Anatomical basis of an original pedal approach to the great saphenous vein for surgery

Varicose vein repair often necessitates a distal approach to the great saphenous vein (GSV). The classic method involves a medial pre-malleolar approach. We propose a more distal approach via the medial surface of the foot where there is a cutaneous landmark, which can be used to locate the GSV in a simple, reliable and reproducible fashion. In 20 cadaveric feet, we dissected out the GSV exploiting the above-mentioned cutaneous landmark. We then extended the dissection up as far as the medial pre-malleolar region (from where the GSV is classically approached) in order to be able to compare the diameter of the vein at the two different points (in the foot and in the pre-malleolar region). We also compared the cutaneous landmark with ultrasonographic location of the GSV in 22 feet of healthy subjects. Both dissections and ultrasound examinations demonstrated the reliability of the cutaneous landmark. Moreover, no significant difference was detected in the diameter of the GSV at the two different approach points. This original distal approach to the GSV requires only minor modifications of current practice for varicose veins surgical treatment.