SAPHENOUS VEIN INSUFFICIENCY (INCOMPETENCE)

 

The saphenous veins are the largest "superficial" veins of our leg. Their function is to transport deoxygenated blood to the deep veins of the leg and thus to ensure that it is delivered to the lung. There are two saphenous veins. The great saphenous vein (GSV) starts from the inner part of the foot, extends to the thigh and connects with the deep veins in the groin. The small saphenous vein (SSV) starts from the posterior-outer part of the foot, extends from the posterior aspect of the calf to the knee and joins into the deep veins at the posterior part of the knee.

 

Varicose veins appear years after the onset of venous insufficiency

Saphenous vein insufficiency is the most common cause of varicose veins. Approximately 50% of the patients with varicose veins have GSV and 20% have SSV insufficiency. Saphenous vein insufficiency may cause typical symptoms in most patients, such as pain, burning, swelling, itching and cramping. Varicose veins occur years after the onset of venous insufficiency. These veins, which were formerly normal veins, grow over the years and become large protruding varices similar to bunch of grapes. Large varicose veins can sometimes be accompanied by small black-purple colored capillary varices called corona phlebectica that appear around the ankle. As the disease progresses, itchy wounds may occur around the ankle. Initially tiny, these wounds grow over time, deepen and become typical venous ulcers. Venous ulcers are difficult to heal because they occur due to an underlying circulatory problem (venous insufficiency).

 

 

Where are varicose veins located in saphenous vein insufficiency?

In saphenous vein insufficiency, the location of varices and venous ulcers is usually typical: In GSV insufficiency, varices are usually below the knee and inside the calf, and in the case of SSV insufficiency, varices are below the knee but at the posterior-outer side of the calf. Venous ulcers, on the other hand, are located on the inner face of the ankle in GSV insufficiency and in the posterior-outer part of the ankle in SSV insufficiency.

 

 

 

 

 

 

 

 

 

 

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In patients with varicose veins, saphenous vein insufficiency should always be treated before the varices. The aim of the treatment is to eliminate the diseased saphenous vein. For this purpose, the formerly used method is to remove the saphenous vein by surgery. In the new method, which is called ablation, the saphenous vein is entered with a needle and destroyed by laser, radiofrequency, MOCA or adhesive methods. The destroyed vein is closed and then eliminated by the body's natural mechanism. So much so that, saphenous vein can hardly be seen even on ultrasound at 6 months after laser or radiofrequency ablation.

 

 

 

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Incompetent saphenous veins can not be used for bypass surgery

Normal saphenous veins are sometimes used in vascular bypass operations in heart and leg artery occlusions. However, the saphenous vessel must be "normal", ie a few millimeters in diameter, to be used as a bypass. In venous insufficiency, saphenous veins are generally larger than 5-6mm, often close to 1cm in diameter and therefore cannot be used as a bypass vessel. In addition, the arteries of the breast and wrist arteries are preferred more frequently than saphenous vein for bypass. For these reasons, patients undergoing saphenous ablation should not be worry about losing their saphenous vein as such incompetent veins are not suitable to be used in bypass surgery anyway.

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Our body transfers the function of the incompetent veins to healthy veins

In saphenous vein insufficiency, when the insufficiency begins, the body notices the problem in the incompetent vein and tries to find ways to send back the deoxygenated blood to the lung. For this purpose, it uses the connecting vessels, ie, perforating veins, to direct venous blood to deeper healthy vessels. As venous insufficiency increases, the body expands the connecting vessels even more. Thanks to this mechanism, patients often do not realize for a long time that they have superficial vein failure. Therefore, when venous insufficiency is diagnosed, the body has already transferred the function of the saphenous vein (years ago) to healthy deep vessels. Thus, patients undergoing laser treatment of saphenous vein should know that they are not losing a functioning vein.