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Understanding Saphenous Veins

By Dr Ken Seifert – Follow me on +

My name is Ken Seifert, M.D. I work at Optima vein care and I will be publishing in this blog weekly to help inform the public about the work we do and the help we can provide you with your varicose and spider veins.

Every week I will write a short article that I hope will help you understand the problem and the treatment of varicose and spider veins.

Last week I wrote about the valves in veins. You can think about the superficial vein system like an upside down tree. Most peoples legs have two or three trunks. The largest trunk in the so called “great saphenous vein.” It begins in the groin and goes down to the ankle on the inside of the leg. The next largest trunk is the short saphenous vein in the back of the calf. It usually begins at the knee in the back of the leg and goes down the middle of the back of the leg and then veers toward the outside of the ankle. Then, sometimes, there can be a vein in the front of the thigh called the “anterior duplicated saphenous vein” and it goes down the front of the thigh and then may go to the outside of the thigh.

The course of the great saphenous vein is quite reliable but there are interesting variations. One of the things that surprised me when I took my anatomy class in medical school is that people are as different inside as they are outside. About 8% of people have a so-called duplicated great saphenous vein in the thigh. In people who have this variation two veins run next to each other for some distance and then rejoin. It is important during ultrasound examination to recognize this variation when it occurs. Both branches of the duplicated vein may need to be treated in order to achieve a long-lasting cure of the varicose veins. This variation is even more common below the knee. There are branches of the great saphenous vein that almost always occur and others branches that are unusual. In examining individuals it is important to know about these variations.

The small saphenous vein has even more variations. Most of the time it begins in the back of the calf at the level of the knee. But it may begin above the knee, or rarely, below it. In fact, it may connect to the great saphenous vein in the middle of the thigh and not directly connect to the deep veins at all.

Knowledge of the variations is extremely important in planning therapy.

If the valves are working correctly then the vein is said to be “competent”. If the vein valves are not working correctly then the vein is said to be “incompetent”. It is incompetent valves that cause varicose veins. These valves cannot be repaired. Forty years of research have gone into finding ways to repair these valves and so far no way as been found. Veins of the superficial system of the leg are really too small and too delicate to repair.

Methods of treatment mostly consist of selectively destroying trunks and branches of the superficial vein system. I’ll write about this next week.