The article tells of the clinical importance of saphemoral junction tributaries following endovenous laser ablation of the great saphenous vein. Unlike surgery, the procedure called the endovenous laser ablation, or EVLA, with the aid of zoom microscope abolishes great saphenous vein reflux but does not specifically interrupt the GSV tributaries at the groin. There is one major vein in the leg. This is the greater saphenous vein. This vein connects to many of the superficial surface veins. The said saphenous vein runs down from the groin to the lower leg with varicose veins commonly occurring in the lower thigh, around the knee and in the calf. The veins carry blood from the tissues eventually back to the heart. Muscles can squeeze the thin walled veins as they contract. The failure of the valves in this vein is quite common and is a major cause of surface varicose veins. This forces the blood into non-return valves. If the non-return valves become faulty and they fail to close, the blood can run backwards and pool in the legs. This causes the blood to reflux and pool in the legs. If this extra blood is sitting in veins close to the surface of the skin, the veins will swell up and become visible as varicose veins.

Surgical ligation and stripping is performed under general anesthesia and involves at least two surgical incisions in order to tie off and pull out the faulty vein. The procedure of endovenous laser ablation with the aid of zoom microscope is a progressive alternative to surgical ligation and stripping. With the endovenous laser ablation, no anesthesia is involved. A fine fiber optic probe from an 810 nm diode laser delivers the laser beam energy. The procedure occurs with the laser beam targeting the vein walls with the aid of zoom microscope, then shrinking them and closing the faulty vein. This stops the blood from flowing through it. The procedure is performed via a tiny skin nick, so there will be no postoperative scarring. The probe is guided into place using ultrasound.

The clinical significance of these tributaries was assessed in a prospective study discussed in the article. Seventy patients, or 81 legs, were studied. They all underwent colour flow duplex ultrasonography 12 months after GSV ablation for primary varicose veins. Specific observations such as saphenofemoral junction reflux, tributary potency, and recurrent or residual varicosities were recorded in the study. The investigation used teh Aberdeen Varicose Vein Severity Scores and results were compared with pretreatment values.

The results showed that the GSV had recanalized without evidence of reflux in two patients. None of the 81 legs of the patients showed SFJ reflux although one or more patent tributaries were visible in 48 patients, that is 59 percent. All showed to be competent. In 32 legs, comprising 40 percent, there was flush GSV occlusion with the SFJ and no tributaries were detectable. The article also tells that one leg showed evidence of neovascularization in the groin. The results further show that the AVVSS values were similar in groups with or without visible tributaries, both before and after EVLA. This showed a median of 13.9 before EVLA and 2.9 at follow up in patients with visible tributaries. It showed a 14.9 and 3.1 respectively in those without. Results show that recurrent varicosities were present in one leg only, due to an incompetent mid thigh perforating vein. The authors of the study conclude that persistent non-refluxing GSV tributaries at the SFJ did not appear to have an adverse impact on clinical outcome 1 year after successful EVLA of the GSV. Read more