The multimodal treatment approaches to varicose veins: Preservation versus thermal ablation of the incompetent great saphenous vein

Abstract

Objective: To compare the clinical efficacy of Ambulatory Selective Varices Ablation under Local Anesthesia (ASVAL) and Endovenous Laser Ablation (EVLA) with concomitant phlebectomy in patients with the incompetent Great Saphenous Vein (GSV). Design: “Prospective Case Series study (C2-C3 patients) with 2 and 5 years follow-up. Methods: This was a prospective observational cohort study in a single center. Seventy-six patients (59 females) with GSV incompetence and C2-C3 were included in the prospective consecutive case study. The diameter of GSV at the 15-cm below the SFJ level was the main criterion to identify two groups of patients. Thirty-three patients (25 females, mean age 37.03) with the GSV diameter ≤6 mm were treated with ASVAL. Forty-three patients (34 females, mean age 46.19) with the GSV diameter >6 mm were treated by EVLA with concomitant phlebectomy. Clinical and functional outcomes measured by Venous Clinical Severity Score (VCSS) and clinical recurrence-free rate according to the classification of recurrent varicose veins after treatment (PREVAIT) were analyzed in 2 years follow-up. The clinical recurrence-free rate was analyzed in 5 years follow-up. Results: 2-year follow-up was detected a significant decrease in the postoperative VCSS in the ASVAL and the EVLA group (p< 0.001). There was no statistically significant difference between both groups in VCCS in 2 years post-operation (p= 0.681). Frequency of recurrence did not differ between ASVAL (18.8%) and EVLA (21.4%) groups 2 years after treatment (p= 0.776) and the diameter of the GSV significantly decreased in the ASVAL group (5.48 vs 5.13, p= 0.008). The 5-year follow-up was detected recurrences in 40.0% of patients ASVAL group and 45.6% EVLA group (p = 0.668). Conclusions: Both ASVAL and EVLA effectively improve the disease severity in the groups of patients, selected according to the GSV diameter (≤ 6 mm or > 6 mm).