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Veins of the lower extremity can be categorized into three hierarchically ordered groups: the epifascial, the interfascial, and the deep ones. In the past, the interfascial veins, e.g., the great saphenous vein, were categorized as superficial veins. But nowadays, experts recommend regarding these veins as a separate group because of their unique topography and clinical relevance. In order to better understand the venous anatomy of the lower limbs, which is highly variable, one should also comprehend their embryological development. Venous embryogenesis in the lower limb consists of three stages. During the first stage the primitive fibular vein is the main vein of the extremity. During the second stage it is replaced by the axial vein and finally by the femoral vein. In some adult individuals this embryonic or fetal venous anatomy is still present. Unfortunately, current anatomical textbooks and atlases, as well as traditional cadaver dissections, are not very useful regarding these issues. Therefore, undergraduate teaching of anatomy can be challenging. New educational tools, such as ultrasonography, seem indispensable to teach the anatomy of these veins properly. [ABSTRACT FROM AUTHOR]

Veins of the lower extremity can be categorized into three hierarchically ordered groups: the epifascial, the interfascial, and the deep ones. In the past, the interfascial veins, e.g., the great saphenous vein, were categorized as superficial veins. But nowadays, experts recommend regarding these veins as a separate group because of their unique topography and clinical relevance. In order to better understand the venous anatomy of the lower limbs, which is highly variable, one should also comprehend their embryological development. Venous embryogenesis in the lower limb consists of three stages. During the first stage the primitive fibular vein is the main vein of the extremity. During the second stage it is replaced by the axial vein and finally by the femoral vein. In some adult individuals this embryonic or fetal venous anatomy is still present. Unfortunately, current anatomical textbooks and atlases, as well as traditional cadaver dissections, are not very useful regarding these issues. Therefore, undergraduate teaching of anatomy can be challenging. New educational tools, such as ultrasonography, seem indispensable to teach the anatomy of these veins properly.

Saphenopopliteal junction classification has been developing, but still the precise knowledge of junction type is crucial for proper surgical treatment. We examined the saphenopopliteal junction by duplex venous scanning in 244 extremities in healthy volunteers (median age: 23.0 years, 83 females, 39 male) and performed a meta-analysis of 13 studies focusing on structural types of the junction. According to Schweighoffer's classification we distinguished 5 types of the junction and we subdivided type A according to Cavezzi's classification of gastrocnemial veins termination into two. We added type F (small saphenous vein-SSV terminates into popliteal vein-PV), described especially in cadaveric studies. In our study, the most frequent type was A1 (96 cases), followed by C (70), B (48), A2 (20), E (6), D (3) and F (0). The pooled prevalence estimate for types A + B + D + E was 54.7% (95% CI 40.9–69.6%) and for type C 24.4% (95% CI 19.3–29.5%), whereas in 17.1% (95% CI 6.3–27.9%) of cases, the SSV terminated in the PV with no cranial extension present. The knowledge of the saphenopopliteal junction and its variations prevalence can help clinicians to quickly identify the real type of the junction during routine examination. In mid-European population, the main type is A1 and worldwide type A. [ABSTRACT FROM AUTHOR]

Introduction: Laser and radiofrequency ablation are two thermal ablation methods currently widely used to treat lower limb venous insufficiency. However, very few studies have been conducted on the use of microwaves, a form of thermal ablation, for the treatment of small saphenous vein (SSV) insufficiency. This study aimed to examine the efficacy and safety of endovenous microwave ablation (EMA) for the treatment of SSV insufficiency. Methods: The clinical data of 126 patients (126 lower limbs) with SSV insufficiency (SSV trunk reflux time ≥ 500 ms on lower limb color Doppler ultrasound) treated at the Surgery Department of The Sixth People's Hospital of Zhuji from January 2020 to June 2022 were analyzed retrospectively; 64 patients underwent EMA and 62 underwent endovenous laser ablation (EVLA). The perioperative marker data [duration of surgery, duration of hospitalization, length of thermal ablation, duration of thermal ablation, number of incisions, and numerical pain rating scale (NPRS)], complication data [skin ecchymosis, skin burns, surgical site infection, paresthesia, deep vein thrombosis (DVT), and heat-induced thrombosis (EHIT)], venous clinical severity score (VCSS), chronic venous disease quality of life questionnaire (CIVIQ-20) before and 1, 3, 12 months after surgery, and SSV trunk occlusion rate at 12 months after surgery were compared between the two groups. Results: No significant differences in the surgery or hospitalization durations were observed between the two groups. There were no significant differences in the length of the SSV that required thermal ablation between the two groups; however, the thermal ablation time was shorter in the EMA group than that in the EVLA group (6.14 ± 1.47 min vs 7.05 ± 1.16 min, P < 0.001). There were no statistical differences in the number of incisions, volume of tumescent solution used, or quantity of sclerosing foam used. The NPRS scores of the EMA group at 24 h and 72 h after surgery were significantly greater than those of the EVLA group (4.03 ± 0.98 vs 3.52 ± 1.28, P = 0.013; 3.78 ± 1.06 vs 3.15 ± 1.03, P = 0.001). Moreover, the two groups showed no significant difference in the NPRS score at 1 month (1.14 ± 0.84 vs 1.07 ± 0.75, P = 0.623). The EMA and EVLA group patients experienced similar postoperative complications. The VCSS and CIVIQ-20 score significantly improved at 1, 3, and 12 months after surgery. The VCSS and CIVIQ-20 scores were compared between the two groups at 12 months after surgery, and there were no significant differences (1.44 ± 0.63 vs 1.56 ± 0.56, P = 0.261; 24.24 ± 4.96 vs 25.19 ± 5.36, P = 0.304). There was no significant difference in the incidence of SSV trunk occlusion at 12 months after surgery between the two groups (95.31% vs 96.77%, OR 1.475; 95% CI 0.238–9.146, P = 1.000). Conclusion: EMA and EVLA are equally effective treatment methods for SSV insufficiency. EMA is associated with higher NPRS scores in the early postoperative period. [ABSTRACT FROM AUTHOR]

