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Introduction Provision, uptake, adherence, and completion rates for supervised exercise programmes (SEP) for intermittent claudication (IC) are low. For patients, SEPs are too time intensive. High-intensity interval training (HIIT) may be a time-efficient, effective alternative. Methods This was an NIHR funded, multicentre, proof-of-concept study. HIIT was performed three times per week for six-weeks and involved a 1:1 work to rest ratio. Outcomes were feasibility, tolerability, safety and potential efficacy. Results 279 patients were screened, 59% were eligible and 25% were recruited for HIIT. 78% of patients completed HIIT, though 3 patients (7.5%) were unable to tolerate it. Patients attended 99% of training sessions, with 84% of sessions completed in full, largely at the required intensity. There were no related serious adverse events. The mean improvements in MWD and physical functioning were 94m (95%CI=66.6-120.8m), and 4.4% (95%CI=-1.1–9.9%) respectively. Conclusion Uptake to HIIT was comparable to SEPs, but completion rates were higher. Most sessions were completed in full with no related serious adverse events. There was an improvement in MWD. HIIT appears feasible, safe, tolerable and potentially beneficial for patients with IC. It may provide a more deliverable, more acceptable, SEP. A non-inferiority trial of HIIT vs. SEPs appears warranted.

Introduction The goal of this study was to compare the long-term outcomes of patients with intermittent claudication (IC) who completed supervised exercise therapy (SET) versus patients who either declined or prematurely discontinued SET. Methods A retrospective, observational, single-centre cohort study of patients with IC referred to SET. Outcomes included progression to chronic limb-threatening ischemia (CLTI), revascularization requirement, and cardiovascular death.1:1 propensity score matching (PSM) using nearest-neighbour (caliper=0.2) was performed. Multivariate analysis (MVA) and logistic-regression (LR) were used to identify significant effect modifiers to guide PSM. Time-to-event data were analysed using Kaplan-Meier survival analysis. Results 241 patients were referred to SET between July 2015 and July 2016. Forty-nine patients completed SET and 192 patients did not. There was no significant difference in age, diabetes, smoking-cessation, and medication compliance between groups. After PSM, 49 patients who declined SET and 41 patients who completed SET were analysed. Progression to CLTI was significantly lower (10.2% vs 65.9%; p Conclusion SET for claudication reduces requirement for future revascularisation by slowing disease progression.

Background: Surgical wounds healing by secondary intention (SWHSI) represent a significant burden to patients and services. An understanding of quality of life factors affecting this population is essential to recognise the impact of this wound entity on patients. Understanding of the patient experience is necessary to building effective services and designing high-quality research studies to improve care in this population. Methods: Twelve individuals with lived experience of living with a SWHSI or caring for a person with a SWHSI were recruited to one of two focus groups. Participants were identified from those who had previously been recruited into the NIHR-funded SWHSI-2 trial (NIHR17/42/94; a study assessing healing of surgical wound healing by secondary intention). All participants in this cohort had lower limb SWHSIs and a history of peripheral vascular disease. Sessions followed a general topic guide and were guided by the research team. Sessions were audio-recorded, transcribed and analysed using thematic analysis methods. Results: Four main areas of impact on quality of life were identified: mental health, physical symptoms, lifestyle symptoms and service-based impacts. There was a clear heterogeneity of experience seen within the group, with some reporting a more significant impact than others. This was ascribed to the loss of social and professional functioning, and the subsequent impact on mental health. There was a differential impact of this on younger participants (who tended to be employed and hold caring roles for children or family members) compared to older participants who did not have these social roles to fulfil, and were less affected in these areas. The need for improved preoperative counselling was highlighted, as many participants reported feeling unprepared for the postoperative course. Conclusions: This study considered the experiences of patients with a SWHSI and identified the main areas of impact on quality of life. This work will help to underpin future research into treatments and services for the SWHSI population. It may also form the basis for identifying an appropriate patient-reported outcome measure (PROM) related to quality of life in SWHSI for use in the research setting. Limitations of the study included the number and diversity of participants, and the impact of the SARS-CoV-2 (COVID-19) pandemic on the experiences of participants. Further exploration of the area through formal qualitative study is warranted to understand the breadth, generalisability and possible future applications of the work.

Welcome to the latest issue of the Journal of Vascular Societies Great Britain and Ireland (JVSGBI).

