Anterior accessory great saphenous vein as a cause of postoperative recurrence of veins after radiofrequency ablation

Abstract

There are problems of postoperative relapse of veins after radiofrequency ablation (RFA). The study aims to analyze the causes of postoperative recurrence of veins after RFA. 928 patients with varicose veins of the lower extremities, clinical classes C2-C4 according to the CEAP classification, were treated in the ambulatory surgery centers using RFA. The causes of varicose recurrence showed that it was caused by: a) high fusion of the anterior accessory great saphenous vein (AAGSV) with great saphenous vein (GSV) directly in the saphenofemoral junction (SFJ), which was not revealed by preoperative ultrasound (1.7%); a long stump of the GSV after the RFA (7.8%); progression of varicose disease with the small saphenous vein (SSV) and formation of new reflux associated with insufficiency of the saphenopopliteal junction (SPJ) (4.7%); d) insufficiency of perforating veins of the tibioperoneal group (Sherman, Boyd), as well as Gunter (3.8%); e) neovascularization with dilation of small vessels in the area of the saphenofemoral junction (0.97%). A comparative assessment of the quality of life (QL) after different surgery methods 3 years after implementation was carried out. Thus, QL in all patients who underwent surgery significantly improved than before surgery. However, after the RFA GSV+AAGSV, the patients had better QL by all scales than those who underwent only RFA GSV. Operations performed simultaneously on GSV and AAGSV have better functionality than GSV-only RFA.

Anatomical variation of anterior accessory great saphenous vein: a case report

“…Their study reported a higher rate of recurrent varicose veins in patients who had saphenofemoral junctional, and GSV reflux on ultrasound, and a direct confluence of the AAGSV at the saphenofemoral junction was found to be a negative predictor for recurre varicos veins [12]. Yriji et al [1] reported that the frequency of isolated reflux in the AAGSV was much higher than described in previous literature [13,14,15].…”

“…The anterior accessory great saphenous vein (AAGSV) can be defined as any vein that accompanies the great saphenous vein (GSV), lies superficial to GSV on the anterior surface of the thigh, and is not surrounded by the saphenous fascial sheath [1]. An anterior accessory of the great saphenous vein (AAGSV) originates from the marginal veins anterior to the GSV and travels anteriorly to the main trunk in the leg to drain either into the great saphenous vein (in the leg, thigh, or groin) or to drain into the posterior accessory saphenous vein in the leg or thigh [2].…”

The anterior saphenous vein. Part 3. Systematic review of the literature and payor coverage policies. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology

“… 4 In most studies, ASV reflux is present in about 10% to 20% of patients presenting for treatment and approximately a third of patients present after prior treatment. 4 – 8 There is an increasing appreciation that addressing ASV reflux is important not only in achieving optimal outcomes in first time treatment patients in the short term but also in addressing the risk of recurrence after treatment in the long-term.…”

The anterior saphenous vein. Part 4. Clinical and technical considerations in treatment. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum, and the International Union of Phlebology

“…1 Anterior saphenous vein (ASV) reflux is the next most common source of superficial reflux in up to 22% of patients presenting for first time treatment and approximately a third of patients presenting after prior varicose vein treatment. [1][2][3][4][5] In the past, there has been a debate about whether the ASV is simply an accessory vein of the GSV or a defined truncal saphenous vein with a distinct natural history that requires different treatment considerations than a tributary. It is now understood that anatomically the ASV is a truncal saphenous vein with its own proper fascial compartment that is distinct from the GSV.…”