Int J Angiol 2024; 33(01): 046-049
DOI: 10.1055/s-0043-1776145
Short Communication

ASVAL with Phlebectomy/Sclerofoam Technique: Preliminary Results

Alberto Garavello
1   Department of Emergency Surgery, Wound Care Specialist Service for Lower Limbs Ulcers and Venous Disease, Ospedale San Filippo Neri, Roma, Italy
Paola Fiamma
1   Department of Emergency Surgery, Wound Care Specialist Service for Lower Limbs Ulcers and Venous Disease, Ospedale San Filippo Neri, Roma, Italy
Enrico Oliva
2   Accademia di Storia dell'Arte Sanitaria, Roma, Italy
› Author Affiliations


The ambulatory selective varicose vein ablation under local anesthesia (ASVAL) method recommends preserving the great saphenous vein (GSV), unless there is a serious terminal valve insufficiency, and suggests phlebectomy of superficial varicose reservoir as a primary treatment. To increase patient comfort, foam safety and cosmetic results, we used ASVAL with a mixed phlebectomy/foam technique on local anesthesia. Thirty consecutive patients treated with ASVAL phlebectomy-sclerofoam technique were reviewed retrospectively between December 2022 and April 2023. All patients were evaluated by clinical examination and duplex ultrasound (DUS); the main selection criteria were a minimal GSV insufficiency (main GSV < or = to 1 cm). Muller phlebectomy of tributaries at entry point in the saphenous trunk was performed; after 1 week, patients were checked for foam sclerotherapy of residual trunk. Under visual control, 0.5% polidocanol foam (from 5 to 10 cc. “Tessari Technique”) was injected in visible veins and elastic compression with pad was applied for 1 week. Compression with Class I elastic stockings was prescribed, and patients were reviewed after 1 month. Postoperative complications included thigh hematoma in two patients, three thrombosis of injected trunk, and hyperpigmentation in three patients. No GSV thrombosis at DUS was recorded. In 27 patients, a satisfying cosmetic result was achieved, and in 3 patients a new foam session was needed. Phlebectomy/foam ASVAL technique is a safe, low-traumatic technique with no need of US guidance, with less risk of foam migrating in GSV, simple and inexpensive, for patients with less advanced GSV insufficiency.

Authors' Contributions

Alberto Garavello contributed to study design. Paola Fiamma was involved in data collection. Enrico Oliva contributed to bibliography.

Publication History

Article published online:
18 October 2023

© 2023. International College of Angiology. This article is published by Thieme.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

  • References

  • 1 Atasoy MM, Oğuzkurt L. The endovenous ASVAL method: principles and preliminary results. Diagn Interv Radiol 2016; 22 (01) 59-64
  • 2 Abu-Own A, Scurr JH, Coleridge Smith PD. Saphenous vein reflux without incompetence at the saphenofemoral junction. Br J Surg 1994; 81 (10) 1452-1454
  • 3 Recek C. Assessment of the CHIVA and the ASVAL Method. Int J Angiol 2022; 31 (02) 83-87
  • 4 De Maeseneer M, Pichot O, Cavezzi A. et al; Union Internationale de Phlebologie. Duplex ultrasound investigation of the veins of the lower limbs after treatment for varicose veins - UIP consensus document. Eur J Vasc Endovasc Surg 2011; 42 (01) 89-102
  • 5 Pittaluga P, Chastanet S, Rea B, Barbe R. Midterm results of the surgical treatment of varices by phlebectomy with conservation of a refluxing saphenous vein. J Vasc Surg 2009; 50 (01) 107-118
  • 6 Zolotukhin IA, Seliverstov EI, Zakharova EA, Kirienko AI. Short-term results of isolated phlebectomy with preservation of incompetent great saphenous vein (ASVAL procedure) in primary varicose veins disease. Phlebology 2017; 32 (09) 601-607
  • 7 Zamboni P, Cisno C, Marchetti F, Quaglio D, Mazza P, Liboni A. Reflux elimination without any ablation or disconnection of the saphenous vein. A haemodynamic model for venous surgery. Eur J Vasc Endovasc Surg 2001; 21 (04) 361-369
  • 8 Creton D. Diameter reduction of the proximal long saphenous vein after ablation of a distal incompetent tributary. Dermatol Surg 1999; 25 (05) 394-397
  • 9 Biemans AAM, van den Bos RR, Hollestein LM. et al. The effect of single phlebectomies of a large varicose tributary on great saphenous vein reflux. J Vasc Surg Venous Lymphat Disord 2014; 2 (02) 179-187
  • 10 Quill RD, Fegan WG. Reversibility of femorosaphenous reflux. Br J Surg 1971; 58 (05) 389-393
  • 11 Chernookov A, Ramishvili V, Kandyba S, Dolgov S, Atayan A, Khachatrian E. Long term results of treatment of patients with varicose disease after using ASVAL technique. Georgian Med News 2021; (320) 13-17
  • 12 Chastanet S, Pittaluga P. Influence of the competence of the sapheno-femoral junction on the mode of treatment of varicose veins by surgery. Phlebology 2014; 29 (01) 61-65
  • 13 Theivacumar NS, Darwood RJ, Gough MJ. Endovenous laser ablation (EVLA) of the anterior accessory great saphenous vein (AAGSV): abolition of sapheno-femoral reflux with preservation of the great saphenous vein. Eur J Vasc Endovasc Surg 2009; 37 (04) 477-481