From the Guidelines
Endovenous Ablation Therapy (EVAT) is indicated for reflux in the right and left Great Saphenous Vein (GSV) with incompetent segments and varicosities.
Treatment Options for Varicose Veins
- Conservative measures: compression therapy, elevation of the affected leg, lifestyle modifications, and weight loss may provide relief from discomfort, although evidence is lacking 1.
- Interventional treatments:
- Thermal ablation: endovenous thermal ablation (using a laser or radio waves) is used for larger vessels, including the greater saphenous vein 1.
- Endovenous sclerotherapy: a variety of agents may be used, including hypertonic saline, sodium tetradecyl, and polidocanol 1.
- Surgery: ligation and stripping of the great or small saphenous vein, although a growing body of literature does not consistently support surgery as the best interventional treatment option 1.
Rationale for EVAT
The decision to proceed with EVAT is based on symptoms and patient preferences, as well as the presence or absence of deep venous insufficiency and the characteristics of the affected veins 1. EVAT has been shown to be a effective treatment option for varicose veins, with better outcomes and fewer complications than other treatments 1. The American College of Radiology recommends saphenous vein ablation as a treatment option for varicose veins 1.
Important Considerations
- Diagnosis: US duplex Doppler of the lower extremity is usually appropriate for the initial diagnosis of varicose veins 1.
- Treatment: the choice of treatment is based on symptoms and patient preferences, as well as the presence or absence of deep venous insufficiency and the characteristics of the affected veins 1.
From the Research
Indications for EVAT in Reflux of the Great Saphenous Vein (GSV)
- EVAT is indicated for reflux in the right and left Great Saphenous Vein (GSV) with incompetent segments and varicosities, as it can improve symptoms and reduce the need for sclerotherapy 2, 3.
- The procedure can be safely performed with minimal complications, including postoperative paresthesia and wound infection 2.
- Endovenous ablation of the refluxing below-knee (BK) GSV segment can be performed concomitantly with above-knee (AK) GSV treatment to improve long-term outcomes 2.
Patterns of Reflux in the GSV
- Reflux patterns in the GSV can be classified into different types, including segmental, proximal, distal, and diffused reflux 4, 5.
- The most common pattern of GSV reflux is segmental, involving one or more segments of the vein 4.
- Reflux in the BK-GSV can persist after AK-GSV EVLA, leading to residual symptoms and a greater need for sclerotherapy 6, 3.
Clinical Significance of BK-GSV Reflux
- Persistent BK-GSV reflux after AK-GSV EVLA can be responsible for residual symptoms and a greater need for sclerotherapy 3.
- The clinical significance of BK-GSV reflux highlights the importance of considering concomitant ablation of the BK-GSV in treatment of patients with varicose veins with reflux extending to the BK segment of the GSV 2, 3.