Photo Credit: AI

The following is a summary of “Prognosis of distal segment reflux after proximal segment treatment of an incompetent small saphenous vein” published in the March 2025 issue of Annals of Vascular Surgery by Hong et al.

This study aimed to evaluate postoperative changes in distal segment reflux following treatment of the proximal segment of an incompetent small saphenous vein (SSV). A retrospective analysis was conducted on patients diagnosed with SSV incompetence who underwent treatment between April 2017 and July 2022. Patients with a history of prior varicose vein interventions, including sclerotherapy, or those without post-procedural Doppler ultrasound follow-up were excluded from the study. A total of 129 patients (151 limbs) were included, with a mean follow-up period of 15 months (range: 6–62 months). The cohort had a male-to-female ratio of 1:1.9 and a mean age of 56 years (range: 24–83 years). Persistent reflux in the distal segment of the SSV following proximal segment treatment was observed in 19% (29/151) of treated limbs. However, only five patients (5/129) experienced lower extremity symptoms associated with residual reflux in the distal SSV segment.

Statistical analysis revealed no significant association between the persistence of reflux and patient-specific factors, including age, sex, body mass index, limb laterality, preoperative SSV diameter, reflux duration, concomitant popliteal vein reflux, incompetent great saphenous vein (GSV) below the knee, CEAP clinical classification, or treatment modality. These findings suggest that residual reflux in the distal SSV segment is relatively uncommon and rarely symptomatic following proximal segment treatment. Notably, fewer than 4% of patients in the study cohort experienced persistent distal reflux with associated clinical symptoms in the ipsilateral lower extremity. The results support the efficacy of proximal SSV treatment in resolving venous incompetence while indicating that persistent distal reflux is generally not a significant clinical concern. Further research may be warranted to explore the long-term implications of residual distal reflux and its potential impact on symptom progression in select patient populations.

Source: annalsofvascularsurgery.com/article/S0890-5096(25)00114-1/abstract