Research Associate NYU Langone Hospital-Brooklyn Brookyn, New York, United States
Objective: Endothermal ablation (ETA), such as endovenous laser ablation (EVLA) and radiofrequency ablation (RFA), has been increasingly used for treatment of anterior accessory saphenous vein (AASV) insufficiency. Accessory vein insufficiency is not a common source of reflux. However, it is not uncommon.Reflux in the AASV can occur independently or simultaneously with great saphenous vein (GSV) reflux. Several published reports describe recommendations and treatment of symptomatic refluxing AASVs, but descriptions of reports on redo AASV procedures for symptomatic recanalized AASVs is sparse. The objective of the present study was to determine the efficacy of redo venous ablation for symptomatic recanalized AASVs and to predict the factors related to recanalization.
Methods: A retrospective analysis of 16,506 ETAs were performed in 4,871 patients, from 2012 to 2022. Of those, 764 AASV procedures in 542 patients with chronic venous insufficiency due to AASVs from 2012 to 2022 was performed, using individual medical record review for data extraction. All 764 procedures were performed using endothermal ablation for patients in whom initial conservative management had failed. Postoperative duplex ultrasound scans were performed within 3 to 7 days after treatment. We defined successful obliteration as a lack of color flow using postoperative duplex ultrasound. We defined recanalization as the presence of reflux on duplex ultrasound in the target vessel during follow-up. We conducted follow-up examinations every 3 months during the first year and every 6 months subsequently.
Results: Of the 764 procedures 542 were in females, 222 were in males, 421 were performed on the left lower extremity and 343 on the right lower extremity. 27 patients were Asian, 129 were Black, 138 were Hispanic, and 470 were white. 1 patient recanalized in the Asian group, 3 in the Black group, 3 in the Hispanic group, and 22 in the White group. The mean body mass index was 33.89 ± 9.2 kg/m2. The mean age was 62.98±14.7 years. The CEAP (Clinical, Etiology, Anatomy, and Pathophysiology)class was C1, C2, C3, C4, C5, and C6 for 5, 22, 289, 327, 14, and 106 patients, respectively. Of the 801 procedures, 341 were performed using EVLA and 460 were performed using RFA. The initial technical success rate was 96.2%(735/764). The redo technical success rate was 96.6%(28/29). No correlation was found between successful obliteration with the redo procedure and age, gender, CEAP class, laterality, EVLA vs RFA. However, higher BMI was correlated with higher rates of AASV recanalization (p < .001).
Conclusions: The rates of successful closure for AASVs with initial and redo procedures were 96.2% and 96.6%, respectively. These data have validated the potential usefulness of performing redo AASV ablation.