Small (Lesser) Saphenous Vein Crossectomy
Genaral remarks
- 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
Step by step
- Place patient in prone position
- Make a transverse incision of approximately 3cm just at the insertion site of the saphenous vein into the popliteal vein
- Subcutaneous dissection
- Opening of the investing fascia
- Beware of the sural nerve which runs along the small saphenous vein
- Identification of the small saphenous vein and its insertion into the popliteal vein
- Ligate all side branches
- Ligate and remove about 2 cm of small saphenous vein
- Close fascia
- Skin closure
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