Fate of the tributaries of sapheno femoral junction following endovenous thermal ablation of incompetent axial vein - A review article.

Sapheno femoral junctional tributaries are usually left untreated at the time of endovenous ablation of axial vein. The long-term clinical significance of these untreated tributaries remains elusive and there is very little research done into this area. This article reviews the fate of untreated tributaries at sapheno femoral junction following ablation of incompetent axial vein. A literature search and analysis of evidence reveal that the junctional tributaries are one of the commonest (ranges between 8% and 31%) cause for recurrence following endovenous ablation of the axial veins. Follow up of this subset of patients after their axial vein treatment should be considered to identify neoreflux in side branches at sapheno femoral junction and plan treatment.

Endovenous laser ablation: does standard above-knee great saphenous vein ablation provide optimum results in patients with both above- and below-knee reflux? A randomized controlled trial.

BACKGROUND: Following above-knee (AK) great saphenous vein (GSV) endovenous laser ablation (EVLA) 40% to 50% patients have residual varicosities. This randomized controlled trial (RCT) assesses whether more extensive GSV ablation enhances their resolution and influences symptom improvement. METHOD: Sixty-eight limbs (65 patients) with varicosities and above and below-knee GSV reflux were randomized to Group A: AK-EVLA (n = 23); Group B: EVLA mid-calf to groin (n = 23); and Group C: AK-EVLA, concomitant below-knee GSV foam sclerotherapy (n = 22). Primary outcomes were residual varicosities requiring sclerotherapy (6 weeks), improvement in Aberdeen varicose vein severity scores (AVVSS, 12 weeks), patient satisfaction, and complication rates. RESULTS: EVLA ablated the treated GSV in all limbs. Sclerotherapy requirements were Group A: 14/23 (61%); Group B: 4/23 (17%); and Group C: 8/22 (36%); chi2 = 9.3 (2 df) P = .01 with P(A-B) = 0.006; P(B-C) = 0.19; P(A-C) = 0.14. AVVSS scores improved in all groups as follows: A: 14.8 (9.3-22.6) to 6.4 (3.2-9.1), (P < .001); B: 15.8 (10.2-24.5) to 2.5 (1.1-3.7), (P < .001); and C: 15.1 (9.0-23.1) to 4.1 (2.3-6.8), (P < .001) and P(A-B) = 0.011, P(A -C) = 0.042. Patient satisfaction was highest in Group B. BK-EVLA was not associated with saphenous nerve injury. CONCLUSIONS: Extended EVLA is safe, increases spontaneous resolution of varicosities, and has a greater impact on symptom reduction. Similar benefits occurred after concomitant BK-GSV foam sclerotherapy.