When it comes to the treatment of venous insufficiency, a comprehensive understanding of reflux pathophysiology is essential. While the saphenofemoral junction (SFJ) of the great saphenous vein has been extensively studied, insights into the reflux origin of the small saphenous vein (SSV) are limited. In a recent study published in the Journal of Vascular Surgery – Venous and Lymphatic Disorders, a team led by Hans-Jürgen Veltman, Philipp Zollmann, Maria Zollmann, Christine Zollmann, Ivonne Berger, Anja Preller, and Erika Mendoza delves into the pathophysiology of the saphenopopliteal junction (SPJ) in cases of refluxing SSV.
Investigating Reflux Patterns
The study involved the examination of 1142 legs with chronic venous insufficiency, scheduled for endoluminal thermal ablation of the insufficient SSV, between April 1, 2019, and February 15, 2023. A preoperative standardized duplex ultrasound assessment of the SPJ, including the cranial extension of the SSV and the Giacomini vein, was conducted to determine the origin of reflux. Moreover, the study considered the relevance of the draining type based on Cavezzi’s classification.
In the majority of cases (86%), the study detected saphenopopliteal reflux from the popliteal vein into the insufficient SSV. In 16% of these cases, simultaneous refluxing blood from the cranial extension or Giacomini vein was found. Reflux resulted only from the cranial extension or Giacomini vein with a competent SPJ in 10% of cases. In 3% of cases, the reflux source was diffusely from side branches and/or perforating veins.
Cavezzi’s junction types A1 and A2 were found in 65% and 35% of cases, respectively. These junction types significantly influence the choice of treatment.
Implications for Treatment
The study’s findings highlight the frequency of axial reflux from the deep into the SSV, indicating the need for high ligation or thermal ablation at the level of the SPJ or immediately distal to the inflow of muscular veins, depending on the junction type. Notably, 14% of cases showed a competent junction of the SSV, suggesting no indication for ligation or thermal destruction of the SPJ.
This research enhances our understanding of SSV reflux patterns and their implications for treatment decisions. With a more targeted approach, medical professionals can provide more effective and personalized care for patients with venous insufficiency.
For a detailed exploration of this study, you can access the publication here.
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