Treatment outcomes after thermal ablation for Anterior Accessory Great Saphenous Veins compared to Great Saphenous Veins

Introduction

Endovenous therapies are currently the standard of care for the treatment of patients with symptomatic Great Saphenous Vein (GSV) reflux.  The effectiveness and long-term outcomes of these therapies for Anterior Accessory Great Saphenous Veins (AAGSVs) are poorly defined.  The objective of this investigation is to determine treatment outcomes in patients with symptomatic AAGSV reflux compared to patients with symptomatic GSV reflux.

Methods

Data were prospectively collected in the Center for Vein Restoration’s electronic medical record system (NexGen Healthcare Information System, Irvine, California) and retrospectively analyzed.  Patients with isolated AAGSV and GSV were compared to each other and a cohort of patients with combined AAGSV and GSV reflux.  Treatment outcomes were assessed utilizing the revised venous clinical severity score (rVCSS) and the CIVIQ20 survey for quality of life.  Medical and surgical co-morbidities, CEAP, BMI, gender, race and the average number of procedures performed were all analyzed.

Results

From January 2015 to December 2018, 31,186 patients and 49,193 limbs were assessed.  Of these, 91 patients/103 limbs had isolated AAGSV reflux and 7,704 patients/10,371 limbs had isolated GSV reflux.  There were 95% and 75% females in the isolated AAGSV and GSV groups respectively.  For the isolated groups, there were no differences in pre-intervention (7.0±2.0 vs 6.8±2.8) and six month (3.9±2.6 vs 3.9±2.9) rVCSS scores between AAGSV and GSV patients.  Similar results were observed when ablations and phlebectomies were performed.  CIVIQ20 scores for isolated AAGSV and GSV patients were 53.3±19.6 vs 50.6±18.8 pre-intervention and 41.3±21.7 vs 35.1±15.7 at six months respectively.  Post-procedure scores within groups significantly improved at one and six months(p≤0.02), however six month AAGSV CIVIQ20 scores increased slightly compared to one month scores and were not significantly different to pre-intervention GSV scores. When phlebectomies were performed with ablations, six month CIVIQ20 scores were similar between groups. There was no difference in the average number of ablations and/or phlebectomies in the isolated AAGSV or GSV group (1.24±0.44 vs1.35±0.49).

Conclusion

Endovenous therapies for the treatment of symptomatic AAGSVs demonstrates similar outcomes compared to patients with symptomatic GSV reflux.  For standalone ablations, the rVCSS scores are similar between groups, however, CIVIQ20 scores increase to pre-intervention levels in AAGSV patients at six months.  This increase disappears when phlebectomies are performed with ablations.  Based on these data, patients with symptomatic AAGSV require ablations and phlebectomies to achieve similar outcomes to GSV patients and calls into question the effectiveness of ablation for isolated AAGSV reflux.