The socalled high saphenopopliteal junction terminates on the posterior aspect of the thigh, in the femoral vein, which communicates with the long saphenous vein. The great saphenous vein that runs from the groin to the ankle and the thigh of the leg is the most common vein that becomes insufficient. Reflux probability in saphenous veins of women with. Patient demographics were recorded and an analysis made for each affected limb, of i competence at. To investigate and compare the anatomical success rates and complications of the treatment modalities for small saphenous vein ssv incompetence. Short saphenous vein incompetence and chronic lower. Small saphenous vein ssv reflux is an important and often overlooked cause of superficial venous insufficiency. Medical policy treatment of varicose veinsvenous insufficiency table of contents. Those from patients with primary incompetence of the short saphenous system, and those with evidence of previous deep vein thrombosis, were excluded. Small saphenous vein interventional treatment servier. Chronic venous insufficiency cvi is a medical condition in which blood pools in the veins, straining the walls of the vein. Ta arises on the lateral side of the foot from a union of the dorsal vein of the little toe with the dorsal venous arch, ascends posterior to the lateral malleolus, along the lateral border of the calcanean tendon and then through the middle of the calf to the inferior aspect of the popliteal space where it empties into.
The small short or lesser saphenous vein is a superficial vein of the leg. The technique of invagination stripping is of the long saphenous vein lsv and short saphenous vein ssv using the pin stripper ps is described. Patterns of short saphenous vein incompetence m i qureshi. Investigation and significance of short saphenous vein incompetence. Ceap clinical class and saphenous vein insufficiency, there was significant difference between presence of reflux.
Short saphenous incompetence did not produce a significant increase in the incidence of ulceration, whereas popliteal reflux produced an increase in the risk of ulceration which was statistically significant when compared with limbs without reflux in these two veins chi 2 4. It was decided to treat the ssv initially in order to incrementally improve her symptoms of leg pain and. Duplex ultrasound evaluation of patients with chronic. Endovenous laser treatment of the short saphenous vein. The great saphenous vein gsv is the most common source of superficial venous reflux. Preoperative vein mapping can be useful to determine length, diameter, and caliber of this vessel for use in lowerextremity limb salvage procedures. It showed venous occlusion rate and ulcer healing rate as 98. It is therefore time to survey the ideal management of an incompetent gastrocnemius vein in conjunction with a short saphenous primaryrecurrent varicose vein.
The most commonly documented site of reflux is the great saphenous vein gsv. Reflux duration, measured in the standing position, meets the following parameters. Pdf endovenous laser ablation for short saphenous vein. Saphenous vein insufficiency is the most common chronic venous incompetence of lower limbs.
Multimodal treatment of small saphenous vein incompetence michael wyatt sandip nandhra freeman hospital, newcastle upon tyne, uk. A study of variations in the short saphenous venous system with clinical correlation int j cur res rev, july 20 vol 05 page 31 clinical implications several anatomical studies have described various types of short saphenous vein termination among which the. Subfascial ligation of the incompetent short saphenous vein. Duplex scanning ofthe veins showed patent and competent deep venous system. If more than one vein on the same leg needs to be ablated, they may be treated during the same visit. Ssv incompetence greater detriment to qol than for gsv. Shortterm efficacy of evla in saphenous incompetence was assessed in many rcts. Complications develop in a relatively small number of cases, and may prompt the patient to seek medical care. It is present in about onesixth of patients with superficial venous insufficiency, and its manifestations are often confused with reflux in the great saphenous vein gsv.
In this study, 186 limbs with varicose veins or venous skin changes were examined using duplex ultrasonography. Incompetence of the accessory saphenous vein is isolated, and. To identify patterns of incompetence and which veins are involved. Small saphenous vein an overview sciencedirect topics. Lateral venous ulcer and short saphenous vein insufficiency. The small saphenous vein ssv is the first important superficial vein in the lower limb, and the axial, or sciatic, vein, the first vein of the deep venous system, develops from an earlier vein even before the development of the great saphenous vein gsv. In this article we will discuss the anatomy and clinical relevance of the small saphenous vein. Endovenous laser ablation for short saphenous vein incompetence article pdf available in annals of vascular surgery 231. Radiofrequency ablation rfa is associated with an excellent outcome in the treatment of great saphenous vein gsv incompetence. Limbs were classified on the basis of short saphenous or popliteal venous incompetence and the number of limbs with venous ulceration active or healed recorded. The saphenofemoral junction and its tributaries in the groin are ligated and divided, and the great saphenous vein is stripped from groin to knee level.
