Signs

Signs

The presence of tortuous dilated subcutaneous veins is usually clinically obvious. These are confined to the GSV and SSV systems in approximately 60% and 20% of cases, respectively . The distribution of varicosities may indicate which superficial axis is defective; medial thigh and calf varicosities suggest GSV incompetence ( Figure 62.3a ), posterolateral calf varicosities are suggestive of SSV incompetence ( Figure 62.3b ), whereas anterolateral thigh and calf varicosities may indicate isolated incompetence of the AAGSV ( Figure 62.3c ). Any of the clin ical features above may be present. Large, dilated veins around the SFJ may present as a (usually painless) lump, emergent when standing and disappearing when recumbent. This is a saphena varix ( Figure 62.5 ). Gentle palpation over the varix during coughing may elicit an impulse and it ma y be mistaken for a groin hernia.