{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T11:48:37Z","timestamp":1793274517571,"version":"4.5.0"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T00:00:00Z","timestamp":1609977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\"><jats:title>Background<\/jats:title><jats:p>Recurrent varicosities after endovascular laser ablation (EVLA) of the great saphenous vein (GSV) are frequently due to varicose transformed, initially unsealed major ascending tributaries of the saphenofemoral junction (SFJ). Preventive ablation of these veins, especially the anterior accessory saphenous vein, is discussed as an option, along with flush occlusion of the GSV. However, few related data exist to date.<\/jats:p><\/jats:sec><jats:sec id=\"sec002\"><jats:title>Methods<\/jats:title><jats:p>A consecutive case series of 278 EVLA procedures of the GSV for primary varicosis in 213 patients between May and December 2019 was retrospectively reviewed. The ablations were performed with a 1470 nm dual-ring radial laser and always included flush occlusion of the GSV, and concomitant ablation of its highest ascending tributaries by additional cannulation and ablation when this seemed anatomically appropriate. The initial technical success, comprising occlusion of the GSV and its major tributaries, was set as the primary endpoint. Possible determinants were explored using downstream multiple logistic regression analysis.<\/jats:p><\/jats:sec><jats:sec id=\"sec003\"><jats:title>Results<\/jats:title><jats:p>The early technical success was 92.8%, with the GSV occluded in 99.6% and the highest ascending SFJ tributary, if present, in 92.4%. Additional ablations of ascending tributaries were performed in 171 cases (61.5%), the latter being associated with success (OR 10.39; 95% CI [3.420\u201336.15]; p &lt; 0.0001). Presence of anterior as opposed to posterior accessory saphenous vein was another positive predictor (OR 3.959; 95% CI [1.142\u201313,73]; p = 0.027), while a confluence of the tributary in the immediate proximity to the SFJ had a negative impact (OR 0.2253; 95% CI [0.05456\u20130.7681]; p = 0.0253). An endothermal heat-induced thrombosis (EHIT) \u2265 grade 2 was observed in three cases (1.1%).<\/jats:p><\/jats:sec><jats:sec id=\"sec004\"><jats:title>Conclusions<\/jats:title><jats:p>A co-treatment of the tributaries is feasible and could improve the technical success of EVLA if a prophylactic closure of these veins is desired, especially if their distance to the SFJ is short. Its effect on the recurrence rate needs further research.<\/jats:p><\/jats:sec>","DOI":"10.1371\/journal.pone.0245275","type":"journal-article","created":{"date-parts":[[2021,1,8]],"date-time":"2021-01-08T00:50:43Z","timestamp":1610067043000},"page":"e0245275","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":12,"title":["Feasibility and potential significance of prophylactic ablation of the major ascending tributaries in endovenous laser ablation (EVLA) of the great saphenous vein: A case series"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3501-0367","authenticated-orcid":true,"given":"Lars","family":"M\u00fcller","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens","family":"Alm","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,1,7]]},"reference":[{"key":"pone.0245275.ref001","doi-asserted-by":"crossref","first-page":"314","DOI":"10.3399\/bjgp14X680329","article-title":"Diagnosis and management of varicose veins in the legs: NICE guideline","volume":"64","author":"N O'Flynn","year":"2014","journal-title":"Br J Gen Pract"},{"issue":"Suppl 1","key":"pone.0245275.ref002","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1258\/phleb.2012.012s28","article-title":"Guidelines for the management of varicose veins","volume":"27","author":"P Gloviczki","year":"2012","journal-title":"Phlebology"},{"key":"pone.0245275.ref003","doi-asserted-by":"crossref","first-page":"1759","DOI":"10.1002\/bjs.10961","article-title":"Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins","volume":"105","author":"T Wallace","year":"2018","journal-title":"Br J Surg"},{"key":"pone.0245275.ref004","doi-asserted-by":"crossref","first-page":"760","DOI":"10.1016\/j.ejvs.2017.08.034","article-title":"Editor's Choice\u2014Five Year Results of Great Saphenous Vein Treatment: A Meta-analysis","volume":"54","author":"SAS Hamann","year":"2017","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"pone.0245275.ref005","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1177\/0268355518783635","article-title":"Fate of the tributaries of sapheno femoral junction following endovenous thermal ablation of incompetent axial vein\u2014A review article","volume":"34","author":"MA Anwar","year":"2019","journal-title":"Phlebology"},{"key":"pone.0245275.ref006","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1024\/0301-1526\/a000598","article-title":"Comparison of heat induced damage at the saphenofemoral junction after ablation with 1,470 nm laser or radiofrequency","volume":"46","author":"E Ozcinar","year":"2017","journal-title":"Vasa"},{"key":"pone.0245275.ref007","doi-asserted-by":"crossref","first-page":"282","DOI":"10.3400\/avd.oa.15-00084","article-title":"Comparison of 1470 nm Laser and Radial 2ring Fiber with 980 nm Laser and Bare-Tip Fiber in Endovenous Laser Ablation of Saphenous Varicose Veins: A Multicenter, Prospective, Randomized, Non-Blind Study","volume":"8","author":"M Hirokawa","year":"2015","journal-title":"Ann Vasc Dis"},{"key":"pone.0245275.ref008","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.1016\/j.jvsv.2020.01.017","article-title":"2020. Feasibility and safety of flush endovenous laser ablation of the great saphenous vein up to the saphenofemoral junction","volume":"8","author":"L Spinedi","year":"2020","journal-title":"J Vasc Surg Venous Lymphat Disord"},{"key":"pone.0245275.ref009","doi-asserted-by":"crossref","first-page":"176","DOI":"10.23736\/S0392-9590.18.03939-1","article-title":"Recurrent varices after surgery: a clinical and color-Doppler ultrasound scan analysis","volume":"37","author":"D Bissacco","year":"2018","journal-title":"Int Angiol"},{"key":"pone.0245275.ref010","doi-asserted-by":"crossref","first-page":"207","DOI":"10.1016\/j.ejvs.2008.03.013","article-title":"Residual stumps associated with inguinal varicose vein recurrences: a multicenter study","volume":"36","author":"B Geier","year":"2008","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"pone.0245275.ref011","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1007\/s00105-019-04532-y","article-title":"Endovenous (minimally invasive) procedures for treatment of varicose veins: The gentle and effective alternative to high ligation and stripping operations","volume":"71","author":"K. 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