Evaluation of non-invasive and invasive methods in the assessment of short saphenous vein termination

Abstract

Surgery of the short saphenous vein is associated with a high recurrence rate because of variations in the anatomy or inadequate clinical examination. To prevent this, accurate definition of the pattern and level of termination of the saphenopopliteal junction and flush ligation is necessary. Clinical examination, Doppler ultrasound, duplex scanning and peroperative venography have been compared to assess the level of termination of the short saphenous vein. In all, 64 limbs of 46 patients were examined. In 39 limbs there was primary short saphenous incompetence, in 13 limbs there was recurrent short saphenous incompetence; in ten of these there was incompetence of the gastrocnemius vein. In 12 limbs a duplex scan did not demonstrate incompetence of the short saphenous vein or gastrocnemius vein. The accuracy of these methods when locating incompetence of the short saphenous vein to within 2 cm of the saphenopopliteal junction was 56 per cent for clinical examination, 64 per cent for Doppler ultrasound and 96 per cent for duplex scanning. When there was no saphenopopliteal junction (9 per cent), duplex scanning correctly detected the pattern of the incompetent vein. The apparent success of clinical examination was because the vein was not felt above the femoral intercondylar groove and 52 per cent of the veins terminated at this level. Duplex scanning is a non-invasive technique which is almost as accurate as venography and provides additional haemodynamic information about the incompetent veins by demonstrating the presence and extent of reflux.

A prospective evaluation of the outcome after small saphenous varicose vein surgery with one-year follow-up

“…6 Most UK vascular surgeons (89% in a recent questionnaire study) employ routine diagnostic imaging before SSV surgery because of the difficulty assessing this area by hand-held Doppler, and the variable anatomy of veins in the popliteal fossa. 7,8 Preoperative duplex marking of the SPJ was done selectively, according to the result of the diagnostic scan by surgeons in the present study, as mirrored by national data. 9 As in other studies, preoperative duplex marking of the SPJ has not been shown to improve outcomes.…”

Duplex Ultrasound Assessment of Neovascularization after Saphenofemoral or Sapheno-Popliteal Junction Ligation

“…Where the vascular technologist is able to obtain a good view at duplex scanning, it has been found that the duplex results closely mirror the peroperative situation. Also in the assessment of recurrent varicosities of the SSV, colour-coded duplex examination of the SPJ was reported to have an accuracy ranging between 96 and 100% [25,26].…”

Early Results of Endovenous Ablation with a 980-nm Diode Laser for an Incompetent Vein of Giacomini

“…This affected 5% of the limbs with primary varicose veins and 10% of the limbs with recurrent varicose veins after previous greater saphenous surgery. Other studies also reported that the prevalence of reflux in the VG ranged from 2% to 19% (6, 19-22). However, we could not evaluate the prevalence of VG among all patients who underwent Doppler US because we only evaluated the incidence of an incompetent VG.…”