The Effect of Isolated Phlebectomy on Reflux and Diameter of the Great Saphenous Vein: A Prospective Study

Pittaluga, Paul; Chastanet, S.; Locret, T.; Barbe, Rémy

doi:10.1016/j.ejvs.2010.03.031

Cited by 65 publications

(45 citation statements)

References 22 publications

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“…The surgical ASVAL approach is accepted as the method of choice by many phlebologists in cases with segmental GSV reflux accompanied by minimal or no terminal valve reflux (6). Using the classical surgical ASVAL technique (isolated phlebectomy), GSV reflux was reduced with a significant reduction in reflux duration and peak reflux velocity (26). These results suggest that the hemodynamics and diameter of the GSV can be improved using a treatment focusing on the saphenous tributaries.…”

Section: Discussionmentioning

confidence: 58%

The endovenous ASVAL method: principles and preliminary results

Atasoy

Oğuzkurt²

2015

Diagn Interv Radiol

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A mbulatory selective varicose vein ablation under local anesthesia (ASVAL) is a surgical treatment for varicose veins based on the ascending hypothesis that venous insufficiency progresses in an ascending manner, from the superficial tributaries to the saphenous vein (SV) and then to the sapheno-femoral junction (SFJ). Recent scientific data based on precise and detailed duplex scanning support this hypothesis (1-6). The ASVAL method recommends preserving the great saphenous vein (GSV), unless there is a serious terminal valve insufficiency, and suggests the surgical removal (phlebectomy) of the superficial varicose reservoir (SVR) as a primary treatment. The major argument in favor of preserving the GSV is the essential physiologic role that the GSV could play in superficial drainage and, to a lesser extent, its availability as revascularization material. Although the original ASVAL method is performed using simple phlebectomies, many patients refuse to have this treatment because they regard it as a surgical operation that would likely yield poor cosmetic results. Thermal endovenous techniques and foam sclerotherapy are less aggressive and are reported to be as effective as traditional surgical treatments (7). The question arises as to whether the ASVAL approach can be performed using endovenous techniques. To the best of our knowledge, this research will be a preliminary study describing the endovenous technique for the ASVAL approach.The purpose of this study was to investigate the feasibility and safety of endovenous ASVAL (eASVAL) technique and to present the short-term results with one-year ultrasonography (US) follow-up in a selected group of patients. PURPOSEWe aimed to investigate the feasibility and safety of the endovenous ambulatory selective varicose vein ablation under local anesthesia (eASVAL) method in a selected group of pa tients with varicose disease and present the short-term results of one-year ultrasonographic follow-up. METHODSThree hundred and ninety-five consecutive patients with varicose veins who had been treated with endovenous laser ablation (EVLA) were retrospectively reviewed over a period of two years. From this group, 41 patients who were treated using the eASVAL technique and had the great saphenous vein (GSV) preserved were included in the study. These patients had only limited segmental GSV reflux accompanied by a competent terminal valve. The eASVAL technique can be defined as EVLA of the proximal straight segments of the major tributaries connecting the symptomatic varicose veins with the GSV, followed by ultrasound-guided foam sclerotherapy of the superficial varicose veins themselves. The patients were assessed before and after the treatment by duplex scan findings and clinical assessment scores. RESULTSThe GSVs were successfully preserved in all 41 cases, and all patients showed significant clinical improvement using the eASVAL approach (P < 0.001). Segmental reflux was no longer present in 75.3% of patients. The mean diameters of the GSVs were significantly reduced at...

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Section: Discussionmentioning

confidence: 58%

The endovenous ASVAL method: principles and preliminary results

Atasoy

Oğuzkurt²

2015

Diagn Interv Radiol

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“…The reduction in diameter may be explained in general terms through a reduction in flow and a diminished venous reservoir. Stockings have been shown to reduce the venous volume in the calf with air‐plethysmography, and excision of varicose tributaries has been shown to have beneficial effects on the GSV …”

Section: Discussionmentioning

confidence: 99%

“…Stockings have been shown to reduce the venous volume in the calf with air-plethysmography, 24 and excision of varicose tributaries has been shown to have beneficial effects on the GSV. 25 It is a common observation that varicose veins do not fully collapse when the leg is elevated. The reasons for this may include a high outflow resistance, tricuspid regurgitation, or a reduction in the resistance of the microcirculation.…”

Section: Discussionmentioning

confidence: 99%

Hemodynamic Changes at the Saphenofemoral Junction During the Application of a Below-Knee Graduated Compression Stocking

Lattimer

Azzam

Kalodiki

et al. 2012

Dermatologic Surgery

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“…These data suggest that the haemodynamics and the diameter of the saphenous vein can be improved by using a treatment focusing on the saphenous tributaries. 20 Additionally, surgeon Creton pointed out in the journal 'Phlebologie' in 2008 that it is of great importance to perform a flush ligation only in case of incontinent terminal and preterminal valves. Saphenous trunk reflux with continent represents 28% of the cases.…”

Section: Clinical Relevance For the Differentiation Of The Three Typementioning

confidence: 98%

New Concept: Different Types of Insufficiency of the Saphenofemoral Junction Identified by Duplex as a Chance for a More Differentiated Therapy of the Great Saphenous Vein

et al. 2013

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Even though the item 'saphenofemoral junction' (SFJ) is anatomically well defined, the incontinence of the SFJ is often incompetently described in clinical practice and studies. Especially with regard to the optimal therapy of the great saphenous vein, it might be of importance to have a more distinct regard to the SFJ as it is known that about 10-30% of the saphenous refluxes have no femoral origin. Considering the terminal and preterminal valve three types of incompetence of the SFJ may be differentiated: Type 1: Incompetent terminal, but competent preterminal valve; Type 2: Competent terminal, but incompetent preterminal valve; Type 3: Incompetent terminal and preterminal valve (complete incompetence). A review on prior studies and reports leads to the assumption that the differentiation of the distinct types of SFJ-incompetence allows a more individual and - perhaps - more effective therapy. Finally, studies are necessary to evaluate the here given new concept.

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The Effect of Isolated Phlebectomy on Reflux and Diameter of the Great Saphenous Vein: A Prospective Study

Cited by 65 publications

References 22 publications

The endovenous ASVAL method: principles and preliminary results

The endovenous ASVAL method: principles and preliminary results

Hemodynamic Changes at the Saphenofemoral Junction During the Application of a Below-Knee Graduated Compression Stocking

New Concept: Different Types of Insufficiency of the Saphenofemoral Junction Identified by Duplex as a Chance for a More Differentiated Therapy of the Great Saphenous Vein

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