Comment to: Pre-operative determination of anatomic variations of the small saphenous vein for varicose vein surgery by three-dimensional computed tomography venography, by Kim SY, Park EA, Shin YC, et al. Phlebology 2012;27:235-41.

Short saphenous vein (SSV) surgery is more challenging due to higher recurrence and complication rates than great saphenous vein (GSV) surgery. The main reason for that is the presence of many anatomic variations in SSV anatomy and the close proximity of the vein with adjacent nerves in the somewhat crowded popliteal fossa. Accurate anatomic knowledge about the varicose veins (VV) and neural topography is necessary to prevent nerve damage during surgery. Duplex ultrasound (DUS) imaging is the gold standard investigation for VV, but has limitations such as operator-dependent variable results, a time-consuming procedure, possible omission of perforators in unusual locations and a difficulty in the evaluation of pelvic vessels. Three-dimensional computed tomography venography (3D-CTV) cannot replace DUS, but can provide additional powerful 3D images. The exact anatomy of the individual patient can be evaluated before surgery, so that the surgery can be performed with full knowledge of the patient specific anatomy and hemodynamic. This may contribute to minimizing complications and recurrence after VV surgery with SSV reflux. From January 2005 until December 2007 a total of 120 limbs in 103 patients with SSV insufficiency confirmed by duplex underwent conventional operations of high ligation, segmental stripping and varicosectomy....