PURPOSE We aimed to investigate the feasibility and safety of the endovenous ambulatory selective vari-cose vein ablation under local anesthesia (eASVAL) method in a selected group of patients with varicose disease and present the short-term results of one-year ultrasonographic follow-up. METHODSThree hundred and ninety-five consecutive patients with varicose veins who had been treated with endovenous laser ablation (EVLA) were retrospectively reviewed over a period of two years. From this group, 41 patients who were treated using the eASVAL technique and had the great saphenous vein (GSV) preserved were included in the study. These patients had only limited segmental GSV reflux accompanied by a competent terminal valve. The eASVAL technique can be defined as EVLA of the proximal straight segments of the major tributaries connecting the symptomatic varicose veins with the GSV, followed by ultrasound-guided foam sclerotherapy of the superficial varicose veins themselves. The patients were assessed before and after the treat-ment by duplex scan findings and clinical assessment scores. RESULTSThe GSVs were successfully preserved in all 41 cases, and all patients showed significant clinical improvement using the eASVAL approach (P < 0.001). Segmental reflux was no longer present in 75.3% of patients. The mean diameters of the GSVs were significantly reduced at one-year follow-up (8.5 mm vs. 7.5 mm, P < 0.001). CONCLUSIONeASVAL is a feasible and safe procedure in selected patients, with promising results at one-year ultrasonographic follow-up. However, prospective studies are required, comparing this approach with the standard techniques.
Labropoulos N, Giannoukas AD, Delis K, et al. Where does venous reflux start? J Vasc Surg 1997; 26:736-742. [CrossRef]
Labropoulos N, Leon L, Kwon S, et al. Study of the venous reflux progression. J Vasc Surg 2005; 41:291-295. [CrossRef]
Cooper DG, Hillman-Cooper CS, Barker SG, Hollingsworth SJ. Primary varicose veins: the sapheno-femoral junction, distribution of var- icosities and patterns of incompetence. Eur J Vasc Endovasc Surg 2003; 25:53-59. [CrossRef]
Engelhorn CA, Engelhorn AL, Cassou MF, Salles-Cunha SX. Patterns of saphenous reflux in women with primary varicose veins. J Vasc Surg 2005; 41:645-651. [CrossRef]
Pittaluga P, Chastanet S, Rea B, Barbe R. Classi- fication of saphenous refluxes: implications for treatment. Phlebology 2008; 23:2-9. [CrossRef]
Chastanet S, Pittaluga P. Influence of the com- petence of the sapheno-femoral junction on the mode of treatment of varicose veins by sur- gery. Phlebology 2014; 29:61-65. [CrossRef]
Fernandez CF, Roizental M, Carvallo J. Com- bined endovenous laser therapy and micro- phlebectomy in the treatment of varicose veins: efficacy and complications of a large single-center experience. J Vasc Surg 2008; 48:947-952. [CrossRef]
Atasoy MM. Fill and aspirate foam sclerother- apy (FAFS): a new approach for sclerotherapy of large superficial varicosities concomitant to endovenous laser ablation of truncal vein. Clin Radiol 2015; 70:48-53. [CrossRef]
Porter JM, Moneta GL. Reporting standards in venous disease: an update. International Con- sensus Committee on Chronic Venous Disease. J Vasc Surg 1995; 21:635-645. [CrossRef]
Kundu S, Lurie F, Millward SF, et al. Recommend- ed reporting standards for endovenous ablation for the treatment of venous insufficiency: joint statement of the American Venous Forum and the Society of Interventional Radiology. J Vasc Interv Radiol 2009; 20:417-424. [CrossRef]
Launois R, Reboul-Marty J, Henry B. Construction and validation of a quality of life questionnaire in chronic lower limb venous insufficiency (CIVIQ). Qual Life Res 1996; 5:539-554. [CrossRef]
De Maeseneer M, Pichot O, Cavezzi A, et al. Duplex ultrasound investigation of the veins of the lower limbs after treatment for varicose veins - UIP consensus document. Eur J Vasc En- dovasc Surg 2011; 42:89-102. [CrossRef]
Labropoulos N, Tiongson J, Pryor L, et al. Defini- tion of venous reflux in lower-extremity veins. J Vasc Surg 2003; 38:793-798. [CrossRef]
Yilmaz S, Ceken K, Alimoglu E, Sindel T. US-guid- ed femoral and sciatic nerve blocks for analgesia during endovenous laser ablation. Cardiovasc In- tervent Radiol 2013; 36:150-157. [CrossRef]
Pittaluga P, Chastanet S. Lesser importance of the saphenous vein in varicose vein treatment. In: Bergan JJ and Cheng LV, eds. Foam sclero- therapy: a textbook. 1st ed. London: Royal So- ciety of Medicine Press, 2008; 163-176.
