A 5-year Evaluation of the Recurrence Rate Following Conventional Surgery and Ablation for Venous Insufficiency Revealed That Although Ablation Methods Were Employed, Conventional Surgery Was Not Abandoned

Abstract

Objectives: Although conventional surgery (CS) has been less frequently employed in the treatment of great saphenous vein (GSV) in recent years, our clinic has not entirely abandoned this method. The objective of this study was to evaluate the recurrence and symptoms of patients treated with CS and radiofrequency ablation (RFA) for venous insufficiency (VI) 5 years ago. Methods: A retrospective review was conducted on the results of 233 patients who were treated for varicose veins in our clinic 5 years ago (all in the same year). Patients aged 20 years or older with clinical class C2 to C6 clinical, etiological, anatomical, pathophysiological and GSV diameter >5.5 mm, reflux degree of at least 0.5 s were treated with RFA or conventional stripping. A total of 121 patients were treated with CS and 112 patients were treated with RFA. The method to be applied to the patients was randomly assigned without prior planning. The quality of life and recurrence rate were evaluated using the venous clinical severity score before surgery and at 1-month and 5-year intervals following surgery. Results: In 2017, 233 patients were treated with RFA and CS methods due to VI (n=112, n=121). Clinical follow-up and examinations were conducted at the 1st week, 1st month, and 5th year after surgery. A comparison of the two groups revealed that RFA was non-inferior to CS in terms of clinical relapse after 5 years. However, in terms of recurrence, the situation was 16.36% (n=9) in CS and 46.80% (n=22) in RFA. Recurrence was found to be significantly associated with the operational technique (p<0.006). Furthermore, the recurrence rate was significantly higher among patients who underwent venous pouch excision simultaneously with the main procedure (90.84%, n=139) compared to those who did not (9.15%, n=14; p<0.05). Conclusion: As long as the recurrence rate of the traditional surgical stripping method remains low in the treatment of VI, this method will continue to be valuable. Although ablation methods are effective in our clinic, we have not abandoned traditional surgery. Since traditional surgery greatly reduces the risk of reoperation after many years, it should be recommended as an alternative choice to patients who are indicated for the procedure.