The small saphenous vein runs up the back of the calf and joins the deep popliteal vein behind the knee. Disconnecting it there treats reflux in the calf, but the sural nerve lies alongside, so this operation is done more cautiously than its counterpart in the groin.
Saphenopopliteal junction ligation disconnects the small saphenous vein from the popliteal vein through a short cut behind the knee. It treats varicose veins and aching in the calf caused by reflux in that vein. Because the sural nerve runs beside the vein, the junction is located with ultrasound first and the dissection is deliberately limited. Most patients go home the same day.
The small saphenous vein is the calf equivalent of the great saphenous vein of the inner thigh. When its valves fail, blood falls back down the vein on standing and produces varicose veins over the calf, aching that worsens through the day, and sometimes skin changes at the outer ankle.
Two things make this operation different from groin surgery. The first is that the junction is not always in the same place. In a proportion of people the vein joins the popliteal vein higher or lower than expected, or drains elsewhere entirely, so the junction is marked with ultrasound before any cut is made rather than assumed.
The second is the sural nerve. It supplies sensation to the outer edge of the foot and runs immediately alongside the vein in the lower calf. Handling it causes numbness, so the dissection is kept deliberately short and the lower part of the vein is often left alone rather than stripped.
Reflux must be demonstrated on ultrasound at this junction specifically. Calf varicose veins are often fed from the great saphenous vein instead, and then this operation would achieve nothing.
The junction is found with ultrasound while you stand, and its exact position marked. This step is not optional here, because the anatomy varies.
You are placed face down so the back of the knee is accessible.
A small cut is made in a skin crease behind the knee, directly over the marked junction.
The sural nerve is identified and protected before the vein is handled.
The small saphenous vein is divided and tied flush with the popliteal vein.
Bulging surface veins are removed through tiny stab incisions. The vein low in the calf is often left in place to keep the nerve safe.
You walk the same day. The back of the knee feels tight, and bending is uncomfortable at first.
Compression stocking replaces the bandage, usually at 48 hours. Numbness along the outer foot, if present, is noticed now. Bruising over the calf is normal.
Wound healed. Knee bending comfortable. Most people back at desk work by the end of week two.
Numbness, where it occurred, usually recovers over this period. Scar softens and fades.
Aching and heaviness in the calf usually improve well. Some numbness along the outer border of the foot is common in the first weeks and usually recovers, though a small number of patients are left with a permanent patch. The scar behind the knee sits in a skin crease and normally fades well, but it can be more noticeable than the groin scar because the skin there is under tension when you bend the knee.
The nerve is the issue that sets this operation apart, and it is discussed in every consultation before consent.
The wound sits over a joint, so it is treated a little more gently than one on a flat surface.
Many are fed from the great saphenous vein on the inner thigh. Treating the wrong junction achieves nothing, which is why the scan comes first.
Most numbness comes from bruising of the sural nerve and recovers over weeks to months. A small number of patients keep a permanent patch on the outer foot.
Stripping the small saphenous vein low in the calf risks the nerve for limited benefit. The lower portion is often deliberately left.
The junction behind the knee is variable in position and sits beside a nerve that matters. Marking it with ultrasound on the day, rather than relying on where it usually is, is what keeps the dissection small.
Usually priced as part of small saphenous vein surgery. Treatment for symptomatic varicose veins is commonly covered by health insurance and government schemes. A written estimate follows the scan.
Almost every question here is about the nerve.
Ask your question →Some numbness along the outer edge of the foot is common in the first weeks, because the sural nerve sits right beside the vein and is easily bruised. It usually recovers over weeks to months. A small number of patients are left with a permanent patch, which is why the dissection is kept short.
Because the nerve is wrapped closely around the vein low in the calf. Stripping that part risks lasting numbness for little extra benefit, so the junction and the bulging surface veins are dealt with and the lower trunk is often left.
Unlike the groin, this junction is genuinely variable. In some people it sits well above the knee crease, and in some the vein drains somewhere else entirely. Marking it beforehand keeps the incision small and in the right place.
Once you can bend the knee comfortably and perform an emergency stop without hesitating, usually around a week to ten days. Check your insurer's wording as well.
It can be, if both systems are refluxing. That means one anaesthetic and one recovery, though the first fortnight is less comfortable. The scan determines whether both are involved.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
