A 55-year-old male presents with a 5-year history of varicose veins in the right lower limb. On examination, he has dilated, tortuous veins along the medial thigh and calf. Trendelenburg test is positive. Which of the following is the most likely site of venous incompetence?

Explanation

## Diagnosis: Saphenofemoral Junction Incompetence **Clinical Presentation:** The patient has varicose veins along the medial thigh and calf with a positive Trendelenburg test. This pattern is classic for greater saphenous vein (GSV) insufficiency. **Key Point:** A positive Trendelenburg test indicates proximal venous incompetence. When the leg is elevated and the superficial veins are emptied, rapid refilling upon standing (within 20 seconds) suggests incompetence at the saphenofemoral junction (SFJ). **Anatomical Correlation:** - The **saphenofemoral junction** is where the GSV drains into the femoral vein in the groin - GSV incompetence causes varicose veins along the **medial thigh and medial calf** — the distribution of GSV tributaries - This is the most common site of primary venous insufficiency (80% of cases) **High-Yield:** Positive Trendelenburg + medial lower limb varicosities = SFJ incompetence until proven otherwise. **Management Implication:** SFJ incompetence is treated by high ligation of the GSV at the SFJ (open or endovenous ablation), not just stripping.