Diameter of saphenous veins: does it influence therapeutic options? (results of a worldwide survey)
M. DE MAESENEER
S. VAN DER VELDEN
Erasmus Medical Centre
Nowadays, numerous treatment possibilities are available for patients with varicose veins. Treatment
strategy may be different depending on the diameter of the refluxing truncal vein. However, the optimal
management strategy cannot always be retrieved from existing guidelines.
To evaluate how duplex ultrasound findings, in particular measured
diameter, influence management
decisions of physicians with specifi c expertise in the fi eld of chronic venous disease.
Presidents of national phlebologic societies were invited to nominate up to twenty physicians who are
recognized experts (at least 5 years of experience) in varicose vein treatment techniques, including
phlebectomy, endovenous thermal ablation (EVTA), and chemical ablation with sclerosant foam. A total
of 364 physicians were invited by email to complete a survey concerning different case vignettes of
patients with great saphenous vein (GSV) refl ux. The basic case vignette represented a 47 year old
man with varicose veins below the knee and CEAP classifi cation C2SEpAs2,5Pr. The GSV diameter,
measured mid thigh, was 6 mm. After determining their strategy for this patient, participants were asked
if diameter was relevant to choose between ablation or no ablation, and for the choice of the ablation
technique. They also were asked to determine a cut off value, below which or above which they would
decide to change their strategy. Changes in management strategies were analysed.
Between January and March 2014 a total of 211 specialists from 36 different countries completed
the survey. In the basic case vignette 55% of participants proposed to perform EVTA, with or without
concomitant phlebectomies. A vast majority of respondents (74%) answered that vein diameter was
important for the treatment strategy. They would decide to change their management strategy in case
the diameter of the GSV was below a median value of 4 mm (IQR 3- 5) or above 10 mm (IQR 7- 10).
If the diameter of the GSV was below 4 mm, 44% of participants indicated a change to a less invasive
treatment compared to the basic case vignette. If the diameter was above 10 mm, more EVTA with
additional high ligation or classic surgery were proposed, representing 31% of all options.
According to this worldwide survey, diameter measurement is important, leading to either a less invasive
treatment, in case of small diameter, or to a more invasive treatment, in case of large diameter of the