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Vein Saphenous Reflux
A Most Common Problem

Most likely vein saphenous reflux is what you heard was the problem in past varicose veins treatments you had.  Or maybe with a family member or friend.

So often the saphenous vein is the defect underlying many surface varicosities.  If it is not dealt properly any other treatment will not be effective.

Assuming that is their cause.

Why is this so?

The Saphenous Veins

As I note elsewhere the saphenous vein occurs in two distinct entities - the long and the short of it.

The long saphenous vein tracks blood from the ankle to your groin.  

The short version runs from about the achilles tendon to the crease behind your knee.  The top connection can be quite variable though.

Vein saphenous reflux in the short saphenous vein territory at the back of the calf shown in a hikerVaricose vein in short saphenous vein territory

Each one in its true form lies in a compartment on top of the muscle surrounded by a firm fibrous like envelope. 

As well as communicating with the deep vessels in the muscles at their very top end, usually there are other connections along the length of each one.

Vein Saphenous Reflux Dynamics

When vein saphenous reflux occurs part or all of one of these veins has become stretched or dilated.  Occasionally both can be involved. 

With the larger their internal valves cannot seal properly to prevent reverse flow - much like a leaky tap washer. 

Blood flows backwards with gravity once the muscle pump pressure pauses.

As there are links to these vessels from the deeper system, pressures from the pelvic area and the large leg muscles transmit back from deep down to the outside.

Causes Of Raised Pressure

Straining with heavy lifting or going to the toilet raises your pressure in the abdomen.  This communicates back.  Right to the surface varicose veins. 

Muscle contractions can raise pressure to twice arterial levels.  This has been demonstrated in medical student volunteers…. if there is such a thing.

Besides these pressure effects the height of the unsupported blood column in the damaged saphenous vein will be added whenever you stand or sit.

Sizes Of Refluxing Saphenous Veins

Dilated, or stretched, saphenous veins are usually greater in diameter than the healthy ones.  The normal veins vary from 2mm to 4.5mm.  Larger further up the leg. 

At times ones of lesser diameter reveal vein saphenous reflux.  Their original, healthy size was obviously smaller. 

I have seen only about three long saphenous veins at the top of the thigh at 6mm and just over that were still functioning normally. 

At the upper end of refluxing veins 8mm diameter and more may occur.

Saphenous Veins Territory

Between them the long and short saphenous systems drain nearly all the surface veins of your legs.

If you added the anterolateral vein of the thigh, which drains into the long saphenous vein, they cover even more.

Individual perforating veins can produce varicose veins aside from vein saphenous reflux. 

In a way the giacomini vein is independent too.  But it does connect the short to the long saphenous systems.

Preserving The Long Saphenous Vein

There was a time when cardiovascular surgeons were encouraging those treating veins to spare long saphenous veins.  They did, and still do to an extent, use the vein as a graft in coronary artery bypass surgery

Vein surgical techniques were modified in response to the request. 

The results though were poor. 

A further modified technique proved more effective. 

But if the vein is dilated it is of no use for bypass purposes anyway.

Essential Venous Control

As shown, with the relatively high pressures in the saphenous systems, it is essential to gain control of these vessels if you are to have any chance of long-term improvement. 

Treatments used for them need to create a strong repair to be effective under these high stressors.

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