title: Duplex scanning is no substitute for surgical expertise in identifying the saphenopopliteal junction: results following short saphenous vein surgery.
abstract: OBJECTIVE
  Short saphenous vein (SSV) surgery carries a high risk of failure to identify the saphenopopliteal junction (SPJ). We assessed the impact of surgical expertise on anatomical outcome from SSV surgery and the role of preoperative duplex SPJ marking in improving outcome for vascular and non-vascular specialists.
  
  
  METHODS
  A retrospective analysis identified patients (30 limbs) who had undergone SSV surgery. These were recalled for duplex scanning of the SPJ. In a prospective study, 187 limbs had preoperative duplex marking of SPJ and postoperative duplex to assess outcome. Grade of operating surgeon was recorded in both retrospective and prospective analysis.
  
  
  RESULTS
  In both retrospective and prospective analysis, vascular specialists were significantly more likely than non-vascular specialists to correctly identify the SPJ (P < 0.0001). Preoperative SPJ marking did not improve outcome for the vascular specialist or the non-vascular specialist.
  
  
  CONCLUSIONS
  Preoperative SPJ marking is no substitute for surgical expertise. Competence in SSV surgery should be assessed prior to surgeons proceeding to independent practice.
authors.affiliation: Queen Alexandra Hospital, Portsmouth Hospitals Trust, Southwick Hill Rd, Cosham, Portsmouth PO6 3LY, UK. sabinesonnenberg@tiscali.co.uk
authors.forename: S
authors.initials: S
authors.lastname: Sonnenberg
authors.forename: N F
authors.initials: NF
authors.lastname: Gowland-Hopkins
mesh_terms: D002983:Clinical Competence; D006801:Humans; D010820:Physicians / Q000592:standards*; D011152:Popliteal Vein / Q000000981:diagnostic imaging*; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D018616:Ultrasonography, Doppler, Duplex