Background: Prior to the development of the Journal of Vascular Societies Great Britain & Ireland (JVSGBI), there were limited opportunities for UK based vascular health professionals to publish research relevant for UK vascular practice. A survey was developed to evaluate the appetite and potential infrastructure for a UK vascular journal amongst vascular healthcare professionals. Methods: In May 2020, an online questionnaire was administered by The Vascular Society of Great Britain and Ireland (VSGBI) Research Committee, surveying vascular health professionals regarding the development of a UK-specific vascular journal. The survey was disseminated via email to multi-disciplinary members of the vascular community with links promoted on social media. Results: Responses were received from 359 individuals identifying predominantly as surgeons (38%), nurses (8%), technologists (10%), radiologists (20%), trainees (10%), physiotherapists (7%) and other (7%). The majority of participants (67%) indicated they would be in favour of a UK-specific vascular journal and that it should be available as an online quarterly publication. Almost three quarters (74%) of respondents thought a subscription fee should be included in societies’ membership fees. Free text comments highlighted a few concerns, suggesting the focus should instead be to improve the quality of existing vascular journals. However, most respondents welcomed the idea of a journal relevant to UK practice, with inclusivity of all UK vascular professions to encourage more collaborative working. Conclusions: Overall, feedback collected from the survey was positive and suggested a demand for a UK-specific vascular journal, providing an indication that the development of such a journal should be further explored. The results of this survey helped to inform the development of the JVSGBI.

Introduction: There is increasing need for renal replacement therapy associated with the aging population and dramatic increases in diabetes prevalence. Despite an increasing clinical vascular access workload, there are significant unanswered research questions and a paucity of high quality trials to guide clinical practice. To address where future research in vascular access should be directed, we conducted a Priority Setting Partnership involving multiple disciplines, specialties, patients and carers. Methods: In collaboration with the James Lind Alliance, four rounds of surveys were circulated to identify and score professional and patient priorities in vascular access research. Finally, in a consensus workshop attended by patients and professionals, priorities were discussed and a ranked top 10 list was produced using a nominal group technique. Results: A total of 1,813 research priorities were submitted within all areas of vascular surgery. Following removal of duplicates, consolidation and categorisation, 15 patient and professional priorities in vascular access research were taken forward to the consensus workshop. The workshop produced a ranked top 10 list of vascular access research priorities relating to: optimising access function, preventing access complications and education of patients and healthcare staff. Conclusions: These research priorities should help to direct and contextualise future research in vascular access.

Welcome to the fifth issue of the Journal of Vascular Societies Great Britain and Ireland (JVSGBI). We are really delighted with the success of the journal, and this issue marks the first anniversary of the launch at the Vascular Societies GB&I Annual Scientific meeting last year. The increasing interest in the JVSGBI has been demonstrated by the growing number of submitted articles and the impressive website stats (over 3,000 views). This issue includes three editorials. The first by Andrew Garnham (VSGBI President Elect) and Rachael Forsythe (Rouleaux President) provides a thoughtful reflection on the problem of bullying, undermining and harassment in (vascular) surgical training highlighted as a persistent problem by a Rouleaux Club paper in this edition. The second editorial from Dr Una Adderley, National Wound Care Strategy Programme (NWCSP) Director, outlines past achievements and future plans for the programme. Finally, Duygu Yenidogan-Schmidt, Chair of the Executive Committee of AAA UK, a newly formed patient representative group giving national representation to AAA patients and relatives, highlights the origins, purpose and aims of this group. I am sure these editorials will be of great interest to readers. There are four original research articles, the first from the Rouleaux Club, the UK Vascular Surgery Trainees’ Association, reports the findings from their recent bullying, undermining and harassment survey. The second from the Vascular and Endovascular Research Network (VERN) reports the findings from the Tier 3 COVID-19 Vascular Service (COVER) study. The final two original articles present the findings from the James Lind Alliance Priority Setting Partnership from the Vascular Services and Venous Conditions Groups. It is fantastic to see vascular trainees continuing to undertake meaningful and impactful research and choose the JVSGBI to disseminate their work. This edition also contains a research protocol from Ravindhran et al for a systematic review which aims to study changes in functional health status following open abdominal aortic aneurysm repair. Finally, in this issue there is a short educational report entitled ‘Intraoperative management of REBOA’ and a case report entitled ‘Carotid web: an important cause of stroke in young people’. The National Wound Care Strategy Programme Guidelines for lower limb wounds are published as a supplement to this issue and can be located on the journal website. This is our fifth issue, and we would like to take the opportunity to thank all the authors who have submitted articles during the last year, which is building on the success of the journal – your contribution has been really appreciated and I hope you are delighted with your publication. We would also like to thank all the reviewers for their timely and thorough contributions. Finally, please do continue to share your work by submitting articles for publication.

