2022 Volume 33 Issue 1 Pages 1-6
We investigated consecutive 3253 patients of varicose veins with incompetence of the great saphenous vein (GSV) and/or the small saphenous vein (SSV) to clarify the characteristics of SSV incompetence compared with GSV incompetence. There were 1070 male patients (age 15–91, median 64) and 2183 female patients (age 20–97, median 62). Doppler ultrasound was used to detect reverse flow in the saphenous veins caused by manual compression of the calf. For simplicity, we use the following abbreviation. “R”, “L”, “r” and “l” stand for the incompetence of the right GSV, the left GSV, the right SSV and the left SSV, respectively. For instance, “rl” stands for the incompetence of the bilateral SSV and “Lr” stands for the combination of the left GSV and the right SSV incompetence.
The follow-up period was up to 26 years, and 57 cases (median 9 years of observation period) showed valve failure in the saphenous vein at a different site from the initial diagnosis more than 5 years later. There were 16 cases of men (initial diagnosis age 45–81, median 61) and 41 women (initial diagnosis age 36–78, median 51). In 39 cases valve failure appeared in the GSV on the opposite side at the initial diagnosis (right→left 20, left→right 19). Eleven patients with valve failure only in the SSV at the initial diagnosis later appeared the GSV incompetence (the same side 3, the opposite side 8). On the other hand, seven patients with valve failure only in the GSV at the initial diagnosis later appeared the SSV incompetence (the same side 2, the opposite side 5).
Most of the patients were affected only one vessel (R=912, L=1020, r=135, l=155). Two vessels combination were RL=789, Lr=69, Rl=56, rl=40, Ll=25, Rr=13 from most to least. It is interesting that there were more contralateral combinations (Rl or Lr) than ipsilateral combinations (Rr or Ll). The incidence of bilateral SSV incompetence rl/(r+l+rl)=0.12 was less than that of bilateral GSV incompetence RL/(R+L+RL)=0.29. Three vessels combination (RLr=15, RLl=13, Lrl=5, Rrl=3) and four vessels combination (RLrl=3) were very rare.
Over all, 10% had SSV incompetence only and 6% had both SSV and GSV incompetence. Female/male ratio of SSV incompetence (257/73=3.52) was higher than that of GSV incompetence (1768/953=1.86). The left-sided predominance was more prominent in SSV (l/r=1.15) than in GSV (L/R=1.12). It is also more prominent in male (l/r=1.27, L/R=1.18) than in female (l/r=1.11, L/R=1.09). The incidence of congestive dermatitis (C4, C5 and C6 according to CEAP classification) in SSV incompetence (2.7%) was less than that in GSV incompetence (3.8%).
