Persistent incompetent truncal veins should not be treated immediately

Area of Science:

• Vascular Surgery
• Phlebology
• Venous Disease Management

Background:

• Traditional treatment for chronic venous disorder involves systematically addressing incompetent truncal veins.
• This study evaluates outcomes of selectively treating varicose tributaries while preserving refluxing truncal veins.

Purpose of the Study:

• To assess the efficacy and safety of phlebectomy focused on varicose tributaries without treating all incompetent truncal veins.
• To determine if preserving the great saphenous vein (GSV) impacts clinical and hemodynamic outcomes.

Main Methods:

• Retrospective analysis of ambulatory selective varices ablation under local anesthesia (ASVAL) procedures over four years.
• Included 1212 lower limbs treated with single phlebectomy, preserving a refluxing GSV.
• Clinical and hemodynamic outcomes assessed post-procedure and annually.

Main Results:

• 1212 lower limbs in 816 patients (mean age 53.7) were analyzed, with 85.6% classified as CEAP C2.
• Midterm follow-up (mean 44.5 months) showed a 5-year cumulative incidence of varicose recurrence at 13% and secondary major procedures at 4.5%.
• GSV reflux extension and multiple calf tributary connections were associated with varicose recurrence.

Conclusions:

• Phlebectomy limited to varicose tributaries is a safe and effective midterm treatment for chronic venous disorder.
• Preservation of main superficial venous system veins is feasible and beneficial.
• Systematic treatment of incompetent truncal veins is not essential for the majority of patients.