Saphenous incontinence: what it is and the latest techniques to treat it

By Cristiano Antonino On Jan 30, 2023

More commonly known as varicose pathology, saphenous incontinence is the condition that gives rise to the appearance of varicose veins and varicose veins on the lower limbs, characterised by side symptoms such as heaviness in the legs, oedema and swelling

Saphenous incontinence: what it is

To explain what incontinent saphenous vein is, one must start with the functioning of the superficial venous circulation: the superficial venous circulation of the lower limbs consists of numerous interconnected vessels that carry ‘dirty’ blood, laden with carbon dioxide, to the deep venous circulation.

From here the ‘dirty’ blood is then carried to the heart, to be pushed towards the lungs where once re-oxygenated, it is distributed to the various organs and tissues.

The saphenous veins are the 2 main venous collector vessels of the superficial venous circulation and there are 2 in each limb:

the internal saphenous vein, or saphenousa magna (great saphenous vein), is longer and runs the length of the limb from the ankle to the groin, flowing into the deep venous circulation at the level of the common femoral vein;
the external saphenous vein, or saphenous parva (small saphenous vein), runs on the posterior surface of the leg from the ankle to the popliteal cord (posterior region of the knee), flowing into the popliteal vein.

We imagine the superficial venous circulation of the lower limbs as a tree in reverse, where the branches are a dense network in which the blood flows to the trunks, the saphenous veins.

The saphenous veins are equipped with dovetail valves, which under physiological conditions allow blood flow to move rhythmically from the feet towards the heart.

By opening rhythmically like a parachute, they prevent reflux towards the feet.

In the case of varicose vein disease, where we see degenerative processes of the venous valves and abnormal dilatation of the superficial veins, the venous blood in the superficial circulation ends up completely reversing its natural direction, thus proceeding from above towards the feet.

Saphenous incontinence occurs in such cases, in which the saphenous veins have completely lost their function and can also cause progressive dilation and tortuosity of the collateral branches, leading to the appearance of so-called varicose veins or varices.

How to treat saphenous incontinence

In the past, until not too many years ago, the most common surgical treatment of saphenous vein incontinence was stripping: the diseased saphenous vein was ‘pulled out’ with the help of a plastic guide (stripper) inserted inside the vessel, under selective spinal anaesthesia or sometimes under general anaesthesia and involving a hospital stay of 1-2 nights.

The operation was not without complications such as the appearance of voluminous haematomas and, more rarely, annoying sensory disturbances due to the lesion of the saphenous nerve.

This prompted vascular surgeons to search for less invasive techniques, burdened with fewer complications, possibly without hospital stay, with shorter recovery times and under local anaesthesia or even without the need for anaesthesia.

The latest minimally invasive techniques for treating the saphenous incontinence

Surgical treatment, used until a few years ago for the treatment of this pathology, is giving way to minimally invasive strategies that reduce risks and shorten recovery times.

These are innovative techniques, but with proven efficacy, which aim to close the diseased saphenous vein using different methods.

Thermo-ablation of the saphenous vein

Thermo-ablation of the saphenous vein is the therapy currently recommended by international guidelines for the treatment of the pathological saphenous vein.

It closes the saphenous vein from the inside by means of heat generated by a probe inserted into the vessel, which delivers laser or radiofrequency technology.

Objective in both cases: ‘drying’ the vessel.

Thermoablation is performed under local anaesthesia and in the operating theatre under ultrasound guidance.

Except in particularly complex cases, a hospital stay is not necessary.

Elastocompression stockings to be worn during the day for about 1 month are indicated.

Sclerotherapy and scleromousse

In the case of sclerotherapy and scleromousse, the doctor injects a sclerosing drug in liquid or foam form (which allows a better adhesion between the vessel wall and the chemical agent it is made of), to induce a chemical occlusion of the saphenous vein and, if necessary, also of the varicose collaterals and capillaries.

It is an outpatient treatment, performed under ultrasound guidance and does not require anaesthesia.

Slender post-treatment: elastocompressive stocking to be worn only during the day for about 1 month after the end of the treatment, carried out in 1 or more sessions depending on the case.

Cyanoacrylate glue

This involves the injection inside the saphenous vein of a substance that ‘glues’ it.

It has the advantage of being an outpatient treatment and requiring no anaesthesia.

In the post-treatment period, elastocompression stockings are recommended for about 1 month.

Mechanical-chemical ablation of the saphenous vein (MOCA)

Mechanical-chemical ablation of the saphenous vein (MOCA) consists of causing a microtrauma on the inner saphenous vein wall through a catheter that has a rotating structure at its tip.

At the same time, a sclerosing foam is injected that acts better on the damaged wall, with the aim of occluding the vessel.

Outpatient treatment that does not require anaesthesia.

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