Great saphenous vein diameter at different regions and it's relation to reflux


  • Said I. El Mallah Department of Surgery, Menoufia University, Menoufia, Egypt
  • Yahia M. Al Khateep Department of Surgery, Menoufia University, Menoufia, Egypt
  • Kareem H. Kamel Department of Vascular Surgery, El Sahel Teaching Hospital, Cairo, Egypt



Varicose veins, Great saphenous vein, Vein diameter at different regions, Comparison of clinical trials


Background: Great saphenous vein (GSV) incompetence is involved in the majority of cases of varicose disease. Standard pre-interventional assessment is required to decide the treatment modalities. GSV diameter measured at sapheno-femoral junction, proximal thigh, distal thigh, knee, proximal leg, distal leg. Analysis done to find at which diameter size the reflux expected to occur.

Methods: The study involved 100 limbs from outpatient vascular clinic. GSV diameter measurement was done at the sapheno-femoral junction, at the proximal thigh, at the distal thigh, below the knee, mid leg in correlation to the reflux.

Results: SFJ reflux (group I) was observed at 7.16±2.30 mm, proximal thigh (group II) at 6.60±1.89 mm, distal thigh (group III a) at 6.12±1.63 mm, knee (group III b) at 5.78±1.60 mm, proximal leg (group IV) at 4.6±1.24 mm, and mid leg (group V) at 3.59±1.16 mm.

Conclusions: Measurement at six sites revealed higher sensitivity and specificity to predict reflux, GSV diameter correlates with reflux, sites to predict reflux not only at SFJ and proximal thigh but GSV measurement at knee joint can predict reflux. Measurement of GSV at knee joint can predict reflux if more than 5.5 mm.


Maurins U, Hoffmann BH, Lösch C, Jöckel KH, Rabe E, Pannier F. Distribution and prevalence of reflux in the superficial anddeep venous system in the general population e results from the bonn vein study. Germany J Vasc Surg. 2008;48:680-7.

Mendoza E, Blättler W, Amsler F. Great Saphenous Vein Diameter at the Saphenofemoral Junction and Proximal Thigh as Parameters of Venous Disease Class. Eur J Vasc Endovasc Surg. 2013;45(1):76-83.

Mowatt-Larssen E, Shortell C. CHIVA. Semin Vasc Surg. 2010;23:118-22.

Almeida JI, Kaufman J, Göckeritz O, Chopra P, Evans MT, Hoheim DF, et al. Radiofrequency endovenous Closure FASTversus laser ablation for the treatment of great saphenous vein reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv-Radiol. 2009;20:752-9.

Breu FX, Guggenbichler S, Wollmann JC. 2nd European consensus meeting on foam sclerotherapy 2006. Tegernsee, Germany: VASA. 2008;71:3-29.

Ahmed S. Elmallah, Yehia M.Alkhateeb, Said I. Elmallah. In the era of endo-venous ablation of varicose veins, is surgery still competitive? Int Surg J. 2018;5(12):3904-8.

Alkhateep YM, Zaid N, Fareed A. Combined stab high ligation with retrograde laser ablation compared to endovenous laser ablation in the treatment of symptomatic great saphenous varicose veins. Egyptian J Surg. 2018;37:132-7.

Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs UIP consensus document. Part I. Basic principles. Eur J Vasc Endovasc Surg. 2006;31:83-92.

Pares O. Varicose vein surgery: stripping versus the CHIVA method. A randomized controlled trial. Ann Surg. 2010;251:24-31.

Evans CJ, Allan PL, Lee AJ, Bradbury AW, Ruckley CV, Fowkes FGR. Prevalence of venous reflux in the general population on duplex scanning: the Edinburgh Vein Study. J Vasc Surg. 1998;28:767-76.

Labropoulos N, Tiongson J, Pryor L, Tassiopoulos AK, Kang SS, Mansour A, Baker WH (2003) Definition of venous reflux in lower-extremity veins. J Vasc Surg. 2003;38:793-8.

Lurie F, Comerota A, Eklof B, Kistner RL, Labropoulos N, Lohr J. Multicenter assessment of venous reflux by duplex ultrasound. J Vasc Surg. 2012;55:437-45.

Lattimer CR, Azzam M, Kalodiki E, Geroulakos G. Venous filling time using air-plethysmography correlates highly with great saphenous vein reflux time using duplex. Phlebology. 2014;29(2):90-7.

Lattimer CR, Kalodiki E, Azzam M. Volume displacements from an incompetent great saphenous vein during a standardised Valsalva manoeuvre. Acta Phlebologica. 2012;13(1):25-30.

Kahle B, Hennies F, Bolz S, Pritsch M. The Reproducibility of the Ratio of volume flow in the common femoral vein and artery (VAFI) for quantification of the severity of venous insufficiency. Vasa. 2003;32:199-203.

Rudolphi P, Hunold P, Kahle B. Quantitative Erfassung desSchweregrads der venösen Insuffi zienz anhand der Hämodynamik. Posterpräsentation 54. DGP-Jahrestagung in Lübeck. 2012.

Coleridge-Smith P, Labropoulos N, Partsch H, Myers K, Nicolaides A, Cavezzi A. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbsd UIP consensus document. Part I. Basic principles. Eur J Vasc Endovasc Surg. 2006;31:83-92.

Mendoza E. Duplex-Sonographie der oberflächlichen Beinvenen. Darmstadt: Steinkopff; 2006.

Yamaki T, Nozaki M, Sakurai H, Takeuchi M, Soejima K, Kono T. Comparison of manual compression release with distal pneumatic cuff maneuver in the ultrasonic evaluation of superficial venous insufficiency. Eur J Vasc Endovasc Surg. 2006;32:462-7.

Pittaluga P, Chastanet S, Rea B, Barbe R. Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein. J Vasc Surg. 2009;50:10 7-18.

Cappelli M, Molino Lova R, Ermini S, Turchi A, Bono G, Bahnini A, Franceschi C. Ambulatory conservative hemodynamic management of varicose veins: critical analysis of results at 3 years. Ann Vasc Surg. 2000;14:376-84.

Eklof B, Rutherford RB, Bergan JJ, Carpentier PH, Gloviczki P, Kistner RL, et al. Revision of CEAP classification for chronic venous disorders (CVD). J Vasc Surg. 2004;40:1248-52.

Theivacumar NS, Dellagrammaticas D, Darwood RJ, Mavor AID, Gough MJ. Fate of the great saphenous vein following endovenous laser ablation: does re-canalisation mean recurrence? Eur J Vasc Endovasc Surg. 2008;36:211-5.

Hach W, Hach-Wunderle V. Die Rezirkulationskreise der primären Varikose e Pathophysiologische Grundlagen zur chirurgischen Therapie. Berlin: Springer Verlag; 1994.

Theivacumar NS, Dellagrammaticas D, Mavor AID, Gough MJ. Endovenous laser ablation: does standard above knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial. J Vasc Surg. 2008;48:173-8.

Gibson K, Meissner M, Wright D. Great saphenous vein diameter does not correlate with worsening quality of life scores in patients with great saphenous vein incompetence. J Vasc Surg. 2012;56(6):1634-41.






Original Research Articles