Concomitant versus staged tributary management during endovenous truncal ablation for varicose veins: an evidence-based progress review
10.3760/cma.j.cn112139-20250322-00146
- VernacularTitle:下肢静脉曲张主干消融手术同期或分期处理属支静脉的研究进展
- Author:
Meijia XU
1
;
Lingyu ZHOU
;
Guangdian SHEN
;
Mingjun TANG
;
Mingjuan JIN
;
Yuefeng ZHU
Author Information
1. 浙江大学医学院附属邵逸夫医院血管外科，杭州 310020
- Publication Type:Journal Article
- Keywords:
Varicose veins;
Surgical procedures;
Tributary veins;
Concomitant procedure;
Staged procedure;
Surgical strategy
- From:
Chinese Journal of Surgery
2025;63(9):854-858
- CountryChina
- Language:Chinese
-
Abstract:
Strategic management of tributary veins including concomitant versus staged intervention during endovenous thermal ablation for truncal varicose veins remains debated. Concomitant procedures mainly involves thermal ablation with ultrasound-guided foam sclerotherapy or phlebectomy. Staged strategies include initial truncal ablation followed by deliberated tributary management. Major venous disease guidelines exhibit substantial divergence,Japanese Society of Phlebology guidelines in 2019 contraindicate concomitant procedures, European Society for Vascular Surgery 2022 Clinical Practice Guidelines and Chinese frameworks endorse individualized decision-making,while American Vein and Lymphatic Society guidelines in 2023 prioritize concomitant procedures. Systematic literature review reveals that concomitant procedures do not uniformly translate into reduced reintervention rates or improved early Venous Clinical Severity Scores, yet consistently incur elevated complication risks and postoperative pain. Conversely, staged strategies offer superior tolerability with minimized complications. Hemodynamic principles indicate that most competent tributaries undergo partial or complete regression within 6 weeks to 6 months post-ablation and hemodynamic studies demonstrate that staged approaches preserve the drainage function of tributaries, preventing edema in their respective drainage territories and reducing tributary intervention rates. Future multicenter randomized controlled trials are imperative to delineate comparative outcomes between concomitant and staged management of truncal and tributary veins.
