Endovenous thermal ablation mid-term outcomes for the treatment of large diameter incompetent great saphenous veins

Abstract

Introduction

The aim of this study was to assess the efficacy and safety of endovenous thermal ablation (EVTA) in treating large diameter, ≥12 mm, incompetent great saphenous vein (GSV) in comparison to smaller ones.

Methods

A retrospective comparative study was undertaken including 196 patients (205 limbs) undergoing EVTA. According to maximum GSV diameter patients were divided into two groups (group A <12 mm, group B ≥12 mm). Primary outcome was anatomic success defined as absence of reflux of GSV. Secondary outcomes were complications, postoperative pain using the 10-cm Visual Analog Scale (VAS) and improvement of Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) scores assessed at 7- days, 1 month, 12 months and 24 months postoperatively.

Results

118 patients with GSV diameter <12 mm (group A) and 87 with GSV diameter ≥12 mm (group B) were included. Patients’ demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p = .04 and 5.21 vs 5.77, p = .032, respectively). No differences in adverse events were observed post-operatively among groups. GSV occlusion rate at 1 month was 98.3% (SE 1.3%) in group A and 96.5 % (2.2%) in group B (p = .3), at 12 months 95.7% (SE 2%) and 94.2% (SE 2.8%) (p = .5), and at 24 months 94% (SE 2.4%) and 93.1% (SE 3%) (p = .4) respectively. Both groups experienced significant and similar improvement in their VCSSs and CIVIQ scores postoperatively. In a subgroup analysis among different EVTA and GSV >12 mm, 1470 nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) showed comparable results in terms of occlusion rates, complications, VCSS and CIVIQ scores.

Conclusions

Endovenous thermal ablation techniques are efective and safe in the treatment of GSV incompetence regardless the diameter of the GSV. Both 1470 nm EVLA and RFA techniques performed similar outcomes.

Keywords

Endovenous thermal ablation endovenous laser ablation radiofrequency ablation large diameter great saphenous vein occlusion rates postoperative pain quality of live scores

Get full access to this article

View all access options for this article.

References

Robertson

Lee

Evans

, et al. Incidence of chronic venous disease in the Edinburgh Vein Study. J Vasc Surg Venous Lymphat Disord 2013; 1(1): 59–67.

Rabe

Guex

Puskas

, et al. VCP Coordinators. Epidemiology of chronic venous disorders in geographically diverse populations: results from the Vein Consult Program. Int Angiol 2012; 31(2): 105–115.

De Maeseneer

Kakkos

Aherne

, et al. Editor’s Choice – European Society for Vascular Surgery (ESVS) 2022 clinical practice guidelines on the management of chronic venous disease of the lower limbs. Eur J Vasc Endovasc Surg 2022; 63: 184–267.

Gloviczki

Comerota

Dalsing

, 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 Surg 2011; 53: 2S–48S.

Corcos

Dini

Peruzzi

, et al. Duplex ultrasound changes in the great saphenous vein after endosaphenous laser occlusion with 808-nm wavelength. J Vasc Surg 2008; 48: 1262–1271.

van den Bos

Neumann

de Roos

, et al. Endovenous laser ablation-induced complications: review of the literature and new cases. Dermatol Surg 2009; 35: 1206–1214.

Atasoy

. Efficacy and safety of endovenous laser ablation in very large and tortuous great saphenous veins. J Vasc Intervent Radiol 2015; 26: 1347–1352.

Cabrero Fernandez

Martinez Lopez

Hernandez Mateo

, et al. Prospective study of safety and effectiveness in the use of radiofrequency ablation for incompetent great saphenous vein >12 mm. J Vasc Surg Venous Lymphat Disord 2017; 5: 810–816.

Woo

Kim

, et al. Outcome of ClosureFAST radiofrequency ablation for large-diameter incompetent great saphenous vein. Ann Surg Treat Res 2019; 96: 313–318.

10.

Hamel-Desnos

De Maeseneer

Josnin

, et al. DIAGRAVES Study Group. Great saphenous vein diameters in phlebological practice in France: a report of the DIAGRAVES Study by the French Society of Phlebology. Eur J Vasc Endovasc Surg 2019; 58: 96–103.

11.

Bendix

Peterson

Kabbani

, et al. Effect of endovenous ablation assessment stratified by great saphenous vein size, gender, clinical severity, and patient-reported outcomes. J Vasc Surg Venous Lymphat Disord 2020; 9(1): 128–136. DOI: 10.1016/j.jvsv.2020.04.017.