Background and objectives: The aim of this systematic review is to explore the current evidence surrounding the changes in functional status following open or endovascular abdominal aortic aneurysm (AAA) repair and the role of postoperative exercise-based rehabilitation programmes. Methods: The proposed study will incorporate two separate systematic reviews within it, one to assess changes in functional status (component 1) and another to consider the role of exercise-based rehabilitation for improving functional status (component 2), both following AAA repair. The Medline, EMBASE and Cochrane CENTRAL databases will be searched using two separate search strategies including the terms “aortic aneurysm”, “functional capacity”, “functional decline” and” exercise therapy”. We plan to include all prospective randomised and non-randomised trials that have considered the impact of AAA repair on functional status and/or the effect of exercise-based rehabilitation following AAA repair. For component 1, the primary outcome will be changes in objective measures of functional capacity or physical function following AAA repair and, for component 2, it will be changes in physical function or functional capacity following exercise-based rehabilitation after AAA repair. The extracted data will include study characteristics – ie, sample size, a description of the intervention and control conditions (where applicable), outcome measures, length of follow-up and main findings related to outcome measures. For both components a narrative synthesis will be produced, supported by a summary table. We intend to conduct quantitative meta-analyses for both components. For each selected outcome we plan to evaluate the certainty of evidence based on the GRADE approach and risk of bias of included studies will be assessed using the Cochrane tool. Conclusions: Based on a lack of current evidence, we present a protocol for a systematic review to investigate the functional changes associated with open and endovascular AAA repair and the potential value of postoperative exercise rehabilitation.

Background: The ankle brachial pressure index (ABPI) is a common diagnostic tool used in the assessment of peripheral arterial disease (PAD). The Doppler ultrasound technique is regarded as the gold-standard method for ABPI measurement; however, time constraints and operator experience limit widespread application in clinical practice, particularly in a primary care setting. Automated ABPI devices are not currently widely used due to a lack of evidence regarding their diagnostic accuracy. The aim of this proposed systematic review and meta-analysis is to explore the current evidence for the accuracy of automated ABPI devices in people with known or suspected PAD. Methods: Systematic searches of electronic databases and grey literature will be performed. We plan to include studies of adult patients with diagnosed or suspected PAD that have compared automated ABPI device readings with manual Doppler ABPI measurements or confirmed the diagnosis of PAD using vascular imaging. Two independent reviewers will screen identified literature for inclusion and perform data extraction. Extracted data will include study and participant characteristics, a description of the index and reference tests, outcome measures and main findings. The methodological quality of selected studies will be assessed using QUADAS-2 and QUADAS-C. Meta-analysis will be performed for studies with paired designs using a bivariate random-effect model to provide pooled estimates of summary accuracy statistics. We intend to conduct subgroup analyses and meta-regression for suspected sources of heterogeneity. Discussion: This review aims to assess the diagnostic accuracy of automated ABPI devices for detecting PAD in patients with known or suspected PAD compared with manual Doppler ABPI measurements or vascular imaging. These results will be used to inform clinical practice and guide future trials.

Aim To determine if the NVR frailty score was being routinely collected on all relevant vascular patients on admission, identify the prevalence of frailty in vascular inpatients and determine if frailty was associated with a higher mortality and morbidity. Method A prospective audit of consecutive patients admitted onto the vascular ward who were eligible for inclusion on the NVR. Data was collected from electronic patient records and paper case notes between November 2019 and February 2020. The primary outcome was completeness of frailty assessment. Secondary outcomes were prevalence of frailty and mortality and morbidity associated with frailty score. Results Frailty status was documented in 65% of patients. 43% (28/65) were assessed to be frail. The 30-day mortality rate was 1.53% (1/65). 26.15% (17/65) had one or more complication. The commonest complications were graft occlusions, acute kidney injury, hospital acquired pneumonia and groin infections. 93.84% (61/65) were discharged home. There was no correlation between frailty and number of post-operative complications (p = 0.394), length of stay (p = 0.171) or mortality (p = 0.371). Conclusions This audit found frailty assessment is poorly assessed and the current NVR frailty classification did not correlate to increase mortality or morbidity in this patient cohort.

