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Purpose: The purpose of this study was to determine the most suitable laser irradiation start position for endovenous laser ablation (EVLA) of the small saphenous vein. Methods: Ultrasonography (US) was used to evaluate 78 patients (151 limbs) with lower limb varices at our hospital. The distances between the tibial nerve and small saphenous vein were measured at 20-mm intervals (20, 40, 60, and 80 mm) distal to the sapheno-popliteal junction (SPJ) in 112 of the limbs. The remaining 39 limbs were excluded because the small saphenous vein did not branch off from a deep part of the vein due to a congenital abnormality. Results: The small saphenous vein and tibial nerve were immediately adjacent in 98/112 limbs at the SPJ (1.0±3.3 mm), in 25/112 limbs 20 mm distal to the SPJ (3.9±3.7 mm), in 4/112 limbs 40 mm distal to the SPJ (7.5±3.8 mm), and in none of the limbs 60 mm and 80 mm distal to the SPJ. Conclusion: We recommend points 20 to 40 mm distal from the SPJ as landmarks for the laser irradiation start position for EVLA of the small saphenous vein, because this is where the tibial nerve stops being adjacent to the small saphenous vein.

neurosonology

Ultrasonographic assessment of the radiational position of endovenous laser ablation: Relative position between the tibial nerve and small saphenous vein