Severity of disease and treatment outcomes of anterior accessory great saphenous veins compared with the great saphenous vein

The Anterior Saphenous Vein. Part 2. Anatomic considerations in normal and refluxing patients. Endorsed by the American Vein and Lymphatic Society, the American Venous Forum and the International Union of Phlebology

“…Treatment algorithms for the ASV are similar to other truncal veins and the literature strongly suggest beneficial patient outcomes that are equivalent to GSV ablation by a variety of techniques. 15 Although the ASV clearly shares anatomic features with the other truncal veins, this has been less well described in the literature. While prior studies have detailed the characteristics of the ASV in patients with venous reflux, this is the first study to systematically evaluate its anatomy in normal limbs with the aim to describe the "normal" anatomy of the ASV in addition to that in limbs with venous reflux.…”

“…Thus, these findings are consistent with prior studies where the anatomy of the ASV in varicose limbs is distinct in location but similar to that of the GSV in terms of path and fascial relationships in the proximal thigh. 14,15,22,23 The recognition of the ASV as a proper truncal vein has important implications in treatment planning and for authorities that define treatment coverage. Improved patient symptoms, long term closure, and minimizing the incidence of recurrence can be achieved by following the principles and techniques of other truncal veins such as the GSV and SSV.…”

“…Simply ablating the GSV has been shown to be inadequate in treating ASV derived varicosities resulting into higher recurrence rates. 15 As clinicians examine limbs with US, recognizing the unique anatomic attributes of the ASV as a truncal vein is critical to developing an appropriate treatment plan. This requires a keen understanding of normal ASV anatomy and its variants as well as the hemodynamic patterns of ASV reflux in limbs with thigh varicose veins.…”

“…13 Multiple studies have demonstrated a relevant role of the ASV in the pathogenesis, pathophysiology, and treatment of primary and recurrent varicose disease of the lower limbs. [13][14][15] There are also unique natural history considerations that make ASV reflux similar to that in the GSV and SSV. 15 The lack of clarity and consensus has resulted in a limited access to care for some patients when treating superficial truncal reflux in this distribution.…”

“…[13][14][15] There are also unique natural history considerations that make ASV reflux similar to that in the GSV and SSV. 15 The lack of clarity and consensus has resulted in a limited access to care for some patients when treating superficial truncal reflux in this distribution.…”