Deep Venous Reflux Associated with a Dilated Popliteal Fossa Vein Reversed with Endovenous Laser Ablation and Sclerotherapy

Objective. To report an incidence of reflux in the deep venous system reversed by ablation of a popliteal fossa vein (PFV). Method. A 40-year-old man with pain and swelling in the medial upper calf was found to have an incompetent PFV. Results. Reflux in the femoral and popliteal veins was reversed utilizing endovenous laser ablation and foam sclerotherapy, documented on Duplex studies before and after the intervention. There was also resolution of symptoms. Conclusion. A PFV can be associated with deep venous reflux. Correction of this reflux with ablation of the PFV suggests that his type of reflux is secondary to volume effects of the incompetent popliteal vein. 1. Introduction The popliteal fossa vein (PFV) has been described as a tributary of the popliteal vein found in the popliteal fossa, which is anatomically distinct from the great and small saphenous veins [1, 2]. Classified as a perforating vein at the precongress meeting of the Fourteenth World Congress of the International Union of Phlebology (IUP) in 2001, PFV perforates the muscular fascia to connect superficial veins with deep veins, namely, the popliteal vein [1–3]. The prevalence of reflux in a PFV has varied between 8% in patients with nonsaphenous venous reflux [1] and 1% in patients with primary varicose veins [4]. This case presents a patient with a dilated PFV, with associated symptomatic venous insufficiency and deep venous reflux, reversed with endovenous laser ablation (EVLT) and sclerotherapy. 2. Case Information A 40-year-old man presented to the Vascular Center Clinic with symptomatic chronic venous insufficiency (CVI). The patient began experiencing cramping and swelling in his right leg seven years prior, with worsening symptoms over the past two years. Upon initial physical exam, the patient was noted to have 1+ edema, hyperpigmentation in the “gaiter zone” distribution, and varicosities on the posterior and medial aspect of the right knee (C4a) [5] (VCSS: skin pigmentation 2, inflammation 1, induration 2, active ulceration 0, and compression 3) [6, 7], as shown in Figure 1 [5]. After 14 weeks of compression therapy with thigh-high compression hose, the patient returned to clinic with no significant change in symptoms. Physical exam at the time of the followup revealed a mild increase in the venous stasis pigmentation of the right gaiter zone, with no associated edema or ulceration. Venous color duplex ultrasonography of the right lower extremity at this visit revealed reflux in the common femoral, femoral and popliteal veins. The degree of reflux increased dramatically