The endovenous ASVAL method: principles and preliminary results

Area of Science:

• Vascular Surgery
• Minimally Invasive Procedures
• Phlebology

Background:

• Varicose veins affect a significant portion of the population, leading to discomfort and aesthetic concerns.
• Traditional treatments for varicose veins can be invasive and may involve the removal of the great saphenous vein (GSV).
• There is a need for minimally invasive and safe alternatives for varicose vein treatment that prioritize vein preservation.

Purpose of the Study:

• To evaluate the feasibility and safety of the endovenous ambulatory selective varicose vein ablation under local anesthesia (eASVAL) technique.
• To present the short-term outcomes, specifically one-year ultrasonographic follow-up results, of the eASVAL procedure.
• To assess the efficacy of eASVAL in selected patients with varicose disease, focusing on GSV preservation.

Main Methods:

• A retrospective review of 395 patients treated with endovenous laser ablation (EVLA) over two years.
• Inclusion of 41 patients treated with the eASVAL technique, characterized by limited segmental GSV reflux and a competent terminal valve.
• The eASVAL technique involved EVLA of major tributary varicosities followed by ultrasound-guided foam sclerotherapy, preserving the GSV.

Main Results:

• Successful preservation of the great saphenous vein in all 41 patients.
• Significant clinical improvement observed in all patients undergoing the eASVAL procedure (P < 0.001).
• Absence of segmental reflux in 75.3% of patients and a significant reduction in mean GSV diameter at one-year follow-up (8.5 mm vs. 7.5 mm, P < 0.001).

Conclusions:

• The eASVAL procedure is a feasible and safe treatment option for selected patients with varicose veins.
• The technique demonstrates promising one-year ultrasonographic follow-up results, including GSV preservation and clinical improvement.
• Further prospective studies are warranted to compare eASVAL with standard varicose vein treatment techniques.