Aim To investigate the inter and intra reliability of using 3D imaging to measure wounds. Method 20 wound models of 4 different shaped wounds in 5 different colours were created from plastic mouldable beads. 3D images were taken using the BlasterX Senz3D camera and measured using the GPC Wound Measure application (version 3.15.0.0, UK). Intra-user reliability was determined comparing 20 wound measurements of each wound model. Inter-user reliability was determined by 5 different clinicians photographing each model and independently measuring each wound photo. The inter- and intra-rater measurements for wound surface area and volume were compared using the ICC and differences from the overall mean plotted on Bland-Altman graphs. Results The interclass co-efficient (ICC) for inter-rater reliability in measuring surface area was 0.958 (95% CI 0.919-0.981, p Conclusions 3D imaging offers a quick, reliable, and easy to use solution to measuring wounds. We have shown it is a reliable and reproducible method of measuring wounds between different clinicians.

Aim The purpose of this mixed methods feasibility study was to assess the feasibility of delivering ESWT to patients with DFUs. It also aimed to explore any potential clinical effect of ESWT on wound healing and investigate whether ESWT may offer any patient reported benefits. Method A single centre mixed methods feasibility study. Patients with a DFU who met the eligibility criteria underwent ESWT 3 times in over 7 days. Primary outcome was feasibility of delivering the intervention. Secondary outcomes included wound size, number of DFU healed at 12 weeks and quality of life. Semi-structured interviews explored participants experience of undergoing ESWT. Results 22.6% (24/106) of patients screened were recruited. The mean attendance to clinic was 90.9% and 65.1% to follow up. The mean score for acceptability and tolerability was 9.86 (SD 0.48, 95% CI 9.62-10.01) and 9.15 (SD 2.57, 95% CI 7.87-10.42) respectively. There were no serious adverse events or side effects. 45.5% of DFU healed during follow up and quality of life scores improved until 8 weeks. Key themes identified from the qualitative interviews were desire for the fast healing, improved quality of life, new treatments must be flexible and accessible on transport. Conclusions This study has shown it is possible to recruit and retain patents into this research. This study supports development of a large randomised control trial to determine the clinical and cost effectiveness of ESWT for DFU healing.

Background Lower limb peripheral arterial disease (PAD) affects 20% of population over 65 years. Extracorporeal shockwave therapy (ESWT) has recently emerged as a novel, safe, and effective treatment option. This review aims to assess the mechanism of action by which ESWT improves symptoms in patients with PAD. Methods MEDLINE and EMBASE databases were searched in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Any article investigating the mechanism of action of ESWT in PAD was considered for inclusion. Results The systematic review of the current literature yielded 8 relevant articles reporting studies on animal models of hind limb ischemia or on patients with PAD. These articles described the effects of ESWT on angiogenesis, arteriogenesis, vasculogenesis, endothelial nitric oxide synthase, lower limb micro/macrocirculation, and atherosclerosis. Conclusion ESWT increases the expression of angiogenic, arteriogenic, and vasculogenic factors, reduces vessel wall stenosis, and improves limb perfusion. However, most of the evidence is based on animal studies. Future research should focus on elucidating the mechanism of action of ESWT in PAD patients.

Background Treatment of superficial venous reflux in addition to compression therapy accelerates venous leg ulcer healing and reduces ulcer recurrence. The aim of this study was to evaluate the costs and cost-effectiveness of early versus delayed endovenous treatment of patients with venous leg ulcers. Methods This was a within-trial cost-utility analysis with a 1-year time horizon using data from the EVRA (Early Venous Reflux Ablation) trial. The study compared early versus deferred endovenous ablation for superficial venous truncal reflux in patients with a venous leg ulcer. The outcome measure was the cost per quality-adjusted life-year (QALY) over 1 year. Sensitivity analyses were conducted with alternative methods of handling missing data, alternative preference weights for health-related quality of life, and per protocol. Results After early intervention, the mean(s.e.m.) cost was higher (difference in cost per patient £163(318) (€184(358))) and early intervention was associated with more QALYs at 1 year (mean(s.e.m.) difference 0·041(0·017)). The incremental cost-effectiveness ratio (ICER) was £3976 (€4482) per QALY. There was an 89 per cent probability that early venous intervention is cost-effective at a threshold of £20 000 (€22 546)/QALY. Sensitivity analyses produced similar results, confirming that early treatment of superficial reflux is highly likely to be cost-effective. Conclusion Early treatment of superficial reflux is highly likely to be cost-effective in patients with venous leg ulcers over 1 year. Registration number: ISRCTN02335796 (http://www.isrctn.com).

