Comparison of high saphenous ligation and stripping,radiofrequency ablation,and subfascial endoscopic perforator surgery for the treatment of active venous ulcers: Retrospective cohort with five-year follow-up

Abstract

Objective

To compare the use of high saphenous ligation and stripping, radiofrequency ablation, and subfascial endoscopic perforator surgery for the treatment of active venous ulcers.

Methods

One hundred ninety-five (n = 195) subjects who were treated for venous leg ulcers were enrolled between 2009 and 2014. Three groups were formed (Group A: high saphenous ligation and total stripping, Group B: radiofrequency ablation of the great saphenous vein + perforators, and Group C: radiofrequency ablation of the great saphenous vein + subfascial endoscopic perforator surgery) (n = 65 for each group). The venous clinical severity score for baseline, 1st, 6th, and 12th months, great saphenous vein occlusion at the 1st, 6th, and 12th months, and ulcer rates for the 1st, 2nd, 3rd, 4th, and 5th years were recorded.

Results

For venous clinical severity score, only the first month decrease was significant for the subfascial endoscopic perforator surgery group (p = 0.001). Great saphenous vein occlusion was higher at the 6th and 12th months for the high saphenous ligation and stripping and subfascial endoscopic perforator surgery groups than for the radiofrequency ablation group (p = 0.036 and p = 0.037). The rate of ulcers for the subfascial endoscopic perforator surgery group was lower at the second, third, fourth, and fifth years (p = 0.011). No significant difference was found between groups for the five-year recovery rates (p > 0.05).

Conclusion

Subfascial endoscopic perforator surgery technique in conjunction with radiofrequency ablation of axial vein was superior to both high saphenous ligation and stripping and radiofrequency ablation of axial and perforators for ulcer healing.

Keywords

Venous ulcer venous insufficiency perforator vein endovenous treatment

Get full access to this article

View all access options for this article.

References

Haruta

Recent progress of varicose vein treatment especially about endovascular heat ablation, SEPS and foam sclerotherapy. Ann Vasc Dis 2018; 11: 66–71.

Malas

Qazi

Lazarus

, et al. Comparative effectiveness of surgical interventions aimed at treating underlying venous pathology in patients with chronic venous ulcer. J Vasc Surg Venous Lymphat Disord 2014; 2: 212–225.

Lin

Loveland

Johnston

, et al. Subfascial endoscopic perforator surgery (SEPS) for treating venous leg ulcers. Cochrane Database Syst Rev 2019; 3: CD012164.

Dillavou

Harlander-Locke

Labropoulos

, et al. Current state of the treatment of perforating veins. J Vasc Surg Venous Lymphat Disord 2016; 4: 131–135.

van Gent

Catarinella

Lam

, et al. Conservative versus surgical treatment of venous leg ulcers: 10-year follow up of a randomized, multicenter trial. Phlebology 2015; 30: 35–41.

Reitz

Salem

Mohapatra

, et al. Complete venous ulceration healing following perforator ablation does not depend on treatment modality. Ann Vasc Surg 2020; 27: 30552–30555.

Porter

Moneta

; International Consensus Committee on Chronic Venous Disease. Reporting standards in venous disease: an update. J Vasc Surg 1995; 21: 635–645.

Ostler

Holdstock

Harrison

, et al. Strip-tract revascularization as a source of recurrent venous reflux following high saphenous tie and stripping: results at 5-8 years after surgery. Phlebology 2015; 30: 569–572.

Hartmann

Endovenous (minimally invasive) procedures for treatment of varicose veins: the gentle and effective alternative to high ligation and stripping operations. Hautarzt 2020; 71 (Suppl 2): 67–73.

10.

Gracia

Miserey

Risse

, et al. Update of the SFMV (French Society of Vascular Medicine) guidelines on the conditions and safety measures necessary for thermal ablation of the saphenous veins and proposals for unresolved issues. J Med Vasc 2020; 45: 130–146.

11.

Gohel

Heatley

Liu

, et al. A randomized trial of early endovenous ablation in venous ulceration. N Engl J Med 2018; 378: 2105–2114.

12.

González

Florit

Vilagut

, et al. A randomized controlled noninferiority trial comparing radiofrequency with stripping and conservative hemodynamic cure for venous insufficiency technique for insufficiency of the great saphenous vein. J Vasc Surg Venous Lymphat Disord 2020; 9: 101–112.

13.

Liao

Song

, et al. Randomized clinical trial of radiofrequency-induced thermotherapy combined with transilluminated powered phlebectomy versus high ligation and stripping for the treatment of lower limb varicose veins. J Vasc Surg Venous Lymphat Disord 2020; 9: 95–100.

14.

Oliveira

RÁ

Mazzucca

ACP

Pachito

, et al. Evidence for varicose vein treatment: an overview of systematic reviews. Sao Paulo Med J 2018; 136: 324–332.

15.

Kusagawa

Haruta

Shinhara

, et al. Surgical methods and clinical results of subfascial endoscopic perforator surgery in Japan. Phlebology 2018; 33: 678–686.

16.

van Gent

Wittens

Influence of perforating vein surgery in patients with venous ulceration. Phlebology 2015; 30: 127–132.

17.

Sahoo

Misra

Deshpande

, et al. Subfascial endoscopic perforator surgery: a safe and novel minimal invasive procedure in treating varicose veins in 2(nd) trimester of pregnancy for below knee perforator incompetence. J Minim Access Surg 2018; 14: 208–212.