Jan Sloves: Patterns and Pitfalls Influencing Treatment of Small Saphenous Vein Reflux
Jan Sloves, President and Consultant at Vascular Imaging Professionals LLC, shared a post on LinkedIn about a recent article by Gillian Lee et al, adding:
“Just published in Endovascular Today article by Gillian Lee and Sherry S. on Small Saphenous Vein Reflux.
- SSV disease is common and different: Roughly 10–20% of symptomatic varicose vein patients have SSV incompetence, often older, with fewer visible varices and lower VCSS than classic GSV patients.
- Anatomy drives strategy: An SPJ exists in only nearly 75% of limbs; in ~70% the SSV continues as a cranial extension/intersaphenous vein with multiple drainage patterns into popliteal, thigh perforators, or gluteal veins. If your scan assumes a single straight stump into the popliteal vein, your map is wrong.
- Reflux patterns are complex: Only about half of limbs have combined SPJ + SSV reflux. The rest show various combinations involving cranial extension/ISV, gastrocnemius veins, perforators, and tributaries. Treating “the SSV” without mapping these segments is guesswork.
- Technique matters: Thermal ablation below the gastrocnemius risks sural nerve injury. Tip position at the fascial curve and respect for SPJ type/GV inflow are critical, and NTNT options (cyanoacrylate, microfoam, MOCA) allow safer distal treatment when truly indicated.
When we respect the anatomy, outcomes are excellent. Contemporary series show 89–98% anatomic success and very low clinically significant neuropathy when protocols are followed.
The SSV is not a short straight tube into the popliteal vein; it’s a shape‑shifter with cranial extensions, inter-saphenous connections, gastrocnemius inflow and wildly variable SPJ anatomy.
If your duplex protocol doesn’t deliberately hunt for a high, absent, or rudimentary SPJ, track the cranial extension/Giacomini pathway into the thigh and map how gastrocnemius veins, perforators and tributaries feed the system, then you are not ‘characterizing SSV reflux’ you’re taking a snapshot of one segment and guessing the rest.
For a vein that supplies 10–20% of our symptomatic patients and sits next to the sural and tibial nerves, that level of interrogation is not enough.
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Title: Small Saphenous Vein Reflux: Patterns and Pitfalls Influencing Treatment
Authors: Gillian J. Lee, Sherry D. Scovell
Read the Full Article on Endovascular Today
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