title: Primary varicose veins: the sapheno-femoral junction, distribution of varicosities and patterns of incompetence.
abstract: OBJECTIVE
  to determine the patterns of long saphenous vein (LSV) disease in primary varicose veins (VVs).
  
  
  METHODS
  a retrospective analysis of venous duplex scans performed on patients referred for treatment of primary VVs.
  
  
  METHODS
  analysis was made of sapheno-femoral junction (SFJ) incompetence, non-SFJ incompetence, segmental and perforating vein incompetence, distribution of varicosities, deep venous insufficiency, and short saphenous incompetence.
  
  
  RESULTS
  four hundred and eighty-one patients were assessed (median age 50 (range 12-98) years; male:female ratio 1:1.95), comprising 706 limbs. Forty-six per cent of limbs had a competent SFJ, 64% of which had no incompetent perforating vessels associated. Disease was more widespread when the SFJ was incompetent. Varicosities were most common in the calf, occurring at or below the level of incompetence within the LSV. Incompetent segments occurred most commonly above-knee. There was no obvious correlation between incompetent perforators and distribution of varicosities, or incompetent segments. Short saphenous incompetence and non-SFJ groin recurrence were associated more with a competent SFJ, the converse being true for the Giacomini vein.
  
  
  CONCLUSIONS
  primary VVs develop in isolated segments of the superficial venous system (without connection to the deep system) at, or distal to, the underlying main trunk incompetence, suggesting a process of "spreading incompetence" from one focal point, producing varicosities (mainly in tributaries).
authors.affiliation: The Academic Vascular Unit Department of Surgery, Royal Free and University College London Medical School, The Middlesex Hospital, London W1N 8AA, UK.
authors.forename: D G
authors.initials: DG
authors.lastname: Cooper
authors.forename: C S
authors.initials: CS
authors.lastname: Hillman-Cooper
authors.forename: Stephen G e
authors.initials: SG
authors.lastname: Barker
authors.forename: S J
authors.initials: SJ
authors.lastname: Hollingsworth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005268:Femoral Vein / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012501:Saphenous Vein / Q000033:anatomy & histology* / Q000000981:diagnostic imaging; D012737:Sex Factors; D018616:Ultrasonography, Doppler, Duplex; D014648:Varicose Veins / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000503:physiopathology