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A Journal on Phlebology
Acta Phlebologica 2008 April;9(1):11-6
Safety of endovascular laser treatment of small saphenous vein incompetence in relation to tibial nerve course in the popliteal fossa
Tuveri M., Borsezio V., Medas F., Tuveri A., Brotzu G.
Department of General and Vascular Surgery Clinica Sant’Elena, Quartu Sant’Elena, Cagliari, Italy
Aim. The aim of this work was to investigate the ultrasonographic venous anatomy at the popliteal fossa in relation to tibial nerve (TN) course in patients who are candidates for endovascular laser treatment (EVLT) for small saphenous vein (SSV) incompetence in order to assess anatomical patterns at risk for TN damage.
Methods. Ninety-seven consecutive patients for a total of 194 limbs were investigated by duplex ultrasound examination of the popliteal fossa. Forty-seven patients (48%) were candidates to EVLT due to a SSV reflux. TN course and its relation with the SSV were investigated in healthy and diseased patients.
Results. The TN ran along the medial edge of the SSV in 171 (88%) of the examined limbs; behind the vein in 7 limbs (4%); laterally in 16 limbs (8%) showing an “anastomotic” saphenous-popliteal junction (SPJ). At 2 cm from the SPJ the median distance of the TN from the SSV was 1.4 cm (range, 1.1-2.1) in healthy patients and 1.2 cm (range, 0.9-2.2) in diseased patients, and progressively diminishing as it proceeds upward.
Conclusions. Patient’s eligibility to EVLT for SSV incompetence should always follow a detailed ultrasonographic assessement of the TN course at the popliteal fossa in order to avoid the slightly higher risk of nerve damage due to anatomy.