Anatomy of nerves of the lower extremities in the context of the treatment for varicose veins

Injury of nerves of the lower extremity is the most prevalent complication associated with invasive treatment of varicose veins. These adverse events are particularly frequent after traditional surgical stripping and thermal ablative procedures. The most frequently injured nerves comprise the saphenous nerve, the sural nerve, and the anterior cutaneous branch of the femoral nerve. The high rate of injury to these nerves is primarily related to their close anatomical relationship with major trunks of the superficial venous system. The great saphenous vein is accompanied by two groups of sensory nerves. In its proximal part it runs along the anterior cutaneous branch of the femoral nerve. In some individuals, also the cutaneous branch of the obturator nerve is situated close to the proximal part of the great saphenous vein. The distal part of the great saphenous vein is accompanied by the saphenous nerve, a branch of the femoral nerve. The sural nerve, which typically consists of its medial and lateral branches, runs along the small saphenous vein. Also, during thermal ablation of the small saphenous vein the branches of the sciatic nerve containing motor fibres, the tibial and/or common peroneal nerves can also be injured. In this review the topographic anatomy of nerves accompanying the veins of the lower extremity is described. It is also discussed how to minimise the risk of these neurologic complications, knowing the topography, embryological development, and anatomical variability of veins and nerves in this part of the human body.