Background: A venous aneurysm (VA) is a focal dilatation of a nonvariceal vein (diameter increased by at least 1.5 times compared to the adjacent upstream or downstream venous segment), which carries a risk of venous thromboembolism (VTE) when located in the deep veins of the lower limbs but also when it affects the veins above the muscle fascia. Case: We report the case of a 40-year-old woman who presented with a painful and disabling mass-like lesion of the upper third of the right calf. A Doppler ultrasound (DUS) examination revealed a small saphenous vein (SSV) dilated at the saphenopopliteal junction (SPJ) and thrombosed along its entire length. Anticoagulant treatment was initiated but although the thrombosis regressed on DUS, the functional impotence and the persistence of pain prompted a stripping of the SSV. Histology allowed the diagnosis of SSV's primary aneurysm. Discussion: Dilated segments of the saphenous vein are not always varicose veins (VVs). True VAs can develop on veins located above the muscular fascia and, like deep VAs, may trigger VTE. Small saphenous vein aneurysms have seldom been reported, and only a few clinical observations have described the thrombosis of a SSV aneurysm. Any mass in the popliteal fossa or upper part of the calf should be examined by DUS to look for an SSV aneurysm. Excision of the saphenous vein with junctional ligation is advised if thrombosis is present at the time of diagnosis. [ABSTRACT FROM AUTHOR]

The sural nerve is a sensory nerve which innervates the posterolateral distal calf and lateral foot. It can be demonstrated using high resolution ultrasound and travels near the small saphenous vein throughout most of its course. There are variations in its origin and relative position through the posterior distal calf, lateral ankle, and foot. To allow this nerve and any potential pathology or injury to be sonographically demonstrated, a good understanding of the sonographic relative anatomy, course, and common anatomical variations, as well as the sonographic normal appearances throughout need to be appreciated and these are reviewed in this paper. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the postoperative hemodynamic changes in varicose vein surgery related with SSV reflux using APG. Methods: Totals of 181 limbs and 178 patients who underwent high ligation and stripping (HLS) (87 limbs), radiofrequency ablation (RFA) (43 limbs), or endovenous laser ablation (EVLA) (51 limbs) for SSV reflux from 1995 to 2022 were enrolled. We measured venous volume (VV), venous filling index (VFI), ejection fraction (EF), and residual volume fraction (RVF) preoperatively and at postoperative one and 6 months. Results: Comparing preoperative results to those at postoperative 1 month, the reduction rates of VV, VFI, and RVF were 27, 53, and 31%, while EF increased by 18% (p < 0.001). Comparing preoperative and postoperative 6 month, the reduction rates of VV, VFI, and RVF were 27, 45, and 35%, while EF increased by 27% (p < 0.001). Conclusions: There were hemodynamic improvement in the lower leg after varicose vein surgery including HLS, RFA, and EVLA. [ABSTRACT FROM AUTHOR]

