title: Endovenous laser ablation (EVLA) of the anterior accessory great saphenous vein (AAGSV): abolition of sapheno-femoral reflux with preservation of the great saphenous vein.
abstract: OBJECTIVE
  During surgery for sapheno-femoral junction (SFJ) and anterior accessory great saphenous vein (AAGSV) reflux, many surgeons also strip the great saphenous vein (GSV). This study assesses the short-term efficacy (abolition of reflux on Duplex ultrasound) of endovenous laser ablation (EVLA) of the AAGSV with preservation of a competent GSV in the treatment of varicose veins occurring due to isolated AAGSV incompetence.
  
  
  METHODS
  Thirty-three patients (21 women and 12 men) undergoing AAGSV EVLA alone (group A) and 33 age/sex-matched controls undergoing GSV EVLA (Group B) were studied. Comparisons included ultrasound assessment of SFJ competence, successful axial vein ablation, Aberdeen Varicose Vein Symptom Severity Scores (AVVSS) and a visual analogue patient-satisfaction scale.
  
  
  RESULTS
  At the 1-year follow-up, EVLA had successfully abolished the target vein reflux (AAGSV: median length 19 cm (inter-quartile range, IQR: 14-24 cm) vs. GSV: 32 cm (IQR 24-42 cm)) and had restored SFJ competence in all patients. Twenty of the 33 patients (61%) in group A and 14 of the 33 (42%) in group B (p=0.218) required post-ablation sclerotherapy at 6 weeks post-procedure for residual varicosities. The AVVSS at 12 months follow-up had improved from the pre-treatment scores in both the groups (group A: median score 4.1 (IQR 2.1-5.2) vs. 11.6 (IQR: 6.9-15.1) p<0.001; group B: median score 3.3 (IQR 1.1-4.5) vs. 14.5 (IQR 7.6-20.2), p<0.001), with no significant difference between the groups. Patient-satisfaction scores were similar (group A: 84% and group B: 90%). Previous intervention in group A included GSV EVLA (n=3) or stripping (n=9). Thus, the GSV was preserved in 21 patients. The AVVSS also improved in this subgroup (4.4 (2.0-5.4) vs. 11.4 (6.0-14.1), p<0.001) and SFJ/GSV competence was found to be restored at the 1-year follow-up.
  
  
  CONCLUSIONS
  AAGSV EVLA abolishes SFJ reflux, improves symptom scores and is, therefore, suitable for treating varicose veins associated with AAGSV reflux.
authors.affiliation: Leeds Vascular Institute, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX, UK.
authors.forename: N S
authors.initials: NS
authors.lastname: Theivacumar
authors.forename: R J
authors.initials: RJ
authors.lastname: Darwood
authors.forename: M J
authors.initials: MJ
authors.lastname: Gough
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D005260:Female; D005268:Femoral Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D005500:Follow-Up Studies; D006801:Humans; D053685:Laser Therapy; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012039:Regional Blood Flow / Q000502:physiology; D012501:Saphenous Vein / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D015911:Sclerotherapy; D014463:Ultrasonography; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D014654:Vascular Patency