Patient outcomes after radiofrequency ablation stratified by Clinical, Etiology, Anatomy, and Pathophysiology classification

The ımpact of radiofrequency ablation on quality of life/symptoms (VEINES-QOL/Sym questionnaire score) in patients with chronic venous ınsufficiency

Purpose

Chronic venous insufficiency is defined as a progressive disease that impairs the quality of life. Symptomatic patients can be treated with a 97% success rate through endovenous radiofrequency ablation (RFA) procedures. The aim of this study is to evaluate the effect and impact of RFA therapy on both the Venous Insufficiency Epidemiological and Economic Study Quality of Life/Symptom Questionnaire (VEINES-QOL/Sym) scale and the VEINES-QOL/Sym severity score in patients with isolated vena saphena magna insufficiency.

Methods

Between March and June 2018, a retrospective analysis was conducted on 45 patients with a healthy vena saphena parva. They were divided into two groups based on the diameter of the great saphenous vein (GSV). Patients with GSV < 6 mm were assigned to group I (n = 22, 15 males, 7 females, mean age 52.45 ± 13.98 years), while patients with GSV ≥ 6 mm were assigned to group II (n = 23, 14 males, 9 females, mean age 55.04 ± 10.18 years). The pre-procedural Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification and post-procedural quality of life and symptom assessment at 12-24 months were evaluated using the VEINES-QOL/Sym questionnaire scale.

Results

When all patients were assessed in terms of the VEINES-QOL/Sym questionnaire scale, compared to the previous year, it was found that 57.8% of patients (n = 26) still experienced complaints, and 24.4% of patients (n = 14) reported slightly worse symptoms than the previous year. In group II, 56.5% of patients (n = 13) reported experiencing similar complaints as the previous year, while 30.4% (n = 7) noted slightly worse symptoms.

Conclusions

Our study findings revealed that the increase in vessel diameter does not significantly impact the severity of symptoms and quality of life outcomes after RFA therapy; however, it does have a notable impact on the improvement of symptom characteristics. As a result, early intervention for symptomatic patients is crucial in order to address their symptoms and improve their quality of life.

Correlation between great saphenous length of treatment zone and diameter with improvement in symptoms after ablation

OBJECTIVE

The aim of the present study was to examine the relationship between the great saphenous vein (GSV) length of segment ablated and diameter with symptom improvement.

METHODS

Data from a multicenter, randomized, controlled prospective study of 242 patients undergoing radiofrequency ablation (RFA) or cyanoacrylate closure (CAC) of the GSV were analyzed. The venous clinical severity score (VCSS) was measured at baseline and at 1, 3, 6, 12, 24, and 36 months after ablation. The GSV diameter was evaluated for a correlation with VCSS at each time point. Using the median treatment length of 34 cm, the patients were divided into group I (treatment length ≥34 cm) vs group II (<34 cm) for analysis. The pretreatment VCSS and VCSS improvement (ΔVCSS) after treatment were evaluated with respect to the length of the ablated GSV segment. The postablation VCSS was compared between the pretreatment GSV diameters of <5.5 mm vs ≥5.5 mm.

RESULTS

The mean GSV length ablated by RFA was 35.3 ± 14 cm vs 32.6 ± 11 cm with CAC (P = NS). No significant difference was found in the VCSS (at baseline or follow-up) between RFA and CAC. The pooled data for all participants (n = 242) demonstrated a correlation between the treated GSV length and pretreatment VCSS and the ΔVCSS at 36 months (R = 0.23; P < .001). Greater VCSS improvement was seen in group I (≥34 cm ablated) than in group II (<34 cm ablated) at ≤36 months of follow-up (P = .003). At baseline, group I had had higher VCSSs (6.21 ± 2.75 vs 4.88 ± 2.33; P < .00001) and CEAP (clinical, etiologic, anatomic, pathophysiologic) and reflux scores. Of the 242 patients, 101 had had a GSV diameter <5.5 mm and 141 had had a GSV diameter of ≥5.5 mm. No significant differences were noted in the VCSSs, either at baseline or at follow-up, between the two groups. Within the study population, a poor correlation was found between the GSV diameter and baseline VCSS (R = -0.004; P = .95) and between the GSV diameter and ΔVCSS for ≤36 months (R = 0.04; P = .55).

CONCLUSIONS

Longer segments of GSV reflux appeared to correlate with symptom severity. We found a small to moderate correlation between the length of GSV segment ablated and symptom improvement. This might reflect the greater severity of symptoms at baseline in patients with longer segments with reflux. We found a poor correlation between the proximal GSV diameter and symptom improvement after ablation.

One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device: Cohort study from East Asia

OBJECTIVES

The present study was designed to assess outcomes of patients undergone radiofrequency ablation (RFA) for their incompetent perforator veins (IPVs) with ClosureFast stylets.

METHODS

Data of 165 IPVs in 138 limbs of 117 consecutive patients between July 2017 to Nov. 2019 were retrospectively reviewed. Primary endpoints (technical success rate, complications) and secondary endpoints (VCSS) were analyzed.

RESULTS

The immediate technical success rate was 100%. There were no major complications. The rate of ecchymosis and induration was 5.8%. 129/165 IPVs in 79.5% (93/117) patients had achieved sonographic evaluation at 1 year followed-up, in which 3 perforators were recanalized. VCSS scores at pre-operation and 1-year follow-up were 5.77 ± 1.88 and 2.70 ± 1.39, respectively (t= 29.644, P= .000).

CONCLUSIONS

In conclusion, RFA is safe and effective for the treatment of IPVs. At the 1-year follow-up, the RFA of IPVs showed a low recanalization rate and had a satisfactory improvement on VCSS.