INTRODUCTION

The management of superficial and deep venous reflux and obstruction that leads to the development of varicose veins (VV) and the post-thrombotic syndrome (PTS) forms a large part of the workload for most vascular and endovascular specialists and is likely to increase as the population ages. However, the epidemiology, genetics and pathophysiology of these conditions remains incompletely defined and many clinicians lack a clear understanding of the underlying anatomy and vascular biology. As a result, treatment outcomes are not infrequently sub-optimal.

ANATOMY

Venous blood from the lower limbs returns to the right heart against gravity through the superficial and deep venous systems. The superficial venous system comprises the great saphenous veins (GSV) and small saphenous veins (SSV) and their tributaries. The GSV originates from the medial end of the dorsal venous arch, passes anterior to the medial malleolus, and continues up the medial aspect of the calf and then the thigh to enter the common femoral vein in the groin at the saphenofemoral junction (SFJ). The SSV originates from the lateral end of the dorsal venous arch, passes posterior to the lateral malleolus and then continues up the back of the calf between the heads of gastrocnemius to enter the popliteal fossa. It is joined variably by gastrocnemius veins and then usually enters the popliteal vein at the sapheno-popliteal junction (SPJ). The SPJ may be absent in which case the SSV continues up the postero-medial aspect of the thigh (Giacomini vein) and often joins the GSV.