Endovenous ablation of saphenofemoral insufficiency: analysis of 100 patients using RF closure fast technique

Success rate and factors predictive of redo endothermal ablation of Small Saphenous veins

OBJECTIVE

Endothermal ablation as endothermal laser ablation (EVLA) or Radiofrequency ablation (RFA) is being progressively more employed for small saphenous vein (SSV) insufficiency treatment. Prior studies have shown recurrence rates of 0% to 10% in incompetent small saphenous veins (ISSVs). The objective of this study is to determine the efficacy of redo venous ablations for symptomatic recanalized SSVs and to predict factors related with recanalization.

METHODS

A retrospective analysis of 2,566 procedures in 1,752 patients with CVI due to ISSVs from 2012 to 2018 was performed, using individual chart review for data extraction. All 2,566 procedures were performed using endothermal ablation in patients who failed initial conservative management. Postoperative duplex ultrasound scans were performed within 3 to 7 days. We defined a successful obliteration as a lack of color flow by postoperative duplex scan. We defined recanalization as the presence of reflux on duplex ultrasound in the target vessel at follow-up. We conducted follow-ups every 3 months in the first year, followed by every 6 months subsequently.

RESULTS

Among the 2,566 procedures, redo ablation was performed in 91 ISSVs (86 patients), including 58 women and 28 men. 54 procedures were performed on the left lower extremity, 37 were performed on the right lower extremity. The average Body Mass Index (BMI) was 32.2 ± 7.66. The mean age was 62.4 ± 15.10 years. Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classes of the patients were: C1, 0; C2, 0; C3, 29; C4, 43; C5, 1; and C6, 18. The mean maximum diameter of the targeted veins, for the redo procedures, was 4.51± 1.33 mm. Forty procedures were performed using EVLA, 51 were performed using RFA. Initial technical success was 98.9%. Redo procedures had an early closure of 96.7%. At follow up after a mean duration of 24.9 ± 14.9 months, closure was 96.5%. No correlation was found between successful obliteration in the redo procedure and age, gender, CEAP, laterality, EVLA vs. RFA, BMI, or vein diameter.

CONCLUSIONS

Rates of successful closure for ISSVs on initial and redo procedures are comparable. The data validate the potential usefulness of performing redo SSV ablations.

Systematic review on the incidence and management of endovenous heat-induced thrombosis following endovenous thermal ablation of the great saphenous vein

OBJECTIVE

A systematic review and meta-analysis was performed to determine the incidence of endovenous heat-induced thrombosis (EHIT) and evaluate its management after endovenous thermal ablation of the great saphenous vein (GSV).

METHODS

MEDLINE and Embase were searched for studies with at least 100 patients who underwent great saphenous vein endovenous thermal ablation and had duplex ultrasound follow-up within 30 days. Data were gathered on the incidence of thrombotic complications and on the management of cases of EHIT. The primary outcome for the meta-analysis was EHIT types 2 to 4 and secondary outcomes were deep venous thrombotic events (which we defined as types 2-4 EHIT plus deep vein thrombosis [DVT]), DVT, and pulmonary embolism (PE). Pooled proportions were calculated using random effects modelling.

RESULTS

We included 75 studies (23,265 patients). EHIT types 2 to 4 occurred in 1.27% of cases (95% confidence interval [CI], 0.74%-1.93%). Deep venous thrombotic events occurred in 1.59% (95% CI, 0.95%-2.4%). DVT occurred in 0.28% (95% CI, 0.18%-0.4%). Pulmonary embolism occurred in 0.11% (95% CI, 0.06%-0.18%). Of the 75 studies, 24 gave a description of the management strategy and outcomes for EHIT and there was inconsistency regarding its management. Asymmetrical funnel plots of studies that reported incidence of EHIT 2 to 4 and DVT suggest publication bias.

CONCLUSIONS

The recently published guidelines on EHIT from the Society for Vascular Surgery/American Venous Forum provide a framework to direct clinical decision-making. EHIT and other thrombotic complications occur infrequently and have a benign course.

