ClosureFast endovenous radiofrequency ablation for great saphenous vein and small saphenous vein incompetence: Efficacy and anatomical failure patterns

Abstract

Background

Recurrence rates and patterns after endovenous radiofrequency ablation (ERFA) are poorly documented.

Objective

To assess the incidence and anatomical recurrence patterns of saphenous vein reflux after ERFA.

Method

Two hundred patients previously treated with ERFA were recalled for clinical assessment and venous-duplex ultrasound at three years post-treatment.

Results

A total of 106 patients (68F, 38M) with a mean age of 49.4 years (SD +11.5y) were assessed. Mean follow-up was 42.1 months (SD + 20.1m). Further varicose veins were identified in 31 patients (29.2%). Recanalization/recurrence/failure was diagnosed in 16 patients (15.1%), including 18 trunks (8.7%), 13 great saphenous vein (6.3%) and 5 small saphenous vein (2.4%). Twenty-seven patients (25%) developed neo-incompetence in 31 trunks and 12 non-saphenous veins. All patients with truncal recanalization had a body mass index > 29 (range 29–42).

Conclusion

Disease progression was twice as high as the recanalization rate at three years post-treatment using ERFA in this study. Raised body mass index may be a contributing factor; however, further longitudinal studies are required. Patient self-selection bias may have also influenced our results.

Keywords

Endovenous thermal ablation radiofrequency ablation recurrent varices saphenous vein small saphenous vein

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References

Xenos

Bietz

Minion

et al . Endoluminal thermal ablation versus stripping of the saphenous vein: meta-analysis of recurrence of reflux. Int J Angiol 2009; 18: 75–78.

Onida

Lane

TRA

Davies

AH.

Varicose veins and their management. Surgery Oxford Int Ed 2013; 31: 211–217.

Beebe-Dimmer

Pfeifer

Engle

et al . The epidemiology of chronic venous insufficiency and varicose veins. Ann Epidemiol 2005; 15: 175–184.

Rabe

Berboth

Pannier

Epidemiology of chronic venous diseases. Wien Med Wochenschr 2016; 166(9-10): 260–3.

Kontothanassis

Di Mitri

Ferrari Ruffino

et al . Endovenous laser treatment of the small saphenous vein. J Vasc Surg 2009; 49: 973–979.e1.

O’Donnell

Balk

Dermody

et al . Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials. J Vasc Surg Venous Lymphat Disord 2016; 4: 97–105.

National Clinical Guideline C. National Institute for Health and Care Excellence: clinical guidelines. Varicose veins in the legs: the diagnosis and management of varicose veins. London: National Institute for Health and Care Excellence, 2013.

Perrin

Labropoulos

Leon

Jr.

Presentation of the patient with recurrent varices after surgery (REVAS).

J Vasc Surg 2006; 43: 327–334; discussion 34.

Merchant

Pichot

; Closure Study G. Long-term outcomes of endovenous radiofrequency obliteration of saphenous reflux as a treatment for superficial venous insufficiency. J Vasc Surg 2005; 42: 502–509; discussion 9.

10.

Aktas

Ozkan

Secondary ablation of saphenous veins: the reasons and the ratios. Phlebology 2016; 31: 141–144.

11.

Van der Velden

Lawaetz

De Maeseneer

et al . Predictors of recanalization of the great saphenous vein in randomized controlled trials 1 year after endovenous thermal ablation. Eur J Vasc Endovasc Surg 2016; 52: 234–241.

12.

Mazzaccaro

Stegher

Occhiuto

et al . Varicose veins: new trends in treatment in a Vascular Surgery Unit. Ann Ital Chir 2016; 87: 166–171.

13.

Proebstle

Alm

Gockeritz

et al . Three-year European follow-up of endovenous radiofrequency-powered segmental thermal ablation of the great saphenous vein with or without treatment of calf varicosities. J Vasc Surg 2011; 54: 146–152.

14.

Rasmussen

Lawaetz

Serup

et al . Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy, and surgical stripping for great saphenous varicose veins with 3-year follow-up. J Vasc Surg Venous Lymphat Disord 2013; 1: 349–356.

15.

Winokur

Khilnani

Min

RJ.

Recurrence patterns after endovenous laser treatment of saphenous vein reflux. Phlebology 2016; 31: 496–500.

16.

Bush

Flanagan

et al . Factors associated with recurrence of varicose veins after thermal ablation: results of the recurrent veins after thermal ablation study. Sci World J 2014; 2014: 505843.