A recent editorial published in Phlebology (2025; DOI: 10.1177/02683555251347050) by Jessica Bowie, Marwah Salih, Sarah Onida and Alun H. Davies explores an ongoing debate in venous practice: whether treating anatomically normal, non-incompetent veins may help reduce recurrence following superficial venous interventions.
Traditionally, the principle of “only treating refluxing veins” has guided clinical decision-making. However, increasing attention is being drawn to anatomical segments such as the below-knee great saphenous vein (GSV) and the anterior saphenous vein (ASV), which may appear competent at initial assessment but later develop reflux and contribute to recurrent varicose veins.
Long-term data have highlighted this challenge. In follow-up studies after endothermal ablation, new reflux has been observed in both the ASV and untreated below-knee segments of the GSV, suggesting that these areas may act as future sources of recurrence. This has led to growing interest in whether prophylactic treatment of these veins at the time of initial intervention could improve long-term outcomes.
The editorial discusses current evidence around this evolving concept. Treatment of the below-knee GSV is technically feasible and may reduce recurrence, although some data suggest that a large proportion of below-knee reflux may remain asymptomatic. Similarly, the ASV is recognised as a common source of recurrent varicosities, and early studies have demonstrated the feasibility of its prophylactic treatment, though robust long-term evidence remains limited.
Advances in technique, including flush endovenous laser ablation (fEVLA), have enabled treatment closer to the saphenofemoral junction, potentially reducing recurrence at the groin and limiting future ASV reflux. Early results and ongoing studies suggest a possible benefit of these approaches, although their impact on patient-reported outcomes remains less clearly defined.
The authors highlight that while treating veins with the potential to become incompetent may reduce recurrence, it also introduces additional procedural risk. As such, the balance between preventive intervention and overtreatment remains central to the discussion.
This work reflects a broader shift in venous practice, moving from purely reactive treatment towards consideration of long-term disease progression and recurrence prevention. Further high-quality studies are required to determine whether prophylactic treatment of non-incompetent veins should become part of routine clinical practice.
At Phlebology News, our aim is to provide clear and informative coverage of evolving clinical debates and emerging evidence in venous medicine, supporting clinicians in making informed decisions in an increasingly complex field.
