Congrès SFP décembre 2014

Why it is not always necessary to treat the sapheno-popliteal junction in refl uxing small saphenous veins.


(1) MD, Private Surgery, Via Francesco Datini 46, 50126 Florence, Italy.
(2) Don Gnocchi Foundation, Via di Scandicci 269, Florence, Italy

Basically, the treatment of refl uxing small saphenous vein (SSV) should be addressed by fi rst assessing
the sapheno-popliteal junction (SPJ), which can show three main hemodynamic patterns:
1) no reflux;
2) diastolic reflux;
3) systolic reflux.
The second step of our assessment

should also include the anatomical and functional patterns of SPJ
tributaries, both superior, such as the Giacomini’s vein (GiaV) and the Thigh extension of the SSV (TESSV),
and inferior, such as the Gastrocnemious veins (GVs).
By combining the above two assessments we can plan our strategy, as follows:
1) in the case the terminal valve of the SPJ is competent, there is no refl ux through the SPJ, and it is,
obviously, pointless to disconnect the SPJ.
2) when a diastolic SPJ refl ux is present, the indication for SPJ disconnection is clear. However, in the
case a high speed descending flow is present in the GiaV or in the TE-SSV, the preservation of the
SPJ might be considered. If GVs share a common outlet into the popliteal vein with the SSV, the SPJ
disconnection should be avoided.
3) when a systolic SPJ reflux is present, it is mandatory to exclude first the presence of a vicarious shunt,
as in this case the SPJ must absolutely not be disconnected. If there is not a vicarious shunt, the
indication for SPJ disconnection is clear. However, in the case the systolic reflux, once a vicarious
shunt has been excluded, and it is also directed upward in the GiaV showing a re-entry perforator vein
along its course, the SPJ disconnection might be avoided.
The presentation will go more extensively through the several possible hemodynamic patterns of the
sapheno-popliteal complex and the coherent strategies to treat the sapheno-popliteal junction in
refluxing small saphenous veins.

Key words: sapheno-popliteal junction, short saphenous vein reflux.