Endovenous radiofrequency for chronic superficial venous insufficiency: Clinical outcomes and impact in quality of life

Comparison of Radiofrequency Ablation and Saphenous Vein Stripping for the Treatment of Recurrent Lower Extremity Venous Insufficiency

OBJECTIVE

To compare the efficiency and safety of radiofrequency ablation (RFA) and saphenous vein stripping (SVS) for the treatment of recurrent lower extremity chronic superficial venous insufficiency (CSVI).

METHODS

Patients who underwent SVS and RFA for recurrent lower extremity CSVI following RFA and patients who had 2-year follow-up results were enrolled into the study. Total, 37 patients who underwent a second RFA session with 2-year follow-up results were available. Then 37 patients were selected from 88 patients who underwent SVS for recurrent lower extremity CSVI to achieve a 1:1 ratio for comparison. Groups were compared based on preoperative properties, operative parameters, postoperative outcomes, complications and follow-up results.

RESULTS

Duration of the procedure was 20.7 minutes in the RFA group and 30.7 minutes in the SVS group (P = .001). Postoperative pain at first hour, sixth hour and 24th hour were significantly lower in patients who underwent RF (P = .001 for each parameter). Moreover, hospitalization time (18.1 hours vs 24.6 hours, P = .001) and time to return to normal daily activities (1.6 days and 2.5 days, P = .001) were significantly shorter in the RFA group. Success of the procedure did not statistically significant at first year follow-up (P = .304). However, success was significantly higher for the SVS group at second year follow-up (73% for RFA group and 91.9% for SVS group, P = .032).

CONCLUSION

We achieved significantly shorter procedure time, less postoperative hospitalization time, and a shorter time to return to daily activities with RFA. In contrast, the success rate of SVS was significantly higher at the second year follow-up, but not the first year follow-up in comparison with RFA.

Early Results of Mechanochemical Ablation by Flebogrif and Radiofrequency Ablation in Treating Primary Varicose Veins of Lower Limb

Introduction Chronic venous insufficiency is a common condition that leads to the development of incompetent great or short saphenous veins (GSV or SSV) resulting in varicose vein development. Conservative management is initially employed for its treatment; however, the varicosities that do not respond to conservative management may require intervention by surgery or endovenous routes. Radiofrequency ablation (RFA) and mechanochemical ablation (MOCA) are the two most common endovascular techniques available for the management of incompetent GSV or SSV. Clarivein and Flebogrif are two devices to treat incompetent GSV or SSV by MOCA. Mechanical ablation is provided by their flexible cutting elements and chemical ablation is provided by polidocanol or sodium tetradecyl sulfate (STS). RFA uses radiofrequency waves to treat venous insufficiency. Therefore, the aim of this study was to determine the early treatment outcome results for incompetent GSV or SSV treated with RFA or MOCA by Flebogrif. Materials and methods This was a retrospective cross-sectional study undertaken at the Radiology Department of Indus Hospital and Health Network. Electronic Medical Records of all the patients who underwent RFA or MOCA for GSV or SSV for venous insufficiency from January 2021 to December 2021 were included. Both male and female patients aged 18 years and above diagnosed with venous insufficiency having Clinical, Etiologic, Anatomic, and Pathophysiologic (CEAP) scores of >1 were included. Statistical Package for Social Sciences (SPSS) v 22 (IBM Corp., Armonk, NY) was used for data entry and analysis. Results 137 patients were included in the present study with a mean age of 53.8 ± 12.1 years. Pre-procedure CEAP score was C3 in 59 (84.4%), C4 in four (5.7%), and C6 in seven (10.0%) patients in patients who underwent RFA, and it was successful in 69 (98.6%) patients. Pre-procedure CEAP score was C3 in 62 (92.5%), C4 in two (3.0%), and C6 in three (4.5%) patients who underwent MOCA, and it was successful in 59 (88.1%) patients. Pain was the most frequent complication observed in both RFA and MOCA. Conclusion RFA has a high success rate as compared to MOCA by Flebogrif in treating incompetent GSV or SSVs.

Strategies and challenges in treatment of varicose veins and venous insufficiency

Patients with varicose veins can be treated with conservative or surgical approaches based on the clinical conditions and patient preferences. In the recent decade, the recommendations for managing symptomatic varicose veins have changed dramatically due to the rise of minimally invasive endovascular techniques. The literature was systematically searched on Medline without language restrictions. All papers on the treatment of varicose veins and venous insufficiency with different procedures were included and reviewed. Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) both are same safe and effective in terms of occlusion rate, and time to return to normal activity. In comparison with RFA or EVLT, Cure conservatrice et Hemodynamique de l'Insufficience Veineuse en Ambulatoire (CHIVA) may cause more bruising and make little or no difference to rates of limb infection, superficial vein thrombosis, nerve injury, or hematoma. In terms of recurrence of varicose veins, there is little or no difference between CHIVA and stripping, RFA, or EVLT. Great saphenous vein recanalization is highest in the ultrasound-guided foam sclerotherapy (FS) group (51%) during 1 year of follow-up. The 2013 National Institute for Health and Care Excellence clinical guidelines recommend surgery as a third-line therapeutic option after EVLA or RFA and sclerotherapy. Although the mechanochemical endovenous ablation (MOCA) is a non-thermal, non-tumescent option and appears to be of similar efficacy to stab avulsion with no potential risk of nerve damage, the overall success rate of MOCA is lower than those of other procedures such as EVLA, RFA, or high ligation and stripping. EVLA is the most cost-effective therapeutic option, with RFA being a close second for the treatment of patients with varicose veins. Endovenous thermal ablation (EVLA or RFA) is recommended as a first-line treatment for varicose veins and has substituted the high ligation of saphenofemoral junctional reflux and stripping of varicose veins. Ultrasound-guided FS is associated with a high recurrence rate and can be used in conjunction with other procedures. MOCA and cyanoacrylate embolization appear promising, but evidence of their effectiveness is required.