Background Varicose veins impair quality of life and can lead to chronic leg ulcers. National Institute for Health and Care Excellence (NICE) guidelines (CG168) set out evidence‐based standards for patient management. In England, Clinical Commissioning Groups (CCGs) fund NHS care within their locality. The objective of this study was to evaluate CCGs' commissioning policies and compare them with CG168. Methods Searches were made for the published policies of all 206 English CCGs. They were reviewed for compliance with NICE guidelines and the associated quality standard. Areas of disagreement were analysed for themes. Results Some 203 CCGs (98·5 per cent) had a published policy and 190 (93·6 per cent) of these were published after publication of CG168. Only 73 of the policies (36·0 per cent) were compliant with CG168. Treatment was restricted on the basis of clinical disease severity in 119 CCGs (58·6 per cent); 29 (14·3 per cent) stipulated delay of treatment using a ‘trial’ of conservative treatment; 22 (10·8 per cent) used lifestyle‐related factors such as BMI and smoking status to ration treatment. Treatment was commissioned for uncomplicated symptomatic varicose veins in 87 CCGs (42·9 per cent), but some applied additional rationing mechanisms; 109 CCGs (53·7 per cent) would treat oedema, 183 (90·1 per cent) would treat skin and soft tissue damage, 202 (99·5 per cent) healed ulceration, and all would allow active ulcers to be treated. Discussion The majority of CCGs in England have commissioning policies that contradict NICE guidelines. Rationing strategies include disease severity, delay and patient lifestyle‐related factors, creating unwarranted geographical variation for varicose vein treatment, disregarding the NHS Constitution for England, and perhaps leading to an increase in costly treatment of chronic complications in the long term.

Objectives Several plaque and lesion characteristics have been associated with an increased risk for procedural stroke during or shortly after carotid artery stenting (CAS). While technical advancements in stent design and cerebral protection devices (CPD) may help reduce the procedural stroke risk, and anatomy remains important, tailoring stenting procedures according to plaque and lesion characteristics might be a useful strategy in reducing stroke associated with CAS. In this descriptive report of the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), it was assessed whether choice for stent and use or type of CPD was influenced by plaque and lesion characteristics. Materials and methods Trial patients who underwent CAS between 2008 and 2015 were included in this study. Chi-square statistics were used to study the effects of plaque echolucency, ipsilateral preocclusive disease (90–99%), and contralateral high-grade stenosis (>50%) or occlusion of the carotid artery on interventionalists' choice for stent and CPD. Differences in treatment preference between specialties were also analysed. Results In this study, 831 patients from 88 ACST-2 centres were included. Almost all procedures were performed by either interventional radiologists (50%) or vascular surgeons (45%). Plaque echolucency, ipsilateral preocclusive disease (90–99%), and significant contralateral stenosis (>50%) or occlusion did not affect the choice of stent or either the use of cerebral protection and type of CPD employed (i.e., filter/flow reversal). Vascular surgeons used a CPD significantly more often than interventional radiologists (98.6% vs. 76.3%; p < .001), but this choice did not appear to be dependent on patient characteristics. Conclusions In ACST-2, plaque characteristics and severity of stenosis did not primarily determine interventionalists' choice of stent or use or type of CPD, suggesting that other factors, such as vascular anatomy or personal and centre preference, may be more important. Stent and CPD use was highly heterogeneous among participating European centres.

Background The aim was to compare the long-term outcomes of percutaneous transluminal angioplasty (PTA), a supervised exercise programme (SEP) and combined treatment (PTA + SEP) in patients with intermittent claudication owing to femoropopliteal disease. Methods Patients recruited to an RCT comparing these treatments were invited for long-term follow-up from 2010 to 2011. Indicators of limb ischaemia were recorded (ankle : brachial pressure index (ABPI) and treadmill walking distances). Duplex ultrasound imaging was also done. Patients completed Short Form 36 and VascuQol quality-of-life (QoL) questionnaires. Results Of 178 patients initially recruited to the trial, 139 were alive at the time of follow-up (PTA 46, SEP 47, PTA + SEP 46). Assessments were completed for 111 patients. Median time to follow-up was 5·2 (i.q.r. 3·8–7·4) years. Sixty-nine patients (62·2 per cent) were symptomatic; 18 (16·2 per cent) had experienced a major cardiovascular event since their last follow-up visit. Improvement was observed in ABPI in all groups. QoL outcomes were inconsistent across individual groups. PTA and PTA + SEP groups had a significantly higher ABPI than the SEP group. No significant difference was observed in treadmill walking distances, QoL outcomes, restenosis rates, and new ipsilateral and contralateral lesions on duplex imaging. Patients in all groups required reinterventions (PTA 14, SEP 10, PTA + SEP 6). The total number of reinterventions was higher after PTA (29) compared with SEP (17) and PTA + SEP (9), but failed to reach statistical significance. Conclusion PTA, SEP and combined treatment were equally effective long-term treatment options for patients with claudication owing to femoropopliteal disease. The addition of a SEP to PTA can reduce the rate of symptomatic restenosis and reintervention. Registration number: NCT00798850 (http://www.clinicaltrials.gov).

