Patterns of sartorial vein plexus pathology and clinical outcomes of treatment

Objectives: The sartorial area is a network of veins inside and around the muscle connecting with the superficial and deep veins. Reflux involving veins in the sartorial area has not been investigated. This study was designed to determine the patterns of reflux and to assess clinical outcomes of treatment in patients with sartorial venous plexus pathology. Methods: Consecutive patients with reflux in the sartorial area were detected with duplex ultrasound examination. The patients' clinical characteristics and patterns and extent of reflux were recorded in detail. Treatment was performed with ligation, phlebectomy, and ultrasound-guided foam sclerotherapy. Follow-up was performed with both clinical and ultrasound examinations. Subsequent treatments were noted. All patients had a minimum of 1 year of follow-up. Results: The prevalence of sartorial reflux was 0.46% (32/6950). Of these patients, 22 were included in the study (14 females and 8 males; median age, 49 years); 10 were excluded due to treatment refusal (n = 4) or insufficient follow-up (n = 6). Their Clinical Etiological Anatomical Pathophysiological clinical classification ranged from C2 to C4, with 59% presenting as C2, 32% as C3, and 9% as C4. Symptoms were present in 18 patients and 4 were treated for aesthetic reasons. Reflux in continuity with the deep veins (femoral, popliteal, and calf) was identified in 6 patients, whereas 16 patients had superficial veins (great saphenous vein, small saphenous vein, or their tributaries). Patients were followed for 12 to 24 months (mean, 21 months). After treatment, residual reflux was found in six patients, and recurrence was found in five. Development of new disease occurred in three patients. After treating the sartorial reflux and associated tributaries, deep vein reflux was eliminated in four of the six patients who had great saphenous vein reflux and in all four of those who had small saphenous vein reflux. Complications included two cases of focal superficial venous thrombosis, one case of self-resolving hematoma, and one case of skin discoloration. Reinterventions were performed in 9 of the 11 patients with residual or recurrent disease. At the 1-year follow-up, 18 patients had class C0 or C1, one had C2, one had C3, and 2 had C4 disease; two patients had symptoms. Conclusions: Reflux in veins in the sartorial area can cause variable clinical presentations. The detection of such reflux is important because it can be misdiagnosed for saphenous reflux. Ultrasound-guided sclerotherapy and phlebectomy are effective options for treatment for these veins with good outcomes at 1 year.