Staged or simultaneous varicose vein treatment after saphenous vein ablation

Abstract

Chronic venous disease (CVD) is a progressive condition that affects a significant percentage of the population. Clinical manifestation of CVD differs between the patients: from asymptomatic patients with esthetic problems only to the very severe stages (including venous leg ulcer) that significantly decrease the quality of life (Qol). Although the varicose vein patients can be asymptomatic and they decide for treatment only for cosmetic reasons, many of them present the symptoms and/or signs of CVD, including pain, heaviness, itching, cramps, swelling, trophic changes or ulcerations. Therapeutic management of varicose veins includes surgery, minimally invasive procedures (involving saphenous ablation or sclerotherapy), compression therapy and pharmacological treatment. Traditional surgical treatment has been a leading method in invasive VV management for many years. Nonetheless, minimally invasive treatment thrived in the 21st century and overtook open surgery regarding VVS and more advanced stages of CVD. Another commonly used minimally invasive method in the treatment of VV is foam sclerotherapy. The efficacy of EVLA in the treatment of VV can be improved by performing adjunctive foam sclerotherapy (FS) of the tributaries. The combination of EVLA and FS is an effective method of reducing the rate of reinterventions in VV patients with saphenous vein incompetence. In the patients undergoing saphenous ablation, VV treatment (FS or mini phlebectomy) can be performed within the same procedure or as the delayed treatment. The argument for delayed treatment is the potential possibility of the VV regression (partial or complete) after saphenous vein ablation. On the other hand, saphenous ablation and varicose vein treatment within the same session result in fast and complete varicose vein removal without the need for additional procedures. Nevertheless, there is no consensus regarding the optimal timing of performing FS after EVLA of the GSV trunk and because of many diversified scientific reports there are still different approaches to this problem in phlebological centres around the world. Since the timing of adjunctive FS after EVLA procedure in the treatment of VV associated with GSV incompetence is a topic of open debate among surgeons, this study is a review that compares concomitant and staged treatments of VV.