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

  1. Place patient in prone position
  2. Make a transverse incision of approximately 3cm just at the insertion site of the saphenous vein into the popliteal vein
  3. Subcutaneous dissection
  4. Opening of the investing fascia
  5. Beware of the sural nerve which runs along the small saphenous vein
  6. Identification of the small saphenous vein and its insertion into the popliteal vein
  7. Ligate all side branches
  8. Ligate and remove about 2 cm of small saphenous vein
  9. Close fascia
  10. Skin closure

  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