Fate of Great Saphenous Vein After Radio-Frequency Ablation: Detailed Ultrasound Imaging

Abstract

Radio-frequency ablation (RFA) of the great saphenous vein (GSV) is an endovascular alternative to stripping. To determine long-term effectiveness, the fate of GSV treated for valvular insufficiency with RFA was evaluated in detail with ultrasound imaging (US). One hundred lower extremities were examined with high-resolution color flow US, an average of 8 months after RFA treatment of an incompetent GSV. For every cm of the RFA-treated segment, the US observation was classified as follows: absent, occluded, or recanalized. Lengths of vein segments in each class were added and percentages of absent, occluded, or recanalized segments were calculated. Five groups were identified. Group I (n=15): segment of treated GSV was absent. Group II (n=4): segment of treated GSV was visualized and occluded (these vein segments had no flow and were shrunk and “fibrotic” or thrombosed without clear evidence of significant shrinkage). Group III (n=1): segment of treated GSV was recanalized. Group IV (n= 27): segment of treated GSV was obstructed (absent or occluded). Group V (n=53): segment of treated GSV was partially recanalized, on average being 53% absent, 32% occluded, and 15% recanalized. Maximum recanalization was 50% of treated segment. RFA was successful in obliterating all of the GSV treated segment in 46% of veins (groups I, 15%, plus II, 4%, plus IV, 27%) and obliterated more than half of the treated vein segment in 53% of the cases (group V). A dynamic process of recanalization and thrombosis warrants further evaluation to determine if and how a collateral network may develop.

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References

Manfrini S , Gasbarro V , Danielsson G , et al: Endovenous management of saphenous vein reflux. J Vasc Surg 32:330-342, 2000.

Goldman MP : Closure of the greater saphenous vein with endoluminal radiofrequency thermal heating of the vein wall in combination with ambulatory phlebectomy: Preliminary 6-month follow-up. Dermatol Surg 26:452-456, 2000.

Chandler JG , Pichot O , Sessa C , et al: Treatment of primary venous insufficiency by endovenous saphenous vein obliteration. Vasc Surg 34:201-214, 2000.

Chandler JG , Pichot O , Sessa C , et al: Defining the role of extended saphenofemoral junction ligation: A prospective comparative study. J Vasc Surg 32:941-953, 2000.

Kabnik LS , Merchant RF : Twelve-and twenty-fourmonth follow-up after endovascular obliteration of saphenous vein reflux: A report from the multicenter registry. J Phlebology 1:17-24, 2001.

Weiss RA , Weiss MA : Controlled radiofrequency endovenous occlusion using a unique radiofrequency catheter under duplex guidance to eliminate saphenous varicose vein reflux: A 2-year follow-up. Dermatol Surg 28:38-42, 2002.

Bergan JJ , Kumins NH , Owens EL , et al: Surgical and endovascular treatment of lower extremity venous insufficiency. J Vasc Interv Radiol 13:563-568, 2002.

Rautio TT , Perala JM , Wiik HT , et al: Endovenous obliteration with radiofrequency-resistive heating for greater saphenous vein insufficiency: A feasibility study. J Vasc Interv Radiol 13:569-575, 2002.

Merchant RF , DePalma RG , Kabnick LS : Endovascular obliteration of saphenous reflux: A multicenter study. J Vasc Surg 35:1190-1196, 2002.

10.

Sybrandy JEM , Wittens CHA : Initial experiences in endovenous treatment of saphenous vein reflux. J Vasc Surg 36:1207-1212, 2002.

11.

Bergan JJ : Surgical management of primary and recurrent varicose veins. In: Handbook of Venous Disorders. Guidelines of the American Venous Forum, ed. 2, ed. by Gloviczki P , Yao JST . London: Arnold, 2001, pp 290-302.

12.

Labropoulos N , Delis K , Nicolaides AN , et al: The role of the distribution and anatomic extent of reflux in the development of signs and symptoms in chronic venous insufficiency. J Vasc Surg 23:504-510, 1996.

13.

Evans CJ , Allan PL , Lee AJ , et al: Prevalence of venous reflux in the general population on duplex scanning: The Edinburg vein study. J Vasc Surg 28:767-776, 1998.

14.

Pichot O , Sessa C , Chandler JG , et al: Role of duplex imaging in endovenous obliteration for primary venous insufficiency. J Endovasc Ther 7:451-459, 2000.

15.

Fassiadis N , Kianifard B , Holdstock JM , et al: Ultrasound changes at the saphenofemoral junction and in the long saphenous vein during the first year after VNUS closure. Int Angiol 21:272-274, 2002.

16.

Fassiadis N , Kianifard B , Holdstock JM , et al: A novel approach to the treatment of recurrent varicose veins. Int Angiol 21:275-276, 2002.

17.

Pichot O, Perrin M: Aspects echographiques de la junction sapheno-femorale aprËs obliteration de la grande veine saphene par radiofrequence (Closure). Phlebologie 55:329-334, 2002.

18.

Pichot O , Kabnick LS , Creton D , et al: Duplex ultrasound scan findings 2 years after great saphenous vein radiofrequency endovenous obliteration. J Vasc Surg 39:189-195, 2000.

19.

Rajasinghe H , Salles-Cunha SX , Dosick SM , et al: Patency and reflux findings after greater saphenous vein junction ligation and radio frequency ablation: A duplex ultrasound analysis. Final Program, AVF 15th Annual Meeting, Cancun, Mexico, February 20–23, 2003, p 72-72.

20.

Wakefield TW , Strieter RM , Schaub R , et al: Venous thrombosis prophylaxis by inflammatory inhibition without anticoagulation therapy. J Vasc Surg 31:309-324, 2000.

21.

Wakefield TW , Linn MJ , Henke PK , et al: Neovascularization during venous thrombosis organization: A preliminary study. J Vasc Surg 30:885-892, 1999.

22.

Maeso J , Juan J , Escribano J , et al: Comparison of clinical outcome of stripping and CHIVA for treatment of varicose veins in the lower extremities. Ann Vasc Surg 15:661-665, 2001.