Endovenous Laser Ablation (EVLA) of the Anterior Accessory Great Saphenous Vein (AAGSV): Abolition of Sapheno-Femoral Reflux with Preservation of the Great Saphenous Vein.

Theivacumar NS, Darwood RJ, Gough MJ. Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.

AIM: During surgery for sapheno-femoral junction (SFJ) and anterior accessory great saphenous vein (AAGSV) reflux, many surgeons also strip the great saphenous vein (GSV). This study assesses the short-term efficacy (abolition of reflux on Duplex ultrasound) of endovenous laser ablation (EVLA) of the AAGSV with preservation of a competent GSV in the treatment of varicose veins occurring due to isolated AAGSV incompetence.

METHOD: Thirty-three patients (21 women and 12 men) undergoing AAGSV EVLA alone (group A) and 33 age/sex-matched controls undergoing GSV EVLA (Group B) were studied. Comparisons included ultrasound assessment of SFJ competence, successful axial vein ablation, Aberdeen Varicose Vein Symptom Severity Scores (AVVSS) and a visual analogue patient-satisfaction scale.

RESULTS: At the 1-year follow-up, EVLA had successfully abolished the target vein reflux (AAGSV: median length 19cm (inter-quartile range, IQR: 14-24cm) vs. GSV: 32cm (IQR 24-42cm)) and had restored SFJ competence in all patients. Twenty of the 33 patients (61%) in group A and 14 of the 33 (42%) in group B (p=0.218) required post-ablation sclerotherapy at 6 weeks post-procedure for residual varicosities. The AVVSS at 12 months follow-up had improved from the pre-treatment scores in both the groups (group A: median score 4.1 (IQR 2.1-5.2) vs. 11.6 (IQR: 6.9-15.1) p<0.001; group B: median score 3.3 (IQR 1.1-4.5) vs. 14.5 (IQR 7.6-20.2), p<0.001), with no significant difference between the groups. Patient-satisfaction scores were similar (group A: 84% and group B: 90%). Previous intervention in group A included GSV EVLA (n=3) or stripping (n=9). Thus, the GSV was preserved in 21 patients. The AVVSS also improved in this subgroup (4.4 (2.0-5.4) vs. 11.4 (6.0-14.1), p<0.001) and SFJ/GSV competence was found to be restored at the 1-year follow-up.

CONCLUSIONS: AAGSV EVLA abolishes SFJ reflux, improves symptom scores and is, therefore, suitable for treating varicose veins associated with AAGSV reflux.

Eur J Vasc Endovasc Surg. 2009 Feb 6. [Epub ahead of print]