Functional phlebectomy for saphenous reflux: A retrospective cohort of 759 patients with 3-year follow-up

BackgroundThe optimal management of chronic venous disease with saphenous reflux remains debated. While truncal ablation is commonly recommended, haemodynamically oriented and saphenous-sparing strategies have emerged, possibly challenging the necessity of routine treatment of the saphenous vein in all patients.ObjectiveTo evaluate clinical and haemodynamic outcomes following functional phlebectomy in patients with symptomatic varicose veins and saphenous reflux, and to assess the need for subsequent truncal intervention.MethodsA retrospective cohort study was conducted including 759 consecutive patients with CEAP C2 disease and duplex-confirmed saphenous reflux, treated between 2008 and 2019. All patients underwent functional phlebectomy targeting refluxing tributaries without routine saphenous ablation. Follow-up was performed up to 36 months with clinical assessment and duplex ultrasound. Outcomes were reported descriptively as absolute numbers and percentages as collected at 36 months. Secondary staged treatment with foam sclerotherapy was performed in patients with persistent symptomatic reflux.ResultsAfter functional phlebectomy, absence of reflux was observed in 24.9% of patients, while 49.5% presented persistence of reflux without symptoms and 24.9% persistence with symptoms. Saphenous vein thrombosis occurred in 0.6% of cases. Among patients undergoing secondary sclerotherapy (n = 189), absence of reflux was achieved in 10.05%, while 39.6% became asymptomatic despite persistent reflux. Overall, only a minority of patients required subsequent treatment of the saphenous vein. Saphenous vein diameter appeared to influence treatment outcomes, with preservation observed in all cases with diameters ≤6 mm and increasing need for truncal intervention in larger veins.ConclusionsFunctional phlebectomy, applied within a haemodynamically guided framework, is associated with favourable clinical outcomes in the majority of patients with saphenous reflux, without the need for routine truncal ablation. These findings support a selective, stepwise approach to treatment and contribute to the evolving paradigm of personalised management in chronic venous disease.