Aim or Objective:To investigate the results and complications of our treatment modalities for small saphenous vein (SSV) incompetence. Introduction:Although superficial venous disease has frequently been associated with great saphenous vein (GSV) incompetence, small saphenous vein (SSV) reflux is responsible for ~15% of all varicose vein disease. 1 Symptomatic small saphenous axis incompetence is significant and can result in a greater disease-specific quality of life(QOL) impairment than incompetence in the GSV axis, when controlling for clinical disease severity. 2 There was no uniformity in the surgical treatment of SSVs among vascular surgeons. SSV surgery is considered more challenging and is associated with higher recurrence and complication rates1. We aimed to investigate our management modalities and experience in small saphenous vein incompetence. Methods: 33 patients in our hospital who had received either small saphenous vein (SSV) radiofrequency thermal ablation(RFTA), cyanoacrylate glue closure or SSV ligation surgery between January 2020-May 2023 were retrospectively recruited to the study.25 of the patients had isolated unilateral, primary saphenopopliteal junction incompetence and 8 of the patients had both safenofemoral and safenopopliteal junction incompetence. Results: Pain, swelling and tenderness, itching, burning, discoloration of the legs were the main symptoms. The average age of the patients was 47,96 years.RFTA+miniflebectomy/sclerotherapy in 22 patients, RFTA was performed in 2 patients, cyanoacrylate glue(Venablock) in 2 patients(1 with miniphlebectomy), ligation+RFTA+miniflebectomy/sclerotherapy in 4 patients and ligation with miniflebectomy in 2 patients, ligation with limited striping in 1 patient. In postoperative 7th day control all the patients were cosmetically in good condition.2 patients had thrombophlebitis treated with antibiotics and enoxaparin use for 6 weeks. 3 patients had edema resolved with compression therapy and flavonoids. Neural deficits were seen in two patients who underwent RFTA.One patient had neuralgic pain at the postoperative 2nd week resolved with gabapentins in a month. The other patient had temporary dorsiflexion deficit secondary to peroneal nerve thermal injury. This patient need physiotherapy and gabapentin use. Symptoms completely healed at 6 months. Discussion:Several authors have described nerve complications after thermal ablation of the SSV.3Effective mapping of the sural nerve(SN) give us the opportunity to develop new strategies to approach and protect the SN.SSV insufficiency management is still a challenging procedure4. [ABSTRACT FROM AUTHOR]

Aim: This study aims to explore the effects of three techniques on postoperative symptom recurrence and clinical outcome and define the predictors. Material and Methods: A total of 121 patients (63 males, 58 females; mean age: 47.4±11.3 years; range, 32 to 73 years) who underwent stripping (n=45), ligation alone (n=36), or ligation and foam sclerotherapy (2% polidocanol, n=40) for varicosities due to small saphenous vein (SSV) insufficiency between January 2004 and December 2011 were included in the retrospective study. Preoperative and postoperative CEAP (Clinical, Etiological, Anatomical, and Pathophysiological), symptom recurrence, and Doppler findings were evaluated with univariate and multivariate analyses. Results: The mean follow-up was 25.8±20.4 months. The operation type did not have any effect on postoperative symptom recurrence, high CEAP (≥3), or clinical outcomes. Predictor of postoperative symptom recurrence was preoperative high CEAP (p=0.001, relative risk [RR]: 4.8); predictor of high postoperative CEAP was postoperative perforating vein insufficiency (p=0.001, RR: 5.148). In the ligation group, a preoperative SSV diameter >5 mm was predictive for both postoperative symptom recurrence (p=0.039, RR: 7.8) and high postoperative CEAP (p=0.002, RR: 1.901), and preoperative deep vein insufficiency was also predictive for postoperative symptom recurrence (p=0.044, RR: 1.304). In the stripping group, postoperative neuropathy was significant (p=0.041, RR: 4.168). There was no difference in Kaplan-Meier symptom-free survival curves (p=0.651), venous clinical severity scores, or Aberdeen Varicose Vein Questionnaire scores among groups. Conclusion: High ligation is not a good option for patients with large SSV diameters or deep vein insufficiency. High ligation with stripping comes with an increased risk of sural neuropathy. High ligation with foam sclerotherapy should be considered an effective method with the ability of the foam to spread over the branches and microvenous structures. Performing operations before progression to high CEAP classes or greater SSV diameters is considerable. [ABSTRACT FROM AUTHOR]

