Ten-Year Outcomes of Treatment of Varicose Veins by Ambulatory Selective Ablation of Varices Under Local Anesthesia (ASVAL)

Abstract

We perform the treatment of varicose veins by single phlebectomy and preservation of the saphenous vein in selected indications following the principle of the ambulatory selective ablation of varices under local anesthesia (ASVAL) method since 2003. The results of this treatment have been published at midterm, but we wanted to evaluate the outcomes at longer term. We have retrospectively reviewed the patients with a refluxing great saphenous vein (GSV) who underwent an ASVAL treatment for varicose veins in our institute between September 2003 and September 2005. We gathered the preoperative clinical and hemodynamic data and the preoperative diameter of the GSV at the saphenofemoral junction and at the thigh. The hemodynamic evolution, varicose vein recurrence, outcomes on symptoms and aesthetics, and need of a redo surgical treatment were reviewed. A total of 359 ASVAL procedures have been performed in 264 patients aged 21 to 85 years (average, 52.9 years) on 360 limbs. The limbs treated were classified C0 in 0 cases, C2 in 303 cases (84.2%), C3 in 24 cases (6.7%), C4 in 33 cases (9.2%), and C5 and C6 in 0 cases in the Clinical, Etiology, Anatomy, and Pathophysiology class C classification. Preoperative symptoms were present in 63.3% of the cases. The GSV was refluxing in all cases preoperatively with an average diameter of 6.8 mm (median, 6.5; range, 3-15 mm). The average duration of follow-up was 59.8 months. During follow-up, a redo surgical treatment was performed in 24 cases and consisted of a redo phlebectomy in 15 cases and a secondary stripping and ablation of the GSV in 9 cases. At 24, 60, 84, and 120 months after life-table analysis, we observed freedom from GSV reflux in 71%, 69.7%, 68.5%, and 64.4%, respectively; freedom from redo surgical treatment in 96.9%, 90%, 83.6%, and 76.7%, respectively; improvement of symptoms in 86.7%, 83.8%, 78%, and 69.9%, respectively; and improvement of aesthetics in 92.2%, 86%, 77.2%, and 65.7%, respectively. The ASVAL treatment for varicose veins gives good clinical and hemodynamic outcomes at long term in selected patients, with a limited number of cases that needed a secondary surgical procedure. However, the clinical outcomes seem to decrease faster than the hemodynamic evolution, especially for aesthetics, which could reflect the natural evolution of the venous insufficiency irrespective of the reflux.