Prevalence and Patterns of Small Saphenous Vein Reflux

Abstract

Objective

The small saphenous vein (SSV) often is a forgotten source of venous valvular insufficiency signs and symptoms or is a “victim” of unwillingness to treat. Either way, ultrasound (US) frequently focuses on the great saphenous vein without an equivalent thorough evaluation of the SSV. We investigated the prevalence and patterns of SSV reflux during a voluntary service to the community of Santiago de Guayaquil in Ecuador.

Methods

Patients were screened for SSV reflux while standing. A portable laptop scanner was used to examine the SSV at the proximal, mid, and distal calf (positions A, B, and C) in 410 legs of 205 subjects. Although all patients were C1 – C6 according to the clinical CEAP (i.e., clinical severity, etiology or cause, anatomy, and pathophysiology) classification, 14% of the legs were C0. Forward and reverse flows were noted after a variety of manual compressions. Only severe reflux lasting longer than 4 seconds is reported herein.

Results

The prevalence of SSV abnormalities was 17% (69/410). Reflux was noted in 54 (13%) of the extremities whereas in 15 (4%), the SSV did not have reflux but was intertwined with the pathways of varicose veins. The diameters of the refluxing veins were related to the location and extent of reflux. The most common pattern was reflux in the A, B, and C positions (n = 17) of SSV averaging 4.6 (A) to 4.4 mm (C) in diameter. Reflux was noted in the AB, A, and B positions in 10, 11, and 12 SSV, respectively; diameters of these veins averaged 4.1 (A) to 3.7 mm (B), 4.1 mm (A), and 3.4 mm (B). SSV reflux in the B and C and C only positions were least common (n = 4), noted in veins averaging 2.5 mm in diameter. Varicose veins interconnected with short SSV segments were noted in all three positions (A, B, and C) in seven legs whereas in eight legs the varicosities were segmental, most commonly in the B position (n = 6).

Conclusions

The prevalence of SSV abnormalities was significant. SSV reflux or connection to varicose veins was noted in close to one of five legs. The SSV should be evaluated at least at the proximal and mid calf to avoid missing significant reflux.