The Excluded Saphenous Vein Technique for Great Saphenous Vein Reflux: Five-Year Outcomes from an Institutional Experience

Purpose: This study aimed to assess the long-term effectiveness of the Excluded Saphenous Vein Technique (ESVT) in patients with varicose veins (VVs) associated with great saphenous vein (GSV) incompetence. Materials and Methods: Patients who underwent ESVT for primary GSV incompetence assciated with VVs between January 2017 and December 2019 were included in this retrospective analysis of a prospectively maintained institutional database. Eligible patients had Clinical, Etiologic, Anatomic, and Pathophysiologic class C2 disease. ESVT consists of selective crossectomy, distal ligation of the GSV at the level of the incompetent thigh tributary, catheter-assisted foam sclerotherapy of the excluded GSV segment, and concomitant phlebectomy of non-saphenous varicosities. The primary endpoint was cumulative GSV recanalization during 5-year follow-up. Secondary endpoints included perioperative complications and VV recurrence. Results: Among 312 patients treated during the study period, 268 met the eligibility criteria, and 239 patients with 349 treated limbs had complete 5-year follow-up. The median GSV diameter was 11 mm (interquartile range, 8-14 mm). All procedures were performed in a day-surgery setting. Transient skin dyschromia occurred in 6.3% of patients, persistent dyschromia in 2.1%, and superficial vein thrombosis in 2.1%; all were managed conservatively. No clinically detected deep vein thrombosis or symptomatic pulmonary embolism occurred. During 5-year follow-up, GSV recanalization occurred in 22/349 treated limbs (6.3%), involving 22/239 patients (9.2%). Recurrent VVs were observed in 59 patients (24.7%). Conclusion: ESVT appears to be a safe and effective treatment option for selected patients with primary GSV reflux and VVs.