GSV Incompetence, Medial Circumflex Femoral Vein and External Iliac Vein Competence during Valsalva A young female patient, 31 yo, an opera singer, came for a consultation, mainly for aesthetic problems of the lower limbs. Teleangectasiae and lipodermatosclerosis were clinically evident. An asymptomatic bilateral P-point pelvic shunt was demonstrated by the EchoDoppler, while no nutcracker syndrome was detected. A Haemodynamic Venous Map of the left lower limb was performed to detail the features of the venous network. You can see highlighted in red a Medial Circumflex Femoral Vein, the Common Femoral vein and then the GSV. A computer simulation showed the flow behaviour over the mean of a systo-diastolic manoeuvre. A longitudinal section of the SFJ showed the valves: (from left to right) ilio-femoral, epigastric, SFJ terminal and pre-terminal ones. The exam here detailed was not perfect: the sample volume was correctly positioned at the level of the sapheno-femoral terminal valve, but not exactly over the flow. In the registration at the iliac level instead the angle direction was not along the flow. The Valsalva manoeuvre showed a GSV terminal valve incompetence. A dilated a Medial Circumflex Femoral Vein at the level of the SFJ was the source of the reflux through the GSV, while the external iliac vein was competent. Parana manoeuvre was always negative. Flow in the Medial Circumflex Femoral Vein was directed towards the common femoral vein as in the hypertensive as in …
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