Short-term results of isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) in primary varicose veins disease

Abstract

Objective To establish an effect of isolated phlebectomy in patients with incompetent great saphenous vein (Ambulatory Selective Varices Ablation under Local anesthesia (ASVAL) procedure) on the reflux and diameter of the trunk and to assess recurrence rate of varicose veins at one year. Material and methods We conducted a prospective study on patients with primary varicose veins and with C2 or C2,3 or C2,3,4 or C2,4 classes of chronic venous disease and great saphenous vein incompetence. The study included 67 patients (51 women and 16 men; 75 limbs in total). Age varied from 17 to 71 years; mean age was 46.8 years (SD 13.9). We recorded the presence or absence of reflux in the great saphenous vein with duplex ultrasound before and after surgery. The recurrence of varicose veins was evaluated at 12 months. All the patients underwent isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) under local anesthesia. Results At one year after removing of tributaries of the incompetent trunk, 66% of them were competent. Reflux persisted in 17% of great saphenous veins with reflux above mid-thigh and in 61% of trunks with reflux extended below the mid-thigh (p = 0.0004). The diameter of all the veins decreased significantly no matter reflux disappeared or not. Varicose veins reoccurred in 13.5% cases. In 6.5% of limbs with a reflux above the mid-thigh, the recurrence was registered at one year, while in the limbs with the reflux below the mid-thigh at a baseline, the recurrence rate was 25% (p = 0.036). Conclusion Isolated phlebectomy with a preservation of incompetent great saphenous vein leads to disappearance of reflux in a majority of cases and to significant decrease of vein diameter in all the cases. ASVAL procedure could be considered as a less aggressive and less expensive approach in selected cases. Clear indications for isolated phlebectomy need to be established.

The Analysis of Selected Morphological and Hemodynamic Parameters of the Venous System and Their Presumable Impact on the Risk of Recurrence after Varicose Vein Treatment

“…It is plausible that the failure of the current CVD treatment strategy may be due to the misunderstanding of the hemodynamic pathomechanism of disease. This assumption could, at least partially, be supported by the long-term results of CVD treatment with ambulatory selective varices ablation under local anesthesia (ASVAL) procedure [37,38], and particularly a hemodynamic surgical approach CHIVA (from French: "cure conservatrice et hémodynamique de l'insuffisance veineuse en ambulatoire", i.e., ambulatory conservative and hemodynamic treatment of venous insufficiency) [38,39]. When compared to surgical ligation and stripping, the CHIVA technique, based on ultrasound mapping and reflux re-distribution, was associated with the lower risk of nerve injury, and post-operative bruises, but with a higher risk of superficial vein thrombosis.…”

Mini-invasive foam sclerotherapy-assisted ligation versus surgical flush ligation for incompetent sapheno-popliteal junction treatment

“…Pressure gradient suppression by phlebectomy and/ or flush ligation of incompetent tributaries of the great saphenous vein has demonstrated to lead to a potential caliber reduction. 26,27 Future investigations should address the topic of the SSV caliber variation after isolated phlebectomy/ligation.…”

Comparative assessment of the efficiency of different methods of surgical treatment for varicose veins

“…Частота класичних флебектомій порівняно з ендовенозними методами абляції скоротилася в 4 рази [15]. На даний час звичайну (класичну) флебектомію рекомендується використовувати лише в пацієнтів з дуже звивистими венами та при великому діаметрі судин [16,17].…”