Aim: This study aims to explore the effects of three techniques on postoperative symptom recurrence and clinical outcome and define the predictors. Material and Methods: A total of 121 patients (63 males, 58 females; mean age: 47.4±11.3 years; range, 32 to 73 years) who underwent stripping (n=45), ligation alone (n=36), or ligation and foam sclerotherapy (2% polidocanol, n=40) for varicosities due to small saphenous vein (SSV) insufficiency between January 2004 and December 2011 were included in the retrospective study. Preoperative and postoperative CEAP (Clinical, Etiological, Anatomical, and Pathophysiological), symptom recurrence, and Doppler findings were evaluated with univariate and multivariate analyses. Results: The mean follow-up was 25.8±20.4 months. The operation type did not have any effect on postoperative symptom recurrence, high CEAP (≥3), or clinical outcomes. Predictor of postoperative symptom recurrence was preoperative high CEAP (p=0.001, relative risk [RR]: 4.8); predictor of high postoperative CEAP was postoperative perforating vein insufficiency (p=0.001, RR: 5.148). In the ligation group, a preoperative SSV diameter >5 mm was predictive for both postoperative symptom recurrence (p=0.039, RR: 7.8) and high postoperative CEAP (p=0.002, RR: 1.901), and preoperative deep vein insufficiency was also predictive for postoperative symptom recurrence (p=0.044, RR: 1.304). In the stripping group, postoperative neuropathy was significant (p=0.041, RR: 4.168). There was no difference in Kaplan-Meier symptom-free survival curves (p=0.651), venous clinical severity scores, or Aberdeen Varicose Vein Questionnaire scores among groups. Conclusion: High ligation is not a good option for patients with large SSV diameters or deep vein insufficiency. High ligation with stripping comes with an increased risk of sural neuropathy. High ligation with foam sclerotherapy should be considered an effective method with the ability of the foam to spread over the branches and microvenous structures. Performing operations before progression to high CEAP classes or greater SSV diameters is considerable. [Turk J Vasc Surg 2022; 31(3.000): 140-7]

Objective: To evaluate the incidence of anomalies in the superficial venous system in lower limb. Method: Triplex ultrasonography in clinically suspected cases of acute or chronic venous disease or congenital malformation was performed on 3189 lower limbs in 2000 patients (bilateral in 1189 and unilateral in 811) from Jan 2020 to Dec 2020. Result: (1) Anomalies of great saphenous vein were observed in 496 cases (15.5%), (2) Anomalies of short saphenous vein were observed in 760 cases (23.8%), (3) Anomalies of accessory saphenous veins were seen in 984 (30.88%), 1501 (47%), 1068 (33.5%) and 774 (24.25%) corresponding to the anterior, posterior, lateral systems and posterior accessory vein of leg, respectively. Conclusion: Anomalies of the superficial venous system in lower limb are very common and must be reported in every doppler study. These anomalous veins may be the cause for residual or recurrent disease in chronic venous insufficiency, which warrants further research. [ABSTRACT FROM AUTHOR]

Objective: to compare the outcomes of mechanochemical ablation (MOCA) versus saphenopopliteal junction ligation and stripping (OS) for symptomatic small saphenous vein (SSV) insufficiency. Methods: This is a retrospective study including symptomatic SSV patients treated with MOCA using the ClariVein catheter (Merit Medical, South Jordan, Utah, USA) or OS from 2015 to 2019. Results: A total of 60 limbs (73.3% women, mean age 54.7 ± 14.4 years) were treated with MOCA and 58 limbs (63.8% women, mean age 54 ± 11.6 years) with OS. At 18 months follow-up, recurrence rates were 7.5% (4/53) for MOCA vs. 5.7% (3/52) for the OS group. MOCA group was associated with less pain at first postoperative day, and an early return to work (MOCA 3.5 ± 2.3 days vs. OS 14.2 ± 3.8 days, p <.0001). No cases of leg paresthesia/dysesthesia were observed in the MOCA group, while two patients (3.4%) presented neurological symptoms after OS treatment. Conclusion: MOCA and OS are both safe and effective techniques for symptomatic SSV insufficiency. MOCA group demonstrated to be associated with less postoperative pain and early return to work compared to OS. [ABSTRACT FROM AUTHOR]

Peripheral bypass grafting with autologous vein is the gold standard treatment of peripheral artery disease. In cases when the great saphenous vein is not available the arm veins or small saphenous veins are possible alternatives. The use of small saphenous vein as a bypass conduit is not a spread practice. We present two cases of revascularization procedures using the small saphenous vein as a conduit and a literature review on the theme.

Background: The small saphenous vein (SSV) is affected in 15% of chronic venous insufficiency (CVI) cases. Conventional surgery is the standard technique for treatment of SSV insufficiency, but sural nerve injury is a complication of great concern. Endovenous laser ablation is a surgical technique for treatment of CVI that is considered likely to reduce morbidity and mortality. Objectives: To evaluate patients with CVI undergoing endovenous laser ablation of the SSV at least 30 days after the procedure. Methods: We analyzed 54 lower extremities in 46 patients scheduled for 1470-nm endovenous laser ablation under local anesthesia to treat CVI in a tertiary hospital. Patients were evaluated preoperatively, intraoperatively, and postoperatively over 30 days with clinical examination, physical examination, and ultrasound. Results: In the 54 lower extremities treated, there was a significant difference (p < 0.003) in terms of reduction in the diameter of treated veins (6.37 mm preoperatively and 5.15 mm on the 30th postoperative day) and improvement in the venous clinical severity score (VCSS) (means of 8.02 preoperative and 6.11 on the 30th postoperative day) (95%CI, 5.01-7.21) (p < 0.02). Postoperative complications such as paresthesia and phlebitis were present and diagnosed in 5 and 3 patients, respectively, but did not affect their quality of life or routine activities. Conclusions: Intravenous laser ablation of the SSV proved to be safe and effective for reducing clinical symptoms and improving quality of life. [ABSTRACT FROM AUTHOR]

