Introduction: Chronic venous insufficiency is the most common vascular disease in the adult population. However, randomized clinical trials (RCTs) comparing therapeutic options are limited. Patients and Methods: A total of 180 patients with saphenofemoral junction and great saphenous reflux detected on duplex were randomized to either ultrasound-guided radiofrequency ablation (RFA) or standard surgical treatment. The study participants blindly chose an assignment card that placed them in either group A (ultrasound-guided RFA of the great saphenous vein [GSV]; n = 90); or group B (surgical management n = 90). Patients were followed up for 24 months. Results: The primary occlusion rate in group A was 94.5% versus 100% in group B. Radiofrequency ablation had a lower overall complication rate (P = .02) and shorter post-intervention hospital stay (P = .001). Kaplan-Meier analysis showed no significant differences in recurrence rates at 24 months follow-up (P = .45). Radiofrequency ablation was significantly more expensive (P = .003). Conclusion: Great saphenous vein occlusion was achieved efficiently in 94% of our group using RFA with minimal complications and obvious advantages as compared to standard surgery.
Dietzek AMEndovenous radiofrequency ablation for the treatment of varicose veins . Vascular. 2007;15(5):255-261.
2.
Tzilinis A., Salles-Cunha SX, Dosick SM, Gale SS, Seiwert AJ, Comerota AJChronic venous insufficiency due to GSV incompetence treated with radiofrequency ablation: an effective and safe procedure in the elderly. Vasc Endovascular Surg. 2005;39(4): 341-345.
3.
Johnson CM, McLafferty RBEndovenous laser ablation of varicose veins: review of current technologies and clinical outcome. Vascular. 2007;15(5):250-254.
4.
Perrin MR, Labropoulos N., Leon LRPresentation of the patient with recurrent varices after surgery (REVAS) . J Vasc Surg. 2006; 43(2):327-334.
5.
Brethauer SA , Murray JD, Hatter DG, Reeves TR, Hemp JR, Bergan JJTreatment of varicose veins: proximal saphenofemoral ligation comparing adjunctive varicose phlebectomy with sclerotherapy at a military medical center. Vasc Surg. 2001 ;35(1): 51-58.
6.
Sarin S., Sommerville K., Farrah J., Surr JH, Coleridge Smith PDDuplex ultrasonography for assessment of venous vascular function of the lower limb. Br J Surg. 1994;81(6):1591-1596.
7.
Padberg FTClassification and clinical and diagnostic evaluation of patients with chronic venous disorders. In: Rutherford RB, ed. Vascular Surgery. 6th ed. Philadelphia, PA: Elsevier Inc; 2005: 2230-2240.
8.
Porter JM, Moneta GLReporting standards in venous disease: an update. International Consensus Committee on Chronic Venous Disease. J Vasc Surg. 1995;21(4):635-645.
9.
Morrison N.Saphenous ablation: what are the choices, laser or RF energy. Semin Vasc Surg. 2005;18(1):15-18.
10.
Reijnen MM, Disselhoff BC, Zeebregts CJVaricose vein surgery and endovenous laser therapy. Surg Technol Int. 2007;16:167-174.
11.
Hingorani AP , Ascher E., Markevich N., et al. Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution. J Vasc Surg. 2004;40(3):500-504.
12.
Puggioni A. , Kalra M., Carmo M., Mozes G., Gloviczki P.Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications . J Vasc Surg. 2005;42(3):488-493.
13.
Merchant RF , DePalma RG, Kabnick LSEndovenous obliteration of saphenous reflux: a multicenter study. J Vasc Surg. 2002;35(6):1190-1196.
14.
Kistner RLEndovascular obliteration of the greater saphenous vein: the Closure procedure . Jpn J Phlebol. 2002;13(5):325-333.
15.
Weiss RA, Weiss MAControlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: a 2-year follow-up. Dermatol Surg. 2002;28(1):38-42.
16.
Mozes G., Kalra M., Carmo M., Swenson L., Gloviczki P.Extension of saphenous thrombus into the femoral vein: a potential complication of new endovenous ablation techniques. J Vasc Surg. 2005; 41(1):130-135.
17.
Labropoulos N., Delis K., Nicolaides AN, Leon M., Ramaswami G.The role of the distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency. J Vasc Surg . 1996;23(3):504-510.
18.
Rautio T., Ohinmaa A., Perala J., et al. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs. J Vasc Surg. 2002;35(5):958-965.
19.
Goldman MP, Amiry S.Closure of the greater saphenous vein with endoluminal radiofrequency thermal heating of the vein wall in combination with ambulatory phlebectomy: 50 patients with more than 6-month follow-up. Dermatol Surg . 2002;28(1):29-31.
20.
Callum MJEpidemiology of varicose veins. Br J Surg. 1994; 81(2):167-173.
21.
Perrin M.Varices des membres inferieurs traitees par radiofrequence (CLOSURE). Controle annuel des resultats: un suivi sur 3ans. Phebologie . 2004;57(1):69-73.
22.
Van den Bos R., Arends L., Kockaert M., Neumann M., Nijsten T.Endovenous therapies of lower extremity varicosities: a meta-analysis. J Vasc Surg.2009;49(1):230-239.
23.
Pisano IP, Pala C., Scognamillo F., Rizzuti F., Sale P., Trignano M.Endovenous radiofrequency obliteration of the saphenous veins in the treatment of venous insufficiency of lower legs. Our experience. Ann Ital Chir. 2008;79(3):193-196.
24.
Min RJ, Khilnani NMEndovenous laser ablation of varicose veins. J Cardiovasc Surg. 2005;46(4):395-405.
25.
Ravi R., Rodriguez-Lopez JA, Traylor EA, Barrett DA, Ramaiah V., Diethrich EBEndovenous ablation of incompetent saphenous veins: a large single-center experience. J Endovasc Ther. 2006;13(2):244-248.
26.
Medeiros CAF , Luccas GCComparison of endovenous treatment with an 810 nm laser versus conventional stripping of the great saphenous vein in patients with primary varicose veins. Dermatol Surg . 2005;31(12):1685-1694.
27.
Rasmussen LH , Bjoern L., Lawaetz M., Blemings A., Lawaetz B., Eklof B.Randomized trial comparing endovenous laser ablation of the great saphenous vein with high ligation and stripping in patients with varicose veins: short-term results . J Vasc Surg. 2007;46(2):308-315.
Beale RJ, Mavor AID, Gough MJMinimally invasive treatment of varicose veins: a review of endovenous laser treatment and radiofrequency ablation. Int J Lower Extrem Wounds. 2004; 3(4):188-197.
30.
Mekako A., Hatfield J., Bryce J., et al. Combined endovenous laser therapy and ambulatory phlebectomy: refinement of a new technique. Eur J Vasc Endovasc Surg. 2006;32(6):725-729.
