Introduction
Chronic venous disease, venous incompetence, CVD, saphenous trunk incompetence
CVD, INCOMPETENCE, VARICOSE VEINS, VARICES
Chronic venous disease (CVD), in particular varicose veins, is common in Western countries, affecting about 25–40 per cent of the general populationSince the introduction of high ligation and stripping, treatment strategies for superficial venous incompetence have mainly been based on the classical descending pathophysiological concept of the origin of varicose veins. This concept states that superficial venous incompetence starts at an escape point (the saphenofemoral junction (SFJ), saphenopopliteal junction or perforating veins) and progresses further downwards to the trunk(s) and subsequently their tributaries. The current management strategy for patients with both saphenous trunk incompetence and one or more incompetent tributaries is, therefore, treatment of the GSV, AASV or SSV with concomitant, delayed, or no treatment of the incompetent tributaries with phlebectomy or ultrasound-guided foam sclerotherapy (UGFS)The latter theory resulted in the development of the ambulatory selective varices ablation under local anaesthesia (ASVAL) method, in which the incompetent tributaries are treated by means of phlebectomy, with preservation of the saphenous trunkThese findings changed perspective, suggesting that incompetence of a saphenous trunk may be reversible in selected patients and that treating varicose veins in a more conservative manner by ASVAL may be a cost-effective strategy. To date, there is still a lack of evidence to support the use of ASVAL. Therefore, this treatment strategy received only a class IIb recommendation in the recently published European Society for Vascular Surgery guidelines on CVD