1. Schul MW, Schloerke B, Gomes GM REFLUXING ANTERIOR ACCESSORY SAPHENOUS VEIN (AASV) DEMONSTRATES GREATER CLINICAL SEVERITY WHEN COMPARED TO THE REFLUXING GREAT SAPHENOUS VEIN

2. DISCLOSURES Marlin W. Schul, MD, RVT, CPI, FACPh Owner, Medical Director – Lafayette Regional Vein & Laser Center Lafayette, IN 47905 (765) 807-2770 mschul@lafayetteveins.com I have no disclosures pertaining to this topic

3. Increasing numbers of patients are denied coverage for this common venous pattern AASV reflux as a primary pattern of reflux occurs ~7-11% of limbs AASV also represents an extraordinarily common pattern of recurrent varices after intervention. AASV Ablation has been shown to improve quality of life BACKGROUND

4. Assess primary disease patterns comparing SFJ to AASV and SFJ to GSV above the knee. Null Hyposthesis: Refluxing SFJ to the GSV and/or AASV possess the same disease severity. PURPOSE

5. Group 1: Patients with primary AASV Reflux from SFJ Group 2: Patients with primary GSV reflux from the SFJ Group 3: Patients with combined AASV/GSV Reflux from the SFJ Group 4: Controls without SFJ incompetence All had vein related conditions PATIENTS

6. EMR Specifically Formatted for Registry Participation Demographics CEAP VCSS Duplex Values All data was manually entered Sequential Data Captured for all Consults (Oct13-Feb14) Statistics Team Developed Script/Harvested Data METHODS

7. Demographics Age Gender BMI Disease Specific Measures Duplex values Expanded CEAP VCSS Primary disease state Duplex Values Superficial & Deep Structures Assessed Reflux Threshold > 0.5 s Reporting Measures Normal Reflux Obstruction Obstruction & Reflux Successful Ablation Vein Diameters METHODS

8. Statistical Team SequelPro to mine data Descriptive Statistics Subgroup analysis Means comparisons Regression Analysis Log Linear Modeling DATA ANALYSIS

9. N = 293 limbs (232 Subjects) RESULTS

10. Log Linear Modeling RESULTS AASV Group demonstrated significantly higher VCSS, BMI, yet smaller vein diameter when compared to GSV Group

11. Single center experience Relatively small numbers VCSS Is no surprise HRQL Queries are missing LIMITATIONS DISCUSSION

12. Patients with refluxing AASV possess greater clinical severity by VCSS when compared to GSV and Controls. Despite predominance of female subjects with AASV reflux, the explanatory variables of significance to predict this pattern include: Higher BMI Higher VCSS Smaller Vein diameter. The future of medicine comes from data we report. If you are not currently collecting data the time to start is now. CONCLUSIONS