Background Peripheral arterial disease (PAD) has a population prevalence of 4.6% with intermittent claudication (IC) presenting as one of the earliest and most common symptoms. PAD has detrimental effects on patients’ walking ability in terms of maximum walking distance (MWD) and pain-free walking distance (PFWD). Research has suggested extracorporeal shockwave therapy (ESWT) may induce angiogenesis in treated tissue; therefore, our objective is to assess the tolerability and efficacy of ESWT as a novel treatment of intermittent claudication. Methods/design Patients with unilateral claudication will be randomised to receive either ESWT (PiezoWave 2 shockwave system) or sham treatment to the calf muscle bulk three times per week for 3 weeks. All patients are blinded to treatment group, and all assessments will be performed by a masked assessor. Treatment tolerability using a visual analogue scale, ankle-brachial pressure index, MWD, PFWD and safety will all be formally assessed as outcome measures at baseline and at 4, 8 and 12 weeks follow-up. Discussion This trial will be the first of its kind in terms of methodology in relation to ESWT for intermittent claudication. A double-masked randomised controlled trial will provide useful information about the potential for the use of ESWT as a non-invasive treatment option and the need for further robust research. Trial registration ClinicalTrials.gov, NCT02652078. Registered on 17 October 2014. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1844-4) contains supplementary material, which is available to authorized users.

Background The aim of the study was to identify whether a standard supervised exercise programme (SEP) for patients with intermittent claudication improved specific measures of functional performance including balance. Methods A prospective observational study was performed at a single tertiary vascular centre. Patients with symptomatic intermittent claudication (Rutherford grades 1–3) were recruited to the study. Participants were assessed at baseline (before SEP) and 3, 6 and 12 months afterwards for markers of lower-limb ischaemia (treadmill walking distance and ankle : brachial pressure index), physical function (6-min walk, Timed Up and Go test, and Short Physical Performance Battery (SPPB) score), balance impairment using computerized dynamic posturography with the Sensory Organization Test (SOT), and quality of life (VascuQoL and Short Form 36). Results Fifty-one participants underwent SEP, which significantly improved initial treadmill walking distance (P = 0·001). Enrolment in a SEP also resulted in improvements in physical function as determined by 6-min maximum walking distance (P = 0·006), SPPB score (P < 0·001), and some domains of both generic (bodily pain, P = 0·025) and disease-specific (social domain, P = 0·039) quality of life. Significant improvements were also noted in balance, as determined by the SOT (P < 0·001). Conclusion Supervised exercise improves both physical function and balance impairment.

Objective: The study was performed to evaluate the clinical and technical efficacy of endovenous laser ablation (EVLA) of small saphenous varicosities, particularly in relation to the site of endovenous access. Methods: Totally 59 patients with unilateral saphenopopliteal junction incompetence and small saphenous vein reflux underwent EVLA (810 nm, 14 W diode laser) with ambulatory phlebectomies. Small saphenous vein access was gained at the lowest site of truncal reflux. Patients were divided into 2 groups: access gained above mid-calf (AMC, n = 33) and below mid-calf (BMC, n = 26) levels. Outcomes included Venous Clinical Severity Scores (VCSS), Aberdeen Varicose Vein Questionnaire (AVVQ), patient satisfaction, complications, and recurrence rates. Results: Both groups demonstrated significant improvement in VCSS, AVVQ, generic quality of life Short Form 36, and EuroQol scores ( P < .05) up to 1 year. No differences were seen between AMC and BMC groups for complications (phlebitis: 2 [6%] and 1 [3.8%], P > .05; paresthesia: 2 [6%] and 5 [19%], P = .223) and recurrence (3 [9%] and 1 [3.8%], P = .623), respectively. Conclusions: The site of access in our study does not appear to influence complications specifically neural injury or recurrence rates.

[This corrects the article DOI: 10.1371/journal.pone.0275025.]., (Copyright: © 2024 Mesri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)