This study reports an unusual variant of drainage of the small saphenous vein identified during routine anatomic dissection of a male cadaver at the Human Anatomy Department. Both the right and left small saphenous veins did not drain into the popliteal vein, but continued proximally on the thigh as the deep femoral vein which, in turn, drained into the femoral vein. The left small saphenous vein showed some peculiarities compared to that of the opposite side: presence of the intergemellar perforating vein at the calf, a perforating vein at the popliteal fossa, and Giacomini`s vein at the thigh. Knowledge about the anatomical variability of the small saphenous vein is important for vascular and cardiac surgeons, for radiologists and anatomists.

Vein is regarded superior to artificial graft in peripheral arterial bypass surgery. However, this option is often limited owing to previous use or removal of the ipsilateral greater saphenous vein (iGSV). In this case, the contralateral great saphenous vein (cGSV), the small saphenous vein (SSV), or arm veins (AV) are possible alternatives. Experience with all three grafts for below knee vein bypass is reported. Consecutive patients treated at an academic tertiary referral centre between January 1998 and July 2018 using the cGSV, SSV, or AV as the main peripheral bypass graft were analysed. Study end points were primary patency, secondary patency, limb salvage, and survival. Over the observed time period, 2642 bypass operations for treatment of peripheral artery disease with below knee target arteries were performed at the authors' institution: 1937 procedures using the iGSV; 644 bypass procedures using the cGSV (n = 186; 28.9%), SSV (n = 101; 15.7%), or AV (n = 357; 55.4%); and 61 procedures using a prosthetic graft. The median follow up period was 2.3 years (range 9 days–18.5 years). Thirty day mortality was 1.9% for the whole group and similar between the three groups. After five years, primary and secondary patency rates were comparable between the three groups. Secondary patency was 75% (95% confidence interval [CI] 66–83) in the cGSV and SSV groups, and 65% (95% CI 57–73) in the AV group (p =.47). Limb salvage and survival after five years were, respectively, 73% (95% CI 65–81) and 89% (95% CI 82–95) in the cGSV group, 79% (95% CI 69–89) and 87% (95% CI 79–95) in the SSV group, and 74% (95% CI 68–80) and 83% (77–89) in the AV group (p =.46). All three types of alternative autologous vein graft are equal regarding outcome parameters. Vascular surgeons should consider all autologous options if their preferred choice is not available. [ABSTRACT FROM AUTHOR]

Calreticulin (CRT) protein, has been identified in the endoplasmic reticulum (ER) and lately in the extracellular matrix (ECM) of predentine and arteries. It is responsible for different extracellular functions, such as cell adhesion, ECM regulation, and the prevention of thrombosis. The aim was to identify the presence of CRT in ECM of small saphenous vein. A sample of small saphenous vein from a male specimen was extracted and then processed by histological and immunohistochemical assays to identify its presence. The presence of CRT in the ECM of the small saphenous vein was observed by immunohistochemical techniques. The presence of CRT in the small saphenous vein ECM, indicates that CRT have extracellular functions in this area, however, more precise studies are necessary to determine its main functions. [ABSTRACT FROM AUTHOR]

Purpose: The proximal approach to the small saphenous vein (SSV) must be performed according to precise anatomical landmarks to respect the esthetic profile of venous insufficiency surgery. In this work, we propose the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as palpable landmarks from which to easily identify the situation of this vein. Methods: This was a cadaveric dissection study involving 62 members of fresh and embalmed anatomical subjects. We used a horizontal line passing through the tip of the lateral malleolus and the lateral edge of the calcaneal tendon as reference marks. Once the origin of the SSV as dissected, the distances between the saphenous vein and the landmarks were measured. Results: We found that the small saphenous vein was often unique. The origin of this small saphenous vein projected, on average, to 4.40 cm from the horizontal passing through the tip of the lateral malleolus and 1.2 cm from the lateral edge of the calcaneal tendon. Conclusion: These two measurements constitute the orthogonal coordinates for the situation of the small saphenous vein origin. [ABSTRACT FROM AUTHOR]

