title: The clinical significance of below-knee great saphenous vein reflux following endovenous laser ablation of above-knee great saphenous vein.
abstract: OBJECTIVE
  The standard technique for endovenous laser ablation (EVLA) for varicose veins due to great saphenous vein (GSV) reflux involves obliteration of the above-knee (AK) GSV. This study assesses the significance of persistent below-knee (BK) GSV reflux following such therapy.
  
  
  METHODS
  Sixty-nine limbs (64 patients) with varicosities and GSV reflux underwent AK-EVLA. Post treatment, GSV reflux (ultrasound: six, 12 weeks) and Aberdeen varicose vein severity scores (AVVSS, 12 weeks) were assessed, and residual varicosities treated with foam sclerotherapy (six weeks).
  
  
  RESULTS
  The untreated BK-GSV remained patent in all limbs. Ultrasound showed normal antegrade flow in 34/69 (49%, Group A), flash reflux<1 s in 7/69 (10%, Group B) and >1 s reflux in 28/69 (41%, Group C). Although AVVSS improved in all groups (P<0.001): A: 14.6 (8.4-19.3) versus 2.8 (0.5-4.4), B: 13.9 (7.5-20.1) versus 3.7 (2.1-6.8), C: 15.1 (8.9-22.5) versus 8.1 (5.3-12.6) the improvement was less in Group C (P<0.001 versus A and B) and was associated with a greater requirement (A: 4/34 [12%]; B: 1/7 [14%]; C: 25/28 [89%]) for sclerotherapy (persisting varicosities) (P<0.001).
  
  
  CONCLUSIONS
  Although AK-GSV EVLA improves symptoms regardless of persisting BK reflux, the latter appears responsible for residual symptoms and a greater need for sclerotherapy for residual varicosities.
authors.affiliation: Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK. nadacumar@yahoo.co.uk
authors.forename: N S
authors.initials: NS
authors.lastname: Theivacumar
authors.forename: R J
authors.initials: RJ
authors.lastname: Darwood
authors.forename: D
authors.initials: D
authors.lastname: Dellagrammaticas
authors.forename: D
authors.initials: D
authors.lastname: Dellegrammaticas
authors.forename: A I D
authors.initials: AI
authors.lastname: Mavor
authors.forename: M J
authors.initials: MJ
authors.lastname: Gough
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007717:Knee; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D012039:Regional Blood Flow; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000601:surgery*; D015911:Sclerotherapy; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014463:Ultrasonography; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000601:surgery*; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000628:therapy*