title: A longitudinal single-center cohort study on the prevalence and risk of accessory saphenous vein reflux after radiofrequency segmental thermal ablation of great saphenous veins.
abstract: OBJECTIVE
  Endothermal ablation has become a commonly used technology for occlusion of refluxing great saphenous veins (GSVs). However, the risk for primarily untreated accessory saphenous veins (ASVs) to develop reflux during follow-up has not yet been defined. Here, the prevalence and risk of ASV reflux is explored.
  
  
  METHODS
  During a prospective multicenter cohort study on radiofrequency segmental thermal ablation of refluxing GSVs, the presence and reflux status of ASVs were monitored in 93 legs in a single center. Control examinations were performed after 1 week and at 12, 24, 36, and 48 months. Life-table and multiple regression analyses were used to describe frequency and risk factors for presence of reflux in untreated ASVs.
  
  
  RESULTS
  Of 93 legs, 82 (88%) were available for 4-year follow-up. At baseline, 43 legs (46%) had an anterior ASV detectable by duplex ultrasound, with only two legs (2%) presenting with reflux. During 4 years of follow-up, according to life-table analysis, the proportion of legs with a detectable anterior ASV increased to 71% (n = 65); 32% of all legs and 55% of legs with a detectable anterior ASV exhibited refluxing anterior ASVs. Remarkably, in 35% of all legs with an anterior ASV, this reflux presented as a source of axial reflux, suggesting hemodynamic relevance. Posterior ASVs were detected in only 10 legs during 4-year follow-up, exhibiting reflux in only two cases.
  
  
  CONCLUSIONS
  Whereas posterior ASVs were meaningless, refluxing anterior ASVs occurred in a significant proportion of legs after thermal ablation of GSVs. Whether nonrefluxing anterior ASVs should be treated at the time of GSV ablation needs further examination.
authors.affiliation: Department of Dermatology, University Medical Center Mainz, Mainz, Germany; Private Clinic Proebstle, Phlebology Division, Mannheim, Germany. Electronic address: thomas.proebstle@web.de.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Proebstle
authors.affiliation: Department of Dermatology, University Medical Center Mainz, Mainz, Germany; Private Clinic Proebstle, Phlebology Division, Mannheim, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Möhler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D017115:Catheter Ablation; D015331:Cohort Studies; D005260:Female; D005268:Femoral Vein / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D007866:Leg; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012501:Saphenous Vein; D016896:Treatment Outcome; D014648:Varicose Veins / Q000628:therapy*; D014680:Veins / Q000601:surgery; D014689:Venous Insufficiency; D055815:Young Adult