The Neglected Vein: Why Treating the Small Saphenous Vein ( SSV) Is Crucial for Lasting Varicose Relief
For years, the focus in treating varicose veins has often centered on the great saphenous vein (GSV), the long superficial vein running along the inner thigh. However, a growing body of evidence and the experience of vein specialists suggest that overlooking the small saphenous vein (SSV) in the back of a calf, can undermine the success of treatment and lead to frustrating recurrences.
My own experience, including my training at a major teaching hospital where SSV treatment was often omitted – frequently due to the technical challenges of accessing this smaller, sometimes tortuous vessel – has underscored the critical role the SSV plays in long-term vein health.
Having now performed over 7,000 vein procedures, it has become clear that a comprehensive approach necessitates careful evaluation and, when necessary, treatment of the SSV.
The great and small saphenous veins are often linked by inter-saphenous veins, typically originating in the mid to lower calf. Consequently, if a refluxing (abnormally functioning) SSV is left untreated, the previously treated GSV can become recanalized over time. This allows blood to flow backward, causing a recurrence of symptoms and varicose veins through these connecting vessels.
Therefore, a thorough initial evaluation that includes the SSV is paramount. Even if the SSV appears normal initially, close monitoring after GSV treatment is advisable. Furthermore, I recommend a follow-up examination one month after SSV ablation.
A significant portion – 10 to 20 percent – of patients can develop enlarged distal SSV and mid-calf SSV recanalization accompanied by recurrent symptoms.
In conclusion, neglecting the SSV, particularly in the presence of refluxing intersaphenous veins and complex symptomatic varicose veins, significantly increases the likelihood of recurrence.
While treating SSV can present technical hurdles, seeking out a reputable and experienced vein specialist is the essential first step toward achieving successful and lasting relief from varicose veins.
