Endovenöse Ablation der Stammvenenvarikose

Recurrence types 3 years after endovenous thermal ablation in insufficient saphenofemoral junctions

OBJECTIVE

Although many studies have demonstrated that endovenous therapies have comparable efficacy to crossectomy and stripping, few studies have been published regarding the classification and recurrence patterns of varicose veins after endovenous therapy. This study attempted to provide an objective scheme for the definition and classification of recurrence. Moreover, it describes the types and rates of recurrence after endovenous thermal ablation, as well as factors associated with recurrence.

METHODS

This prospective cohort study comprised a cohort of 449 patients with saphenofemoral junction (SFJ) insufficiency who underwent endoluminal varicose vein treatment for the first time in the limb between October 2013 and January 2015. The treatments were performed by a team of three experienced phlebologists. For endovenous laser ablation, Biolitec ELVeS was used with bare, radial or radial slim fibers. Radiofrequency ablation was performed with VNUS ClosureFAST (Medtronic, Deggendorf, Germany). The patients were consecutively scheduled for 3-year follow-up examinations. Detailed ultrasound findings were collected by two experienced phlebologists who classified the observed duplex ultrasound recurrence into different recurrence types.

RESULTS

Clinically relevant recurrence was found in only 5.1% of cases. Examining only the recanalizations requiring reintervention resulted in a recurrence rate of 2.6%. However, if every new varicose vein that occurred postoperatively was considered a recurrence, the resultant recurrence rate was almost 54%. Preliminarily, we defined a recurrence as newly developed varicose veins within the region of the SFJ or along the course of the former treated vein distal to the SFJ. According to this definition, we obtained a clinically relevant recurrence rate of 5.3%, thus indicating that neovascular vessels were the largest recurrence type (57.7% within the region of the SFJ and 9.9% distal to the SFJ), followed by recanalization (8.9% within the region of the SFJ and 9.4% distal to the SFJ) and a refluxing anterior accessory saphenous vein (7.5%). We also developed a modified classification of progression to better understand recurrence after treatment of chronic venous insufficiency; the scheme included method failure (recanalization), neovascularizations, and disease progression (refluxing untreated vessels and new varicose veins occurring outside the treated region). The diameter of the treated vein (P = .001) and the clinical class according to CEAP classification (P = .008) were significant predictors of recurrence.

CONCLUSIONS

Endoluminal therapies are efficient methods for the treatment of varicose veins, which result in low recurrence rates after 3 years. Several factors influence the development of recurrence. This study provides a practice-oriented classification and description of recurrence with clinical relevance, through making distinctions among technical error, progression of the underlying disease and actual recurrence.

Review of Endovenous Thermal Ablation of the Great Saphenous Vein: Endovenous Laser Therapy Versus Radiofrequency Ablation

BACKGROUND

Endovenous thermal ablation is a popular treatment for varicose veins of the greater saphenous vein. Two common techniques of thermal ablation are endovenous laser therapy (EVLT) and radiofrequency ablation (RFA).

OBJECTIVE

The authors compare EVLT and RFA in vein therapy.

METHODS

A review was conducted using PubMed. Studies comparing the treatment modalities were gathered and compared on the basis of 5 main standpoints, including: efficacy, side effects, serious complications, recurrence, and quality of life.

RESULTS

It was found that EVLT and RFA are both highly efficacious (>80%). Endovenous laser therapy seems to be slightly more efficacious than RFA in numerous studies but its significance is uncertain. Side effect profiles varied regarding postoperative pain and bruising because both were seen to be significantly less using RFA. Serious complications were found to be rare in both with no significant difference in incidence. Recanalization rate was observed to be higher using RFA with uncertainty in significance among various studies. Quality of life improved after both procedures with no significant difference among the 2.

CONCLUSION

Efficacy and recurrence rate seem to favor EVLT, whereas postoperative pain and bruising favor RFA. Further studies are needed to validate the significance of the differences found.