From the Guidelines
A saphenous varix is a dilated bulging of the saphenous vein where it joins the femoral vein in the groin area, typically becoming more prominent when standing and may disappear when lying down, as a result of incompetent valve at the saphenofemoral junction allowing blood to flow backward and pool in the vein 1.
Definition and Pathophysiology
- A saphenous varix is a type of varicose vein that occurs in the saphenous vein, which is a superficial vein in the leg.
- It is characterized by a dilated and tortuous vein that can be seen as a bluish lump in the groin area.
- The condition occurs when the valve at the saphenofemoral junction becomes incompetent, allowing blood to flow backward and pool in the vein.
Diagnosis and Treatment
- Diagnosis typically involves physical examination, with the physician checking for a positive "cough impulse" (the lump expands when coughing) and confirmatory ultrasound imaging 1.
- Treatment is usually only necessary if symptoms are bothersome and may include compression stockings for mild cases or surgical intervention such as endovenous ablation or ligation and stripping for more severe cases 1.
- Endovenous laser ablation and radiofrequency ablation are minimally invasive procedures that have been shown to be effective in treating saphenous varices, with similar efficacy to surgical ligation and stripping 1.
- The choice of treatment depends on the severity of symptoms, patient preferences, and the presence of other underlying medical conditions.
Outcome and Prognosis
- The condition is generally benign, but if left untreated, it can lead to complications such as chronic venous insufficiency, skin ulcers, and thrombophlebitis 1.
- With proper treatment, the prognosis is excellent, and most patients can expect significant improvement in symptoms and quality of life. Treatment should be individualized based on the severity of symptoms and patient preferences, with a focus on minimizing morbidity, mortality, and improving quality of life 1.
From the Research
Definition of Saphenous Varix
- Saphenous varix is a rare condition characterized by isolated distention of the saphenous vein immediately below the sapheno-femoral junction 2.
- It is also referred to as a short (or small) saphenous vein (SSV) varices, which occurs as a result of an incompetent sapheno-popliteal junction, where the SSV joins the popliteal vein, resulting in reflux in the SSV 3.
Clinical Significance
- The clinical significance of saphena varix lies in its differentiation from other conditions that cause a groin mass 2.
- Untreated varicose veins, including saphenous varix, may sometimes lead to ulceration of the leg, which is difficult to manage 3.
Treatment Options
- Treatment options for saphenous varix include endovenous laser ablation (EVLA), radiofrequency ablation (RFA), ultrasound-guided foam sclerotherapy (UGFS), and conventional surgery 3, 4, 5, 6.
- EVLA has been shown to be effective in reducing symptoms, resolving varicose veins, and healing ulcers 5.
- Comparative studies have shown that EVLA is as effective as conventional surgery and superior to UGFS in terms of anatomic success rate and quality-of-life improvement 6.