12.

Mese

Bozoglan

Eroglu

, et al. A comparison of 1470 nm endovenous laser ablation and radiofrequency ablation in the treatment of great saphenous veins 10 mm or more in size. Ann Vasc Surg 2015; 29(7): 1368–1372. DOI: 10.1016/j.avsg.2015.03.063.

13.

Kubat

Ünal

Geldi

, et al. What is the optimal treatment technique for great saphenous vein diameter of ≥10 mm? Comparison of five different approaches. Acta Chir Belg 2019; 121(2): 1–8. DOI: 10.1080/00015458.2019.1684008.

14.

Maeseneer

Pichot

Cavezzi

, et al. Duplex ultrasound investigation of the veins of the lower limbs after treatment of varicose veinsdUIP consensus document. Eur J Vasc Endovasc Surg 2011; 42: 89–102.

15.

Lane

Varatharajan

Fiorentino

, et al. Truncal varicose vein diameter and patient reported outcome measures. Br J Surg 2017; 104: 1648–1655.

16.

Arslan

Çalık

Tort

, et al. More successful results with less energy in endovenous laser ablation treatment: long-term comparison of bare-tip fiber 980 nm Laser and radial-tip fiber 1470 nm laser application. Ann Vasc Surg 2017; 45: 166–172.

17.

Weiss

Eimpunth

, et al. Comparative outcomes of different endovenous thermal ablation systems on great and small saphenous vein insufficiency: long-term results. Laser Surg Med 2015; 47: 156–160.

18.

Hirokawa

Ogawa

Sugawara

, et al. Comparison of 1470 nm laser and radial 2 ring fiber with 980 nm laser and bare-tip fiber in endovenous laser ablation of saphenous varicose veins: a multicenter, prospective, randomized, non-blind study. Ann Vasc Dis 2015; 8(4): 282–289.

19.

Zuniga

Hingorani

Ascher

, et al. Short term outcome analysis of radiofrequency ablation using ClosurePlus vs ClosureFast catheters in the treatment of incompetent great saphenous vein. J Vasc Surg 2012; 55: 1048–1051.

20.

Dabbs

Mainsiouw

Holdstock

, et al. A description of the ‘smile sign’ and multi-pass technique for endovenous laser ablation of large diameter great saphenous veins. Phlebology 2018; 33(8): 534–539. DOI: 10.1177/0268355517734480.

21.

MacKenzie

Cassar

Brittenden

, et al. Introducing endovenous laser therapy ablation to a national health service vascular surgical unit – the Aberdeen experience. Eur J Vasc Endovasc Surg 2009; 38: 208–212.

22.

Fernandez

Roizental

Carvallo

. Combined endovenous laser therapy and microphlebectomy in the treatment of varicose veins: efficacy and complications of a large single-center experience. J Vasc Surg 2008; 48: 947–952.

23.

Karathanos

Spanos

Batzalexis

, et al. Prospective comparative study of different endovenous thermal ablation systems for treatment of great saphenous vein reflux. J Vasc Surg Venous Lymphat Disord 2020; 9(3): 660–668. DOI: 10.1016/j.jvsv.2020.10.008.

24.

Lawson

Gauw

van Vlijmen

, et al. Prospective comparative cohort study evaluating incompetent great saphenous vein closure using radiofrequency-powered segmental ablation or 1470-nm endovenous laser ablation with radial-tip fibers (Varico 2 study). J Vasc Surg Lymphat Disord 2018; 6(1): 31–40.

25.

Bontinis

Koutsoumpelis

, et al. Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: a systematic review meta-analysis and meta-regression. Vasc Med 2023; 28(5): 449–457. DOI: 10.1177/1358863X231183997.

26.

Malgor

Gasparis

Labropoulos

. Morbidity and mortality after thermal venous ablations. Int Angiol 2016; 35: 57–61.

27.

Healy

Kimura

Power

, et al. A systematic review and meta-analysis of thrombotic events following endovenous thermal ablation of the great saphenous vein. Eur J Vasc Endovasc Surg 2018; 56: 410–424.

28.

Shaidakov

Grigoryan

Ilyukhin

, et al. Radiofrequency ablation or stripping of large-diameter incompetent great saphenous varicose veins with C2 or C3 disease. J Vasc Surg: Venous and Lym Dis 2016; 4: 45–50.