# 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.