Duplex-ultrasound assessment of the saphenofemoral junction

Sonographic evaluation of the saphenofemoral junction is one of the most important examinations in the phlebological practice. It is indispensable for proper decision making in the management of varicose veins. This examination should primarily comprise the evaluation of competence of terminal and preterminal valves of the great saphenous vein and haemodynamic assessment of refluxes in the great saphenous vein and the anterior accessory saphenous vein. Since the anatomy of this junction is highly variable and reflux can originate not only in the common femoral vein, but also in the tributaries, they should also be thoroughly evaluated. In this paper we present the technique of sonographic examination of this area, with a description of reflux-provoking manoeuvres, interpretation of sonographic findings, and classification of venous refluxes. Phlebographic classification of pathological flows in the area of the saphenofemoral junction was first proposed by Hach and then revised together with Mendoza after the introduction of ultrasound. Subsequently a classification based on sonographic evaluation of the terminal and preterminal valves was published by Stücker. Here, in addition to the already described types of refluxes in the area of the saphenofemoral junction, we propose a new type, in which the reflux originates in a tributary and enters the anterior accessory saphenous vein, but both terminal and preterminal valves are competent.