The refluxing volume could be the key point to explain the effect of the ablation of the varicose reservoir on the saphenous reflux, according to Paul Pittaluga, Riviera Veine Institut, Nice, France. Pittaluga presented data from “The effect of isolated phlebectomy on reflux and diameter of the great saphenous vein – A prospective study” at the European Society of Vascular Surgery annual meeting in Oslo, Norway, and at the International Union of Phlebology meeting in Monaco.
Pittaluga conducted a prospective study to assess the haemodynamic and anatomic consequences of isolated phlebectomy by analysing the duration and velocity of the saphenous reflux and diameter. Fifty five legs in 54 patients with varices and presence of great saphenous reflux, reaching or not the saphenous junction, which were treated by isolated phlebectomy (with the so called ASVAL method) were included. Of the 54 patients, 24 women were women and the mean age was 62.6 (37–83 years). The wide majority of patients had symptomatic non-complicated varicose veins. The study excluded patients previously operated on for varicose veins, cases of deep venous insufficiency and limbs in which a reflux was present in both great and small saphenous veins.
Reflux duration, peak reflux velocity, and diameter of the great saphenous vein were measured using duplex ultrasound pre-operatively and one month after procedure. Reflux duration was considered abnormal if it lasted longer than 0.5s. The diameter of the saphenous vein was assessed with five measurements from the junction to the calf.
“What has been the modification of the saphenous reflux in our study? A significant saphenous reflux of more than 0.5s was present in 50 cases pre-operatively, while the duration was at the limit at 0.5s in five cases. At the post-operative control, the reflux was significant in only 20 cases, while there was no more reflux in 35 cases. Thus, the reflux was abolished in 30 out of 50 cases (60%),” Pittaluga said.
The modification of the reflux duration was highly significant with a mean reduction from 1.53s before the procedure to 0.81s at one month (p<0.0001). “This reduction was obviously major for limbs in which the reflux has been abolished, but even for limbs in which a reflux of more than 0.5s was still present the mean duration was significantly reduced in more than 30%,” Pittaluga said.
The assessment of the peak reflux velocity also showed a highly significant reduction with a mean modification changing from 248.6mm/s pre-operatively to 119.5mm/s at one month. “Once again, this reduction was significant even if the reflux lasted more than 0.5s at one month,” Pittaluga included. “Concerning the transostial reflux, it was present in 20 out of 55 cases pre-operatively, whereas none of the limbs presented a trans-ostial reflux at one month after the procedure. Thus, the transostial reflux was abolished in all cases in our study.”
Regarding modification in the saphenous diameter, Pittaluga presented data showing that the mean diameter was significantly reduced at all levels of measurement at one month post-operation. “It was interesting to see that, excluding the ostial, the closer the level of measurement was of the bottom, the reduction was higher, from 11.1% at the pre-ostial to 32% at the calf.”
“The ablation of the varicose reservoir had a significant hemodynamic consequence on the refluxing saphenous vein, with the abolition of the reflux in 60% of the cases for the whole cohort and in 100% for the ostial reflux checked with the Valsalva manoeuvre.
Other studies are required to confirm if the refluxing volume is correlated to the clinical consequences of the reflux, said Pittaluga.
