The endovenous ASVAL method: principles and preliminary results.

Ambulatory selective varicose vein ablation under local anesthesia (ASVAL) is a surgical treatment for varicose veins based on the ascending hypothesis that venous insufficiency progresses in an ascending manner, from the superficial tributaries to the saphenous vein (SV) and then to the sapheno-femoral junction (SFJ). Recent scientific data based on precise and detailed duplex scanning support this hypothesis (1–6). The ASVAL method recommends preserving the great saphenous vein (GSV), unless there is a serious terminal valve insufficiency, and suggests the surgical removal (phlebectomy) of the superficial varicose reservoir (SVR) as a primary treatment. The major argument in favor of preserving the GSV is the essential physiologic role that the GSV could play in superficial drainage and, to a lesser extent, its availability as revascularization material. Although the original ASVAL method is performed using simple phlebectomies, many patients refuse to have this treatment because they regard it as a surgical operation that would likely yield poor cosmetic results. Thermal endovenous techniques and foam sclerotherapy are less aggressive and are reported to be as effective as traditional surgical treatments (7). The question arises as to whether the ASVAL approach can be performed using endovenous techniques. To the best of our knowledge, this research will be a preliminary study describing the endovenous technique for the ASVAL approach. The purpose of this study was to investigate the feasibility and safety of endovenous ASVAL (eASVAL) technique and to present the short-term results with one-year ultrasonography (US) follow-up in a selected group of patients.