COMPARATIVE ANALYSIS OF VARICOSE VEIN RECURRENCE RATES AFTER ENDOVENOUS LASER ABLATION OF THE GREAT SAPHENOUS VEIN WITH PRESERVATION VERSUS SIMULTANEOUS ABLATION OF THE ANTERIOR ACCESSORY SAPHENOUS VEIN

Aim of the research is to evaluate the effect of simultaneous endovenous laser ablation (EVLA) of the anterior accessory great saphenous vein (AAGSV) with a diameter greater than 5 mm, in the absence of baseline reflux, on the recurrence rate of varicose vein disease within one year after EVLA of the great saphenous vein (GSV) trunk. This prospective single-center study included 100 patients (78 women and 22 men) with CEAP clinical classes C2–C4 who underwent EVLA of the GSV between October 2023 and October 2024. Patients were divided into two groups: Group I (n = 50) underwent EVLA of the GSV only; Group II (n = 50) underwent EVLA of the GSV with simultaneous EVLA of the AAGSV (diameter >5 mm, without baseline reflux). A 1470-nm diode laser with a radial fiber (IPG, Russia) was used at a power of 7 W, with a pullback speed of 1 mm/s and a linear endovenous energy density of approximately 70 J/cm. Tumescent anesthesia consisted of 0.03% lidocaine (300–350 mL). Pathological reflux was defined as retrograde flow lasting more than 0.5 seconds on duplex ultrasound. Follow-up was performed at 1, 6, and 12 months. The primary endpoint was clinically significant recurrence of varicose vein disease. At 12 months, recurrence was observed in 10 patients (20%) in Group I and in 2 patients (4%) in Group II (relative risk [RR] = 0.20; 95% confidence interval [CI] 0.05–0.87; p = 0.028). The absolute risk reduction was 16 percentage points, with a number needed to treat (NNT) of 6.25. New reflux in the AAGSV was detected in 18% versus 2% of patients (RR = 0.11; 95% CI 0.015–0.845; p = 0.016). Repeat interventions were required in 12% versus 2% of cases. Patient satisfaction scores were significantly higher in Group II (9.4 ± 0.6 vs 8.1 ± 1.2; p < 0.001). The overall complication rate did not differ between groups (8% vs 10%; p > 0.05). Simultaneous EVLA of the AAGSV with a diameter greater than 5 mm, even in the absence of baseline reflux, is associated with an 80% relative reduction in varicose vein recurrence within one year. This approach does not increase the risk of complications and improves patient-reported outcomes. It may be considered a preventive strategy in patients with anatomically prominent AAGSV.