Peripheral intravenous cannulation (PIVC) is a routine procedure in perioperative, and critical care settings and nearly one-third of the patients may have difficult intravenous access (DIVA). PIVC is challenging in a prone position in an intraoperative setting when there is a need for emergency access. Point of care ultrasonography (POCUS) is becoming the standard for assisting DIVA and improving the success rate. The small saphenous vein (SSV) in the posterolateral side of the mid-calf is a consistent vein in the lower extremity that provides an acceptable diameter and optimal depth for POCUS-guided PIVC in the prone position. A successful SSV cannulation was performed with an 18-G peripheral intravenous catheter under POCUS guidance on a 34-year-old male polytrauma patient in the prone position during the intraoperative period scheduled for D2 spine fixation. The SSV can be a credible option for emergency DIVA in the prone position under POCUS guidance., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Insufficiency of the small saphenous vein causes 15% of varicose veins in the lower extremities. Endovenous ablation for the treatment of small saphenous vein varices has become a trend, and an increasing number of studies have reported the effects of different types of endovenous ablation in patients with small saphenous varicose veins. The purpose of this systematic review is to summarize the results of existing studies on endovenous ablation for the treatment of small saphenous varicose veins, compare its role and efficacy, and provide insights into the future development of endovenous ablation for treating small saphenous varicose veins. A systematic review of literature published from January 1, 2002 to January 1, 2022 was conducted from PubMed, Embase, and China Academic Journals full-text databases. The pre-determined inclusion criteria were clinical literature of endovenous ablation for treating small saphenous varicose veins. Keywords included "ablation", "small saphenous vein", "lesser saphenous vein", "short saphenous vein", "xiaoyinjingmai" and "xiaorong". Of the 506 articles screened, 33 articles were included in this review: 19 articles were related to endovenous laser ablation, five were related to mechanochemical ablation, seven were related to radiofrequency ablation, and two were related to both endovenous laser ablation and radiofrequency ablation. The anatomical success rate of endovenous laser ablation, radiofrequency ablation, and mechanochemical ablation were 94.3%, 96.0%, and 88.1%, respectively, and the heterogeneities were all moderate. Most of the current studies are of a low-quality level of research. Hence, long-term follow-up studies and large-scale randomized controlled trials are required to obtain high-quality evidence. Although the gold standard for the treatment of small saphenous vein insufficiency remains unclear, endovenous ablation is still the recommended method.

Objectives: Comparison of a flush sapheno-popliteal junction ligation versus a mini-invasive foam sclerotherapy-assisted ligation. Methods: Forty-eight chronic venous disease patients underwent sapheno-popliteal junction flush ligation (group A). Forty-one patients underwent small saphenous vein ligation by means of mini-invasive incision with foam sclerotherapy of the popliteal stump (group B). Results: At 4.1 ± 3.3 years mean follow-up, sapheno-popliteal junction recurrence was detected in four patients of group A (4/48; 8.3%) and in two cases of group B (3/41; 7.3%) (P = ns). Mean procedural time was 36 ± 11 minutes versus 21 ± 6 minutes (p <0.0001). A mild post-operative paresthesia lasting more than 24 h was reported in 6.3% (3/48) of group A versus 2.4% (1/41) (p <0.009) of group B. At one-year check-up, Aberdeen Varicose Vein Questionnaire significantly improved in both groups with no significant difference between group A and B. Conclusions: Foam-assisted mini-invasive sapheno-popliteal ligation represents a time and clinical-effective option, associated with a decrease in post-operative paresthesia risk. [ABSTRACT FROM AUTHOR]

The small saphenous vein (SSV) is a potential vein source for bypass if neither greater saphenous vein nor arm vein is available. This study reports experience using SSV as part of an all autologous vein bypass policy. This study comprised single centre retrospective data analysis of all consecutive patients treated at an academic tertiary referral centre from January 1998 to February 2017 using the SSV as the main peripheral bypass graft. Study endpoints were primary patency, secondary patency, limb salvage, and survival. One hundred and twenty operations were performed in 118 patients using SSV. Indications were peripheral arterial occlusive disease (n = 91; Rutherford classification 3: n = 11; 4: n = 21; 5,6: n = 59), acute ischaemia (n = 14), popliteal artery aneurysm (n = 12), and bypass revisions (n = 3). Median follow up was 30.5 months (10 months–13.7 years). Primary patency after one, three and five years was 68% (CI: 59–77%), 58% (49–68%), and 54% (45–64%). Secondary patency was 83% (76–89%) after one year and 77% (69–85%) after three and five years. Limb salvage after one year was 88% (82–94%) and 78% (70–86%) after five years. Survival was 96% (92–99%) after one year and 91% (85–97%) at five years. Multivariable analysis identified redo surgery as an independent risk factor. Patients receiving a primary (n = 59) vs. a redo bypass (n = 61) were compared. Primary patency and secondary patency were both significantly better in the primary bypass group than in the redo group (p =.0036 and p =.0003, respectively). Limb salvage was also significantly better in primary bypass patients than in the redo group (p =.0007), whereas overall survival did not differ significantly (p =.48). The SSV is a valuable alternative vein graft in peripheral bypass surgery. It achieves excellent long-term results, particularly in patients with primary procedures but also acceptable results in patients with redo surgery. [ABSTRACT FROM AUTHOR]

