Mid-calf level as a puncture site is not safe enough for thermal ablation of the small saphenous vein

BACKGROUND: Endovenous thermal ablation of the small saphenous vein carries a risk for sural nerve injury. Ablation above mid-calf level is recommended to avoid it. However, this strategy could not eradicate this complication. We present our results of consecutive 30 small saphenous vein thermal ablations which are performed after ultrasonographic identification of the sural nerve. METHODS: We studied 26 consecutive subjects with a total of 30 limbs. Ablation was performed proximal to the risk point by a 1470-nm diode laser. Patients were asked to attend follow-up outpatient controls at 7 days, 30 days, and 180 days postoperatively. Rate of identification of the sural nerve by ultrasonography, safety of the mid-calf level as a puncture site and postoperative sural nerve damage were assessed. RESULTS: The sural nerve identification was achieved by ultrasonography in all patients except for one. Mid-calf level as a puncture site was not safe in three (10%) extremities. None of the patients showed any evidence suggesting postoperative sural nerve damage. CONCLUSION: Choosing the puncture site according to the risk point may be more reasonable than general mid-calf level which is being used.