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.
IbegbunaVDelisKTNicolaidesAN.Haemodynamic and clinical impact of superficial, deep and perforator vein incompetence. Eur J Vasc Endovasc Surg2006;
31: 535–541.
2.
GadMASaberAHokkamEN.Assessment of causes and patterns of recurrent varicose veins after surgery.North Am J Med Sci2012;
4: 45–48.
3.
LabropoulosNKangSMansourM, et al.
Primary superficial vein reflux with competent saphenous trunk. Eur J Vasc Endovasc1999;
18: 201–206.
4.
GohelMSBarwellJRTaylorM, et al.
Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (eschar): randomised controlled trial. BMJ2007;
335: 83.
5.
HowardDPJHowardAKothariA, et al.
The role of superficial venous surgery in the management of venous ulcers: a systematic review.Eur J Vasc Endovasc Surg2008;
36: 458–465.
6.
GloviczkiPComerotaAJDalsingMC, et al.
The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the society for vascular surgery and the American venous forum.J Vasc Surg2011;
53: 2S–48S.
7.
GohelMSBarwellJRTaylorM, et al.
Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (eschar): randomised controlled trial. BMJ2007;
335: 83.
8.
BaconJLDinneenAJMarshP, et al.
Five-year results of incompetent perforator vein closure using trans-luminal occlusion of perforator.Phlebology2009;
24: 74–78.
9.
ShueBMuhsBLynchO, et al.
Patient outcomes after radiofrequency ablation stratified by clinical, etiology, anatomy, and pathophysiology classification. J Vasc Surg Venous Lymphat Disord2020;
8: 371–377.
10.
PassmanMAMcLaffertyRBLentzMF, et al.
Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program. J Vasc Surg2011;
54: 2S–9S.
11.
WallaceTLeungCNandhraS, et al.
Defining the optimum tumescent anaesthesia solution in endovenous laser ablation. Phlebology2017;
32: 322–333.
12.
GianesiniSMenegattiEZuoloM, et al.
Laser-assisted strategy for reflux abolition in a modified Chiva approach. Veins and Lymphatics2015;
4.
13.
EvansCJFowkesFGRuckleyCV, et al.
Prevalence of varicose veins and chronic venous insufficiency in men and women in the general population: Edinburgh vein study. J Epidemiol Community Health1999;
53: 149–153.
14.
KaplanRMCriquiMHDenenbergJO, et al.
Quality of life in patients with chronic venous disease: San Diego population study. J Vasc Surg2003;
37: 1047–1053.
15.
LintonRR.The communicating veins of the lower leg and the operative technic for their ligation.Ann Surg1938;
107: 582–593.
16.
RokaFBinderMBohler-SommereggerK.Mid-term recurrence rate of incompetent perforating veins after combined superficial vein surgery and subfascial endoscopic perforating vein surgery. J Vasc Surg2006;
44: 359–363.
17.
O'DonnellTFBalkEMDermodyM, et al.
Recurrence of varicose veins after endovenous ablation of the great saphenous vein in randomized trials.J Vasc Surg Venous Lymphat Disord2016;
4: 97–105.
18.
O'DonnellTJ.The present status of surgery of the superficial venous system in the management of venous ulcer and the evidence for the role of perforator interruption.J Vasc Surg2008;
48: 1044–1052.
19.
GloviczkiP andGloviczkiML:
Evidence on efficacy of treatments of venous ulcers and on prevention of ulcer recurrence.Perspect Vasc Surg Endovasc Ther2009;
21: 259–268.
20.
SerenMDumantepeMFazliogullariO, et al.
Combined treatment with endovenous laser ablation and compression therapy of incompetent perforating veins for treatment of recalcitrant venous ulcers.Phlebology2017;
32: 307–315.
21.
LawrencePFAlktaifiARigbergD, et al.
Endovenous ablation of incompetent perforating veins is effective treatment for recalcitrant venous ulcers.J Vasc Surg2011;
54: 737–742.
22.
de WaardMMder KinderenDJ:
Duplex ultrasonography-guided foam sclerotherapy of incompetent perforator veins in a patient with bilateral venous leg ulcers. Dermatol Surg2005;
31: 580–583.
23.
PrasadBKJoyBTomsA, et al.
Treatment of incompetent perforators in recurrent venous insufficiency with adhesive embolization and sclerotherapy. Phlebology2018;
33: 242–250.
24.
HagerESWashingtonCSteinmetzA, et al.
Factors that influence perforator vein closure rates using radiofrequency ablation, laser ablation, or foam sclerotherapy.J Vasc Surg Venous Lymphat Disord2016;
4: 51–56.
25.
KulkarniSRSlimFJEmersonLG, et al.
Effect of foam sclerotherapy on healing and long-term recurrence in chronic venous leg ulcers.Phlebology2013;
28: 140–146.
26.
Harlander-LockeMLawrencePF, et al.
The impact of ablation of incompetent superficial and perforator veins on ulcer healing rates. J Vasc Surg2012;
55: 458–464.
27.
MarshPPriceBAHoldstockJM, et al.
One-year outcomes of radiofrequency ablation of incompetent perforator veins using the radiofrequency stylet device.Phlebology2010;
25: 79–84.