Purpose: Studies examining cyanoacrylate closure of saphenous veins with the VenaSeal™ System have not allowed concomitant procedures for tributaries at the time of the index procedure. Outside of clinical trials, however, concomitant procedures are frequently performed in conjunction with endovenous ablation. We report on the frequency of need for saphenous tributary treatment three months after cyanoacrylate closure of the treatment of great saphenous vein, small saphenous vein, and/or accessory saphenous vein. Methods: Fifty subjects with symptomatic great saphenous vein, small saphenous vein, and/or accessory saphenous vein incompetence were treated with no postprocedure compression stockings. Concomitant procedures were not allowed. Treating physicians predicted the type and nature of any concomitant procedures that they would usually perform at the time of ablation, if not limited by the constraints of the study. Evaluations were performed at one week, one and three months and included duplex ultrasound, numeric pain rating scale, revised venous clinical severity score, the Aberdeen Varicose Vein Questionnaire, and time to return to work and normal activities. At the three-month visit, the need for and type of adjunctive procedures were recorded. Results: Complete closure at three months was achieved in 70 (99%) of the treated veins (48 great saphenous veins, 14 accessory saphenous veins, eight small saphenous veins). Revised venous clinical severity score improved from 6.4 ± 2.2 to 1.8 ± 1.5 (P <.001) and Aberdeen Varicose Vein Questionnaire from 17.3 ± 7.9 to 6.5 ± 7.2 (P <.0001). Sixty-six percent of patients underwent tributary treatment at three months. The percentage of patients who required adjunctive treatments at three months was lower than had been predicted by the treating physicians (65% versus 96%, p=.0002). Conclusions: Closure rates were high in the absence of the use of compression stockings or side branch treatment. Improvement in quality of life was significant, and the need for and extent of concomitant procedures was significantly less than had been predicted by the treating physicians. [ABSTRACT FROM AUTHOR]

Background: Recurrence rates and patterns after endovenous radiofrequency ablation (ERFA) are poorly documented. Objective: To assess the incidence and anatomical recurrence patterns of saphenous vein reflux after ERFA. Method: Two hundred patients previously treated with ERFA were recalled for clinical assessment and venous-duplex ultrasound at three years post-treatment. Results: A total of 106 patients (68F, 38M) with a mean age of 49.4 years (SD +11.5y) were assessed. Mean follow-up was 42.1 months (SD + 20.1m). Further varicose veins were identified in 31 patients (29.2%). Recanalization/recurrence/failure was diagnosed in 16 patients (15.1%), including 18 trunks (8.7%), 13 great saphenous vein (6.3%) and 5 small saphenous vein (2.4%). Twenty-seven patients (25%) developed neo-incompetence in 31 trunks and 12 non-saphenous veins. All patients with truncal recanalization had a body mass index > 29 (range 29–42). Conclusion: Disease progression was twice as high as the recanalization rate at three years post-treatment using ERFA in this study. Raised body mass index may be a contributing factor; however, further longitudinal studies are required. Patient self-selection bias may have also influenced our results. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the safety and efficacy of Catheter-Directed Thrombolysis (CDT) in the treatment of mixed deep venous thrombosis(DVT) via the Below the Knee(BTK) access. Methods: The clinical data of patients with acute mixed DVT treated with CDT by the BTK access in the department of interventional radiology, Xuzhou Cancer Hospital from January 2013 to October 2017 were retrospectively analyzed. The patients included 26 males and 12 females with an average age of 54± 11 years old. Results: The technical success rate was 100%. Interventional procedures were performed through small saphenous vein puncture (28 cases), small saphenous vein incision(4 cases), posterior tibial vein incision (4 cases), and posterior tibial vein puncture (2 cases). All CDTs were implanted with a temporarily recyclable filter preoperatively and removed within 2 weeks after surgery. Thirty-six patients achieved successful thrombolysis(Grades II and III). Two patients who did not gain thrombolytic success had a time of more than 10 days from symptom onset to CDT. 13 patients (10 cases on the left and 3 cases on the right) underwent balloon dilatation and stent implantation. During perioperative period, there were 4 cases of incision bleeding, 5 cases of numbness at the incision site, and no major complications such as new pulmonary embolism and major hemorrhage. The average follow-up time was 2 years (1 month to 4years) and 28 patients exceeded 1.5 years. Two patients had repeated patellae DVT due to not taking warfarin. The patency rate and PTS rate during follow-up were 81.6%(31/38) and 31.6%(12/38), respectively. Conclusion: The use of CDT via BTK approach in DVT is feasible and safe and may be considered an alternative to traditional CDT approach. [ABSTRACT FROM AUTHOR]

