 2018 to June 11, 2019. We dissected the femoral veins at Femoral trine level on both sides of 12 cadavers of adults, making a total of 24 femoral veins including 18 in men and 6 in women. The inclusion criteria were: fresh corpses of adults with no operative scar or traces of trauma in the inguinal regions. The exclusion criteria were: corpses with scars or traces of trauma in the inguinal regions. The approach was inguinal. For this, a cutaneous incision was made from the anterior superior iliac spine to the superior medial edge of the thigh passing through the pubic spine. A second incision started from the middle of the first until the junction of the upper 1/3 and 2/3 inferior of the anterior aspect of the thigh. A transverse incision was made from the lower end of the second incision. Thus, three skin flaps were dissected and folded inside, outside and above. The subcutaneous tissue was dissected for the large saphenous vein (LSV) that was dissected until it entered the common femoral vein. The screened fascia was detached, the vascular sheath was opened, the femoral vein was separated from the femoral artery. The femoral arteries and veins were dissected to the top of the femoral trine. The tributaries of the femoral veins have been dissected to the point of failure between the muscles. After these dissections, the measurements were made using a tape measure. The femoral veins were photographed before and after resection. The data was entered and analyzed on the Epi info software.

B. Ba et al. Forensic Medicine and Anatomy Research
The writing of the final document was done on Word 2016.

Results
Socio-demographic characteristics of cadaveric subjects: The distribution of anatomical subjects by sex is summarized in Table 1. The distribution of anatomical subjects by size is summarized in Table 2.

Superficial Femoral Vein (SFV)
The diameter of the superficial femoral vein was 8.75 mm (range: 6 and 11). Of the 24 dissections, the classical modal arrangement (the superficial femoral vein did not receive any affluent) was noted in 19 cases, i.e. 79.17%. The anatomical variations were noted in 5 cases, namely 20.83%: the femoral vein was split in 2 cases and the 2 trunks joined together forming a common trunk before it joined the deep femoral vein to form the common femoral vein; it was accompanied by a collateral canal which united with the superficial femoral vein before it joined the deep femur in 1 case ( Figure 4, left side); and in two cases she received as a tributary a muscular vein of the quadriceps.

Deep Femoral Vein
The diameter of the deep femoral vein (DFV) was 7.60 mm (range: 2 and 13) The modal arrangement (circumflex femoral veins and quadriceps veins were tributaries of the deep femoral vein) was noted in 4 cases, i.e. 16.67%. The anatomical variations noted were the absence of tributaries in the deep femoral vein in 20 cases (83.33%).

Common Femoral Vein
Dimensions: The common femoral vein had a mean diameter of 13.95 mm (range: 11 and 17 mm). Its average length was 80.70 mm (extremes: 16 and 116 mm). Total 12 100 In our study, we performed 24 dissections in 12 cadavers (9 men and 3 women).  Affluent: The common femoral vein received tributaries in the proportions indicated in Table 3. In our study, we observed that the MCVT, just after release between the pectin and psoas muscles, threw itself into the posterior aspect of the femoral vein Table 3. Tributaries of the common femoral vein.  In all cases where the QV, LCVT and MCVT were isolated in the CFV, they were arranged in this order from bottom to top ( Figure 1 on the right, Figure 3 on the left); except in a case where they were arranged in the following manner from bottom to top: the MCVT, the QV and the LCVT (Figure 3 on the left). The first provision was also present in cases where these veins formed a common trunk before reaching into the VFC ( Figure 3 on the right, Figure 4 on the right).

Discussion
Very few studies have been performed on femoral veins especially by anatomic Forensic Medicine and Anatomy Research   dissection. Kamina [2] does not distinguish the common femoral vein from the superficial femoral vein. He describes these two veins as a single venous trunk called the femoral vein, which receives as affluent the deep femoral vein and the great saphenous vein. According to Bouchet and Cuilleret [1], there are three femoral veins: superficial, deep and common. In our study, we divided the femoral veins into three as did Bouchet and Cuilleret to facilitate the description of anatomical variations and comparison.
Dimensions: The dimensions of the femoral veins have not been described by many authors. According to Kamina [2], the femoral vein has a caliber of 9 mm.
In our study, the diameter of the superficial, deep and common femoral veins was 8.75 mm; 7.60 mm and 13.95 mm. The common femoral vein was 80.70 mm long.
Superficial femoral vein: Kamina [2] noted the splitting of the femoral vein.
According to Cruveilhier [3], there are, for the half or two thirds of the femoral vein, one or two collateral channels, which run parallel to its direction. In our series, we noted the splitting of the superficial femoral vein in 2 cases, the SFV was accompanied in one case by a collateral canal ( Figure 4 on the right) and it received as tributary a quadricipital vein in 2 cases.
Deep Femoral Vein: According to Kamina [2], DFV drains the medial and lateral circumflex veins of the thigh, femoral perforating veins and muscle twigs.
According to Rouvière [4], the DFV before its termination receives numerous collateral branches, among which the quadricipital and anterior circumflex veins Forensic Medicine and Anatomy Research (lateral circumflexes). According to Bouchet and Cuilleret [1], the DFV receives close to its termination the circumflex veins and veins of the quadriceps. In our series, the DFV received in the femoral trigone, quadricipital veins, medial and lateral femoral circumflex veins of the thigh in 4 cases or 16.20%. The remaining 83.80% were considered variations in which the DFV did not receive any affluent in the TF.

Conclusion
The diameter of the femoral veins is important. The main tributaries of the common femoral vein are LSV, QV and circumflex femoral veins. Femoral vari-