Effectiveness of Endovenous Radiofrequency Ablation for Elderly Patients with Varicose Veins of Lower Extremities

Objective: The purpose of this study was to evaluate safety and effectiveness of endovenous radiofrequency ablation (RFA) for elderly patients. Materials and Methods: We enrolled 140 patients (194 limbs) who underwent RFA for varicose veins of lower extremities. Patients were divided into two groups; elderly patients (more than 75 years old, E-group, n=36) and young patients (under 75 years old, Y-group, n=104), and perioperative data were analyzed and compared between two groups. Results: In E-group, there were more than patients with hypertension, ischemic heart disease, malignant tumor, and cerebrovascular disease. A partial recanalization was observed in only one limb (0.6%) in Y-group. Endovenous heat induced thrombosis (EHIT) was identified four limbs (2.8%) in Y-group and two limbs (4.1%) in E-group. All EHITs were class 1 by Kabnick classification, and they disappeared within one month after interventions, without antithrombotic therapy. No other major complications were observed. There were no significantly differences for preoperative mean venous clinical severity scores (VCSS) (Y : E=4.84 : 4.47) and postoperative VCSS (Y : E=1.16 : 1.19, 0.35 : 0.58, 0.15 : 0.06, 0.05 : 0.06 at 1, 3, 6, 12 months after) in both groups. Conclusion: RFA for elderly patients is a safe and effective strategy for varicose veins of lower extremities.

Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis

BACKGROUND

Since the 1990s, new techniques for the treatment of varicose veins have emerged, including radiofrequency ablation (RFA) and laser treatment. We performed a study to compare the safety, efficacy and outcomes of RFA compared to those of open surgery and laser ablation for the treatment of varicose veins. We also carried out a cost analysis of RFA compared to open surgery to assess whether RFA could help free up operating room time by being performed in an outpatient context.

METHODS

We conducted a systematic literature review (publication date May 2010-September 2013 for articles in English, January 1991-September 2013 for those in French). We used several checklists to measure the quality of the studies. We also collected data on costing.

RESULTS

The literature search identified 924 publications, of which 38 were retained for analysis: 15 literature reviews, 1 good-practice guideline and 22 new primary studies. The overall level of evidence was low to moderate owing to the limited sample sizes, lack of information on patient characteristics and lack of standardization of the outcome measures. However, the results obtained are consistent from study to study. In the short and medium term, RFA is considered as effective as open surgery or laser treatment (moderate level of evidence) and presents fewer major and minor complications than open surgery (low level of evidence). Radiofrequency ablation can be performed on an outpatient basis. We calculated that RFA would be about $110-$220 more expensive per patient than open surgery.

CONCLUSION

Radiofrequency ablation is a valuable alternative to open surgery and would free up operating room time in a context of low accessibility.

Tumescentless endovenous radiofrequency ablation with local hypothermia and compression technique

Introduction

Modern surgical management of chronic venous insufficiency is possible since the development of catheter-based minimally invasive techniques, including radiofrequency ablation (RFA) and the application of colour Doppler sonography. RFA technology requires the use of tumescent anaesthesia, which prolongs the operating time. Instilling tumescent anaesthesia percutaneously below the saphenous fascia is the steepest part of the learning curve. In our study, we compared operative and postoperative results of tumescentless RFA and RFA with tumescent anaesthesia, to investigate the necessity of tumescent anaesthesia.

Methods

A total of 344 patients with Doppler-confirmed great saphenous vein insufficiency underwent RFA between January and December 2012. Patients were divided into two groups according to anaesthetic management. Group 1 consisted of 172 patients: tumescent anaesthesia was given before the ablation procedure, and group 2 contained 172 patients: a local hypothermia and compression technique was used; no tumescent anaesthesia was administered. The visual analogue scale (VAS) was used and ecchymosis scores of the patients were recorded. Clinical examinations were performed at each visit and Doppler ultrasonography was performed in the first and sixth month.

Results

Mean ablation time was significantly lower in group 2 compared to group 1 (7.2 vs 18.9 min; p < 0.05). Skin burn and paresthesia did not occur. The immediate occlusion rate was 100% for both groups. No significant difference was found between the groups in terms of VAS and ecchymosis scores. All patients returned to normal activity within two days. The primary closure rate of group 1 was 98.2% and group 2 was 98.8% at six months, and there was no significant difference between the groups (p > 0.05).

Conclusion

Eliminating tumescent infusion is a desirable goal. Tumescentless endovenous RFA with local hypothermia and compression technique appears to be safe and efficacious. Our technique shortens the operation time and prevents patient procedural discomfort.