Objective To explore the clinical efficacy of distally based sural nerve nutritional vessel flap in the repair of foot and ankle soft-tissue defects and prevention and treatment of venous congestion. Methods From July 2014 to 2018, 21 patients with soft tissue defects in foot and ankle were repaired by distally based sural nerve nutritional vessel flaps. The area of flap ranged from 7 cm × 4 cm to 15 cm × 8 cm. The rotation point was located on 5 to 7 cm of the lateral malleolus. The width of pedicle fascia was from 3 to 6 cm. Partial skin bridge was reserved and small saphenous vein near the rotation point was selective ligated. The open tunnel transfer was adopted. The donor sites were directly closed or covered by split-thickness skin grafts. Results All of the 21 flaps survived. Distal local necrosis of skin surface occurred in 2 patients and the scar healed after dressing change. No obvious venous congestion and swelling occurred in remaining 19 patients. After 9 to 16 months of follow-up, all defects in foot and ankle were repaired well. The appearance and texture of flaps was good. Conclusion The distally based sural nerve nutritional vessel flap is an ideal surgical option in the repair of foot and ankle soft-tissue defects, especially accompanied with tendon and bone exposure. The venous congestion of flap could be effectively improved by ensuring a certain width of pedicle and selectively ligating the small saphenous vein near the rotation point. [ABSTRACT FROM AUTHOR]

In this case report, we present a patient scheduled for operation due to critical leg ischemia in whom a bilateral great saphenous vein (GSV) had already been used during previous cardiac and peripheral vascular surgeries. The patient underwent femorofemoral crossover bypass from left to right with a small saphenous vein and right femoropopliteal bypass with cephalic vein (CV) during the same session. Distal pulses became palpable, and symptoms regressed dramatically following the operation. A control computed tomographic angiography scan revealed no signs of graft stenosis 32 months after the surgery. Despite the recent advances in synthetic graft materials, small saphenous and CVs should be remembered as alternative long-standing conduits in the absence of the GSV. [ABSTRACT FROM AUTHOR]

Background In previous in vitro and ex vivo studies, we have shown increased thermal spread can be achieved with radiofrequency-induced thermotherapy when using a low power and slower, discontinuous pullback. We aimed to determine the clinical success rate of radiofrequency-induced thermotherapy using this optimised protocol for the treatment of superficial venous reflux in truncal veins. Methods Sixty-three patients were treated with radiofrequency-induced thermotherapy using the optimised protocol and were followed up after one year (mean 16.3 months). Thirty-five patients returned for audit, giving a response rate of 56%. Duplex ultrasonography was employed to check for truncal reflux and compared to initial scans. Results In the 35 patients studied, there were 48 legs, with 64 truncal veins treated by radiofrequency-induced thermotherapy (34 great saphenous, 15 small saphenous and 15 anterior accessory saphenous veins). One year post-treatment, complete closure of all previously refluxing truncal veins was demonstrated on ultrasound, giving a success rate of 100%. Conclusions Using a previously reported optimised, low power/slow pullback radiofrequency-induced thermotherapy protocol, we have shown it is possible to achieve a 100% ablation at one year. This compares favourably with results reported at one year post-procedure using the high power/fast pullback protocols that are currently recommended for this device. [ABSTRACT FROM AUTHOR]

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Objective To systematically review all available English literature on mechanochemical endovenous ablation and to report on the anatomical, technical, and clinical success. Methods A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Library on mechanochemical endovenous ablation for the treatment of insufficient great and/or small saphenous vein. Methodological quality of the included studies was evaluated using the MINORS score. The primary outcome measure was anatomical success, defined as closure of the treated vein on follow-up duplex ultrasound imaging. Secondary outcomes were technical and clinical success, and major complications defined as deep venous thrombosis, pulmonary embolisms or paresthesia. Results The literature search identified 759 records, of which 13 were included, describing 10 unique cohorts. A total of 1521 veins (1267 great saphenous vein and 254 small saphenous vein) were included, with cohort sizes ranging from 30 to 570 veins. The pooled anatomical success rate after short-term follow up was 92% (95% CI 90–94%) (n = 1314 veins). After 6 and 12 months these numbers were 92% (95% CI 88–95%) (n = 284) and 91% (95% CI 86–94%) (n = 228), respectively. The long-term anatomical success rates at 2 and 3 years were 91% (95% CI 85–95%) (n = 136) and 87% (95% CI 75–94%) (n = 48), respectively. Major complications and especially nerve injury were very rare (≤ 0.2%). All studies were of moderate or good quality using the MINORS scoring scale. Conclusions Mechanochemical endovenous ablation using the ClariVein in combination with liquid sclerosant is associated with an anatomical success rate ranging from 87% to 92% and good clinical success. To date, no randomized controlled trials are available studying the anatomical success after mechanochemical ablation, compared to the endothermal ablation. The risk of major complications is very low after the procedure. [ABSTRACT FROM AUTHOR]