The morphology of the varicose short saphenous system

Abstract

Objective: Surgery for the varicose short saphenous vein (SSV) remains unsatisfactory. Specific problems include locating the saphenopopliteal junction (SPJ) and whether the trunk should be stripped. Recurrence rates are high. The objective was to review the morphology of varicose SSV and to address these aspects. Methods: Retrospective study of consecutive patients scheduled for SSV surgery based on initial continuous wave Doppler assessment. Detailed analysis of preoperative duplex ultrasound examinations with quantified reflux. Results: A total of 56 limbs (unilateral) were studied, male to female ratio was 18:38 and mean age was 51 years. SPJ: severe reflux in 47, mean diameter 8.1 mm (all above the skin crease [mean 2.7 cm]). Reflux was 'focal', being confined to the peri-junctional area with normal sized and competent distal short saphenous trunks in 29. In the remainder, incompetence was 'complete' with dilatation and reflux of the entire system. In only one limb did varicosities arise distally from a proximally competent system. Long saphenous vein ( LSV): coexistent reflux in 17, with communications with the SSV in 11. Deep reflux: at least one segment of deep reflux was found in 24 limbs. In this small study, no significant association with other morphology was found apart from 'complete' SSV reflux. Conclusion: The SPJ is usually severely incompetent, enlarged and sited above the skin crease. The morphology of the varicose SSV exhibits important differences from the LSV. In over half, incompetence is 'focal', confined to the peri-junctional vein and the distal trunk is competent suggesting a case for selective trunk stripping. Varicosities arising from a distally incompetent short saphenous trunk are uncommon.

Ultrasound-guided foam sclerotherapy for the treatment of varicose veins

“…In the remainder, injections were confined to adjacent varicosities. As has been previously reported, this is because, unlike the GSVs, these legs exhibited focal saphenopopliteal reflux and the distal trunks were small and competent19. In all these legs, satisfactory closure occurred to the saphenopopliteal junction and in the incompetent trunk where relevant.…”

Endovenous Laser Treatment of the Small Saphenous Vein with a 980-nm Diode Laser: Early Results

“…In the case of the superficially located SSV and SPJ, especially where the reflux was focal to the perijunctional area and where the distal short saphenous trunk was competent, the stab avulsion of the SSV may be considered the preferential treatment because the procedure could be performed with only a small stab incision (1–1.5 cm) and without a substantial risk of sural nerve damage 28,29 …”

“…In the case of the superficially located SSV and SPJ, especially where the reflux was focal to the perijunctional area and where the distal short saphenous trunk was competent, the stab avulsion of the SSV may be considered the preferential treatment because the procedure could be performed with only a small stab incision (1-1.5 cm) and without a substantial risk of sural nerve damage. 28,29 Considering, however, the high recurrent rates of incompetent SSV surgery and the anatomic complexity of SPJ, the endovenous 980-nm diode laser is a safe and effective, cosmetically preferential procedure while a long-term follow-up is being awaited.…”

Effectiveness of endovenous laser treatment in eliminating superficial venous reflux

“…The primary source of truncal reflux must also be eliminated to achieve any degree of long-term control of the patient's varicose veins. 1 Traditionally the treatment of choice for this truncal reflux has been surgical vein stripping. Although a carefully planned and performed vein stripping can be effective at removing saphenous truncal reflux, this is a difficult and uncomfortable procedure for the patient.…”