Does the use of endovenous thermal ablation radiofrequency or laser, microfoam sclerotherapy, mechanochemical ablation, cyanoacrylate adhesive. A systematic literature search was performed in pubmed, embase, and the cochrane library on the following therapies for incompetence of ssvs. The genesis of the superficial venous system occurs before that of the deep system. Chapter 1 the hemodynamics and diagnosis of venous disease mark h. Treating the small saphenous vein endovascular today. The small saphenous vein forms by the confluence of the lateral aspect of the dorsal venous network of the foot lateral marginal vein of the foot. Varicose veins are a progressive disease and will steadily worsen. Nonsaphenous pathways, which are the only explanation for varicose veins in at least 10% of patients, are much more common in multiparous women. Chapter 1 the hemodynamics and diagnosis of venous. Smith, in endovascular surgery fourth edition, 2011. Perforator of the popliteal fossa and short saphenous vein insufficiency. Reflux duration for accessory saphenous veins posterior, anterior, or.
Great saphenous vein incompetence is the most frequent cause of varicose vein disease. Ssv incompetence often causes reflux that goes to the perforating veins, sometimes not. The most common cause of chronic venous insufficiency is reflux of the venous valves of superficial veins. Learn the answer to this health question in a video response by vein specialist william d. Short saphenous vein insufficiency cases were carefully investigated in 590 consecutive patients affected by primary chronic venous insufficiency. Apr 11, 2014 radiofrequency ablation rfa is associated with an excellent outcome in the treatment of great saphenous vein gsv incompetence. Short saphenous vein incompetence and chronic lower extremity. Perforator veins allow communication between the superficial venous system and deep venous system of the legs. Apr 15, 2020 the small short or lesser saphenous vein is a superficial vein of the leg.
A method to eliminate the spj is the exeresis of the short saphenous vein ssv from the ankle to the popliteal vein. Approximately 60% of patients who have varicosities have reflux in the gsv hamper, et al. Saphenous vein venous incompetence semantic scholar. Venous insufficiency is a condition in which the veins have problems sending blood from the legs back to the heart. Conventional surgery for short saphenous vein ssv incompetence has a high incidence of recurrence and is associated with neurovascular injury. Small saphenous vein is the preferred terminology over other terms such as short saphenous vein, external saphenous vein or lesser saphenous vein 5. Short saphenous vein definition of short saphenous vein. Treatment of accessory and nonsaphenous veins jose i. No statistical significance was found between age, sex, body mass index, occupation, and associated chronic disease and deep or superficial venous system incompetence. Great saphenous insufficiency is where the valves and the great saphenous vein are incompetent. The lesser saphenous vein lsv and its tributaries drain the. Many patients simply require some reassurance and explanation regarding the natural history of the disease. The preoperative diameter of the saphenous vein proximal to the.
The impact of isolated lesser saphenous vein system incompetence. Short saphenous vein definition of short saphenous vein by. A 2cm transverse incision is made in the upper leg below the knee joint distal to where the small saphenous. A study of variations in the short saphenous venous system with clinical correlation int j cur res rev, july 20 vol 05 page 30 3. Giacomini vein is a thigh extension of the short saphenous vein, arising just above the saphenopopliteal junction and extending into the thigh. With longterm chronic venous insufficiency, vein walls are weakened and valves are damaged. Incompetence of this system has been declared by some authors as being of no importance in the pathogenesis of venous ulceration, 6 but evidence to the contrary is now accumulating. Multimodal treatment of small saphenous vein incompetence. Secondary ablation of recanalized saphenous vein after.
Guidelines and recommendation on surgery for venous. Sanei taheri m, atqiaee k,tabatabaei sa, tadayon n. Evta offers comparable outcomes to surgery without the shortterm neurological complications. Treatment of accessory and non saphenous veins jose i.
