The Saphenous Vein and Its Importance in Patients with Varicose Veins

The Saphenous Vein and Its Importance in Patients with Varicose Veins

Why Additional Phlebectomy or Sclerotherapy Is Needed for Complete Treatment

How Saphenous Veins and Varicose Veins Interact

In everyone’s legs there are at least two saphenous veins per leg.

The longest vein in your body is called the great saphenous vein.

It begins in the groin and ends at inner ankle. It is technically a superficial vein. It usually runs about an inch or two deep to the skin under a membrane called the saphenous sheath.

The other saphenous vein is called the small saphenous vein. It usually begins behind the knee and runs down the back of the calf and ends in the outer ankle.

Variations of this scenario are not uncommon.

Sometimes additional saphenous veins run along the anterior surface of the thigh.

In over 90% of patients with varicose veins, one or both or all of these saphenous veins may be involved.

The actual varicose veins are the twisted, bulging, and ropey veins that you see on the surface of the skin. They are usually branches off of the saphenous veins.

The saphenous veins and the varicose vein tributaries need to be treated separately.

Just treating the saphenous vein alone and ignoring the varicose vein branches usually leads to failure and recurrence in the long run.

Likewise, just treating the varicose veins that you see on the surface and ignoring the underling feeding saphenous vein leads to the same varicose veins recurring down the road.

Why Complete Varicose Vein Treatment Often Involves Multiple Procedures

Radiofrequency ablation of the saphenous vein

Here is how the saphenous vein is removed with radiofrequency ablation. This is not enough!

Current methods of getting rid of the saphenous veins include laser, radiofrequency ablation, glue, foam sclerotherapy and a combination of foam and mechanical abrasion of the vein with a rapidly twisting wire.

How phlebectomy works to remove varicose veins

Phlebectomy helps to remove clusters of varicose veins. When veins are too large for sclerotherapy, they can be removed through mini incisions. The doctor will make a series of very small nicks along the length of the diseased vein. The vein can be removed through needle holes leaving no scars.

One current method of treating the surface varicose veins is sclerotherapy (injections) for small varicose veins.

Phlebectomy is the other alternative for removal of the visible varicose veins through tiny needle holes. Phlebectomy is often used to get rid of large varicose veins.

Neglecting either an underlying dysfunctional saphenous vein or the varicose veins on the skin’s surface leads to unhappy patients and recurrence.

These two systems can be treated all at once if the problem is not extensive.

If the veins are wide spread, staging of the procedures is often done.

Don’t Drink the – Eliminating the Saphenous Vein is Enough – Kool Aide

Some consultants who are paid by the companies that make the saphenous vein removal devices, tell vein doctors that if you wait a few months after the saphenous vein is treated, the varicose veins on the skin will disappear in 40% of cases.

After that waiting period, they say that the problematic varicose veins will either go away or will no longer will be problematic.

What could go wrong?

In the short run that may be true in some cases.

However, over the years, the same visible varicose veins will come back if they are not completely treated.

When the same veins come back, they are more complex and difficult to treat.

The Issue of Elimination of the Saphenous Vein and Future Bypasses

If the saphenous vein is enlarged and weakened from venous reflux, heart surgeons will not consider using it for bypasses.

They know that a thin-walled and weakened saphenous vein could burst if used for a bypass resulting in immediate exsanguination.

Other options exist for a bypass if the saphenous vein cannot be used.

These alternate options include using the internal mammary arteries (preferred by most cardiac surgeons), arm veins, the radial arteries, and the ever more popular rapidly evolving stents.

From personal experience, people want the “bumps” on the surface of the skin of their legs gone.

We couldn’t agree more.

It’s not just the cosmetic issue of leaving the bumps alone, it’s the inevitable recurrence in patients who will be older and have to deal with the multitude of issues of treatment when they are less healthy.

People Aren’t Told the Whole Truth about Their Varicose Veins

Treatments discussed are purposely deceptive in most advertising.

Don’t be lured into unnecessary ultrasound testing, surgeries and saphenous vein procedures that are unwarranted.

  • Beware of ads that promise ‘simple and fast and easy” varicose vein treatments.
  • Beware of vein clinics that offer free screenings, free consultations, or credit card promotions for you to be lured into their office.
  • Beware of places that use Groupon to promote their vein treatments.
  • Beware of those ads that state that varicose veins are a potentially fatal condition.
  • Beware of misleading credentials like – “board certified in phlebology.”
  • Beware of vein centers that guarantee a cure for your varicose veins.

The Deception of Varicose Vein YouTube Videos – Where’s the Beef?

YouTube videos made by entrepreneurial physicians are notorious for leaving out the negative details.

They simply leave out all of the bad stuff.

They are not “fair and balanced” as the old Fox news slogan used to claim.

Here are the details from a study published in March 2017 in Science Direct about varicose vein Youtube videos.

More than half of all YouTube videos (58.8%) had a focus on minimally invasive treatments. Endovenous laser therapy was the most common focus (31.1%); 14.5% of videos presented significant discussion on multiple treatment modalities; and 19.3% of videos did not have a clear focus on any treatment modality. Of videos that focused on minimally invasive techniques, nearly all (132/134 [98.5%]) were in favor of the intervention discussed without presenting balanced discussion of alternatives.

They concluded by saying that YouTube “educational” promotional videos about varicose vein procedures were neither comprehensive nor adequately balanced to serve as fair and balanced information for patients.


Saphenous veins often need treated if you have varicose veins.

Saphenous vein treatment alone is rarely enough.

Have your all of your symptomatic veins treated completely before they inevitably get worse.

Take it from a vascular specialist who hears people frequently say, “I shouldn’t have let my varicose veins go to this stage”.

It’s the most won­der­ful time of the year, or so the song goes.

And while those who hate the snow might disagree, for treating varicose veins, it is the best time of the year.

During cooler weather, it can be a won­der­ful time to have your varicose veins treated.

Hot stockings after treatments are better tolerated in mild or cold weather.

Untreated or neglected varicose veins inadequately treated usually become a recurring problem.

Call us at 724-969-0600 to learn more.

About The Author

Dr. John Happel

Dr. John Happel has been in practice as a surgeon since 1986 in the Pittsburgh region. He specializes in vascular surgery and has subspecialized in the treatment of varicose and spider veins since 1999. Dr. Happel is board certified in vascular surgery and recertified in vascular surgery in 2012. He was chosen in 1985 to fulfill the position for the vascular surgical fellowship at the world renowned Mayo Clinic.