Small (Lesser) saphenous vein crossectomy

General information

• Varicosis is usually a clinical diagnosis.
• The prevalence of insufficiency of the small saphenous vein is 10-18%
• To determine which surgical approach needs to be applied, additional test should be performed
• Tourniquet tests (like Perthes' test) have a low sensitivity and specificity and should therefore be considered obsolete
• The test of choice is a Duplex test (although a regular handheld doppler device in skilled hands could be an acceptable alternative)
• Exeresis (or stripping) of the lesser saphenous vein, should not routinely be performed since 33% of the patients complain of neulologic pain due to injury of the sural nerve.
• Crossectomy (or saphenopopliteal ligation), with additional compression therapy is to be recommended for most small saphenous vein insufficiencies
• Endovenous laser ablation for treating the incompetent small saphenous vein is also a safe, effective and technically feasible technique
• Palpation of the insertion of the small saphenous vein into the popliteal vein can be difficult, also due to numerous anatomical variations. It is therefore recommended to pre-operatively mark this area

Literature
1. Endovenous laser ablation of the small saphenous vein: prospective analysis of 150 patients, a cohort study.Huisman LC, Bruins RM, van den Berg M, Hissink RJ. Eur J Vasc Endovasc Surg. 2009 Aug;38(2):199-202

2. Bradbury AW, Stonebridge PAS, Ruckley CV, Beggs I. Recurrent varicose veins: correlation between preoperative clinical and hand-held Doppler ultrasonographic examination, and anatomical findings at surgery. Br J Surg 1993;80:849-51.

3. B.C. Vrouenraets en J.N. Keeman. Physical examination--tourniquet tests for varicose veins. Ned Tijdschr Geneeskd. 2000;144:1267-72