Pdf the role of incompetent tributaries to the saphenous vein in. The great saphenous vein gsv sometimes referred to as the long saphenous vein lsv. Mechanical occlusion chemically assisted ablation moca. The significance of short saphenous vein ssv reflux is an underexplored territory in chronic venous disease cvd. The aim of this study was to evaluate the safety and efficacy of endovenous laser ablation evla as an alternative to open surgery for ssv incompetence. The short saphenous vein is not usually larger than 3 mm in diameter, and connects with the deep veins at the saphenopopliteal junction spj in the knee area. Guidance for the appropriate treatment of veins based on location, size and communication with other veins. Almeida, md, facs, rpvi, rvt director, miami vein center voluntary associate professor of surgery university of miami jackson memorial hospital. Valvular incompetence of the great saphenous vein gsv is the most frequent cause of venous insufficiency, but incompetence of the short saphenous vein ssv is not uncommon. Techniques for endoscopic harvest of the small saphenous vein. Greater or long saphenous vein great saphenous vein smaller or short saphenous vein small saphenous vein.
Pdf venous incompetence in the lower extremity is a common clinical problem. Traditionally, short stripping of the great saphenous vein has been the treatment of choice for great saphenous vein incompetence. Great and small saphenous veins insufficiency montreal. Treatment of great saphenous vein insufficiency by endovenous laser therapy. Great saphenous insufficiency is the most common varicose veins that we see. Subfascial ligation of the incompetent short saphenous. Follow from the saphenofemoral junction sfj groin to the ankle using distal augmentation to assess for incompetence. Mechanochemical endovenous ablation moca combines mechanical endothelial damage, using a rotating wire, with the infusion of a liquid sclerosant. Superficial veins include the great saphenous vein and its branches and the lesser or short saphenous vein and its branches, as well as other nonnamed superficial veins in the legs. Treatment of great saphenous vein insufficiency by. Cyanoacrylate for the treatment of small saphenous vein.
Get a printable copy pdf file of the complete article 510k, or click on a page. It drains the lateral surface of the leg, and runs up the posterior surface of the leg to drain into the popliteal vein. It is a superficial vein being subcutaneous, just under the skin. Duplex scan of her lower legs showed an incompetent right saphenofemoral junction, great saphenous vein, saphenopopliteal junction, and small saphenous vein. Evh of the small saphenous vein is performed with the patient in the prone position. The origin of the small saphenous vein, ssv is where the dorsal vein from the fifth digit smallest toe merges with the dorsal venous arch of the foot, which attaches to the great saphenous vein gsv. The great saphenous vein gsv runs from the medial malleolus, up the medial aspect of the leg, draining into the cfv at the groin as the saphenofemoral junction sfj. This test was repeated with a narrow tourniquet inflated to 160 mmhg, applied to the mid. The lesser saphenous vein lsv and its tributaries drain the subcutaneous. If there are changes in competence, note the distance from landmarks such as the groin or knee crease. As functional venous valves are required to provide for efficient blood return from the lower extremities, this condition typically affects the legs. One hundred consecutive legs with long saphenous incompetence have been treated with is of the lsv from the groin to just below the knee using the ps. Small saphenous vein incompetence michael wyatt sandip nandhra freeman hospital, newcastle upon tyne, uk.
The firstline treatment of venous incompetence is thermal ablation, e. The most common cause of cvi is superficial venous reflux which is a treatable condition. Minimally invasive laser treatment of varicose veins. The superficial veins there are 2 main superficial veins draining the subcutaneous tissue of the lower leg. We have examined the origin and significance of ssv reflux in primary and secon. In many cases, duplex ultrasound in patients with varicose veins will not identify saphenous vein incompetence, or the saphenous reflux found may not explain all of the varicose pathways. Great saphenous vein stripping is commonly perceived as a painful and morbid procedure by patients and referring physicians alike. There was severe reflux ofthe long saphenous vein which communicated with the short saphenous vein through a giacornini communicator. Occlusion of the ssv after 3 months was achieved in 9895. The superficial femoral vein and a short segment of popliteal vein were incompetent.
Treatment modalities for small saphenous vein insufficiency. The small saphenous vein usually has more large branches than the gsv, and it lies deeper within the subfascial plane. Care must be taken to avoid injury to the sural nerve, which lies adjacent to the small saphenous vein in the leg. All veins were patent without any evidence of residual thrombus from the previous dvt. Uncomplicated veins, without significant pain, can safely be. Investigation and significance of short saphenous vein. Limbs were classified on the basis of short saphenous or popliteal venous.
The lesser or short saphenous vein should now be called. We have the great saphenous vein that runs from the groin to the ankle and the short saphenous vein that runs up the back of the legs from the ankle to behind the knee. Chronic venous insufficiency caused by dvt may be described as postthrombotic syndrome. Normally, valves in your deeper leg veins keep blood moving forward toward the heart.