Novel subcutaneous side branch access technique compared to traditional access in radiofrequency ablation of the greater saphenous vein

Abstract

Objectives

Chronic venous insufficiency (CVI) is a prevalent condition with significant socioeconomic implications. Endovenous radiofrequency ablation (RFA) is a minimally invasive treatment option that has gained widespread acceptance due to its high efficacy and low complication rates. This study aimed to investigate the effectiveness of a novel venous access technique using a subcutaneous side branch of the greater saphenous vein (GSV) and compare it to the conventional direct GSV access technique.

Methods

A total of 211 patients (288 legs) with CVI were randomly assigned to either the conventional access group (group 1, 145 legs) or the subcutaneous side branch group (group 2, 143 legs). Patients were assessed for demographic characteristics, venous access success rates, complications, and clinical outcomes. The primary outcomes were venous access success and procedural time, while secondary outcomes included complication rates such as vasospasm, ecchymosis, and thrombophlebitis.

Results

The mean access time was significantly lower in group 2 (30.8 ± 9.9 seconds) compared to group 1 (46.7 ± 14.9 s) (p < 0.001). Additionally, group 2 required fewer cannulation attempts (1.28 ± 0.5) than group 1 (2.2 ± 0.9) (p < 0.001). Vasospasm occurred less frequently in group 2 (3.1%) than in group 1 (5.2%) (p = 0.005), and group 2 had significantly lower rates of ecchymosis (p = 0.033), thrombophlebitis (p = 0.026), and paresthesia (p = 0.045). No significant differences were observed between the groups regarding thermal skin injury (p = 0.142) or GSV occlusion rates at 3 months.

Conclusions

This study demonstrates that accessing the GSV via a subcutaneous side branch is a feasible and advantageous technique, leading to faster cannulation and reduced complication rates compared to the conventional approach. Further research is warranted to assess this novel technique’s long-term outcomes and potential benefits in diverse clinical settings.

Keywords

Chronic venous insufficiency endovenous thermal ablation radiofrequency ablation greater saphenous vein

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References

Schwarz

von Hodenberg

Furtwängler

, et al. Endovenous laser ablation of varicose veins with the 1470-nm diode laser. J Vasc Surg 2010; 51: 1474–1478.

Park

. Successful use of VenaSeal system for the treatment of large great saphenous vein of 2.84-cm diameter. Ann Surg Treat Res 2018; 94: 219–221.

Lurie

Creton

Eklof

, et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg 2003; 38(2): 207–214.

Ricci

Caggiati

. Echoanatomical patterns of the long saphenous vein in patients with primary varices and in healthy subjects. Phlebology 1999; 14(2): 54–58.

Pan

Zhao

Mei

, et al. Comparison of endovenous laser ablation and high ligation and stripping for varicose vein treatment: a meta-analysis. Phlebology 2014; 29(2): 109–119.

Luebke

Brunkwall

. Systematic review and meta-analysis of endovenous radiofrequency obliteration, endovenous laser therapy, and foam sclerotherapy for primary varicosis. J Cardiovasc Surg 2008; 49(2): 213–233.

Nordanstig

Behrendt

Baumgartner

, et al. Editor's choice -- European society for vascular surgery (ESVS) 2024 clinical practice guidelines on the management of asymptomatic lower limb peripheral arterial disease and intermittent claudication. Eur J Vasc Endovasc Surg 2024; 67(1): 9–96.

Marsden

Perry

Bradbury

, et al. A cost-effectiveness analysis of surgery, endothermal ablation, ultrasound-guided foam sclerotherapy and compression stockings for symptomatic varicose veins. Eur J Vasc Endovasc Surg 2015; 50(6): 794–801.

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 Venous Lymphat Disord 2018; 6(1): 31–40.

10.

Hind

Calvert

McWilliams

, et al. Ultrasonic locating devices for central venous cannulation: meta-analysis. BMJ 2003; 327(7411): 361.

11.

Nesbitt

. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Sao Paulo Med J 2014; 132: 69.

12.

Cavezzi

Labropoulos

Partsch

, et al. Duplex ultrasound investigation of the veins in chronic venous disease of the lower limbs—UIP consensus document. Part II. Anatomy. Eur J Vasc Endovasc Surg 2006; 31(3): 288–299.

13.

Gunes

Turkkolu

, et al. Comparative efficacy and life quality effects of surgical stripping, radiofrequency ablation, and cyanoacrylate embolization in patients undergoing treatment for great saphenous vein insufficiency. Phlebology 2021; 36(1): 54–62.

14.

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 2021; 121(2): 94–101.

15.

Kistner

. Endovascular obliteration of the greater saphenous vein: the Closure procedure. JPN J Phlebol 2002; 13(5): 325–333.

16.

Weiss

. 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 2002; 28(1): 38–42.

17.

Merchant

DePalma

Kabnick

. Endovascular obliteration of saphenous reflux: a multicenter study. J Vasc Surg 2002; 35(6): 1190–1196.

18.

Hingorani

Ascher

Markevich

, et al. Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: a word of caution. J Vasc Surg 2004; 40(3): 500–504.

19.

Puggioni

Kalra

Carmo

, et al. Endovenous laser therapy and radiofrequency ablation of the great saphenous vein: analysis of early efficacy and complications. J Vasc Surg 2005; 42(3): 488–493.

20.

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(3): 410–424. DOI: 10.1016/j.ejvs.2018.05.008.

21.

Helmy ElKaffas

ElKashef

ElBaz

. Great saphenous vein radiofrequency ablation versus standard stripping in the management of primary varicose veins-a randomized clinical trial. Angiology 2011; 62(1): 49–54. DOI: 10.1177/0003319710380680.

22.

Andercou

Stancu

Coman

, et al. Radiofrequency thermal ablation for the treatment of chronic insufficiency of the saphenous vein-A comparative retrospective study. Int J Environ Res Publ Health 2023; 20(4): 3308. DOI: 10.3390/ijerph20043308.

23.

Zhao

Guo

Zhang

, et al. Comparison of endovenous microwave ablation versus radiofrequency ablation for lower limb varicose veins. J Vasc Surg Venous Lymphat Disord 2024; 12(1): 101662. DOI: 10.1016/j.jvsv.2023.03.022.

24.

Thao Cuong

Tat Bang

Le An

, et al. Quality of life of patients with chronic venous insufficiency of the lower extremities before and after endovascular laser ablation: a prospective pilot study using the chronic venous insufficiency quality of life questionnaire 20 (CIVIQ-20). Cureus 2023; 15(7): e41854. DOI: 10.7759/cureus.41854.