Pichot O, Sessa C, Bosson JL. Duplex imaging analysis of the long saphenous vein reflux: basis for strategy of endovenous obliteration treatment. Int Angiol 2002; 21:233-236.
Wong JK, Duncan JL, Nichols DM. Whole-leg duplex mapping for varicose veins: observa- tion on patterns of reflux in recurrent and pri- mary legs with clinical correlation. Eur J Vasc Endovasc Surg 2003; 25:267-275. [CrossRef]
Merchant RF, Pichot O. Long-term outcomes of endovenous radiofrequency obliteration of saphe- nous reflux as a treatment for superficial venous in- sufficiency. J Vasc Surg 2005; 42:502-509. [CrossRef]
Nicolini P, Closure Group. Treatment of prima- ry varicose veins by endovenous obliteration with the VNUS closure system: results of a pro- spective multicenter study. Eur J Vasc Endovasc Surg 2005; 29:433-439. [CrossRef]
Pichot O, Kabnick LS, Creton D, Merchant RF, Schuller-Petroviae S, Chandler JG. Duplex ultra- sound scan findings two years after great saphe- nous vein radiofrequency endovenous oblitera- tion. J Vasc Surg 2004; 39:189-195. [CrossRef]
Theivacumar NS, Darwood RJ, Gough MJ. En- dovenous laser ablation (EVLA) of the anterior accessory great saphenous vein (AAGSV): ab- olition of sapheno-femoral reflux with preser- vation of the great saphenous vein. Eur J Vasc Endovasc Surg 2009; 37:477-481. [CrossRef]
Zamboni P, Cisno C, Marchetti F, Quaglio D, Mazza P, Liboni A. Reflux elimination without any ablation or disconnection of the saphe- nous vein. A hemodynamic model for ve- nous surgery. Eur J Vasc Endovasc Surg 2001; 21:361-369. [CrossRef]
Creton D. Diameter reduction of the proximal long saphenous vein after ablation of a distal incomponent tributary. Dermatol Surg 1999; 25:394-397. [CrossRef]
Quill RD, Fegan WG. Reversibility of femoro- saphenous reflux. Br J Surg 1971; 58:389-393. [CrossRef]
Pittaluga P, Rea B, Barbe R, Guexx JJ. ASVAL method: principles and preliminary results. In: Becquemin JP, Alimi YS, Watelet J, editors. Updates and controversies in Vascular Surgery. Torino: Minerva Medica, 2005; 182-189.
Pittaluga P, Chastanet S, Locret T, Barbe R. The effect of isolated phlebectomy on reflux and diameter of the great saphenous vein: a pro- spective study. Eur J Vasc Endovasc Surg 2010; 40:122-128. [CrossRef]
Guex JJ. Clinical Methods for sclerotherapy of varicose veins. In: Goldman MP, Bergan JJ, Guex JJ, eds. Sclerotherapy: treatment of varicose and telengiectatic leg veins. 5th ed. Philadel- phia: Mosby Elsevier, 2011; 238-282.
Pittaluga P, Chastanet S, Rea B, Barbe R. Mid- term results of the surgical treatment of varices by phlebectomy with conservation of a reflux- ing saphenous vein. J Vasc Surg 2009; 50:107- 118. [CrossRef]
Atasoy MM, Gumus B, Caymaz I, Oguzkurt L. Targeted endovenous treatment of Giacomini vein insufficiency-associated varicose disease: considering the reflux patterns. Diagn Interv Radiol 2014; 20:481-486. [CrossRef]
Goode SD, Kuhan G, Altaf N, et al. Suitability of varicose veins for endovenous treatments. Cardiovasc Intervent Radiol 2009; 32:988-991. [CrossRef]
Janned'Othée B, Walker TG, Kalva SP, Ganguli S, Davison B. Endovenous laser ablation of the small saphenous vein sparing the sapheno- popliteal junction. Cardiovasc Intervent Radiol 2010;33:766-771. [CrossRef]
Anchala PR, Wickman C, Chen R, et al. Endo- venous laser ablation as a treatment for post- surgical recurrent saphenous insufficiency. Cardiovasc Intervent Radiol 2010; 33:983-988. [CrossRef]
Ozkan U. Endovenous laser ablation of in- competent perforator veins: a new technique in treatment of chronic venous disease. Car- diovasc Intervent Radiol 2009; 32:1067-1070. [CrossRef]