Long-term outcomes of endovenous laser ablation, n-butyl cyanoacrylate, and radiofrequency ablation for treatment of chronic venous insufficiency

Abstract

BackgroundIn the present retrospective, single-center study, we evaluated the long-term effectiveness and reliability of endovenous laser ablation (EVLA), endovenous n-butyl cyanoacrylate (NBCA) application, and radiofrequency ablation (RFA) in the management of chronic venous insufficiency (CVI). MethodsThe medical records of patients who had undergone EVLA, NBCA, or RFA for CVI from January 1, 2014 to January 1, 2017 were reviewed. The medical records included data on sex, age, body mass index, American Society of Anesthesiologists score, and symptoms at admission. The great saphenous vein diameter, CEAP (Clinical, Etiology, Anatomy, and Pathophysiology) classification, and venous clinical severity score were also recorded. All the patients were followed up with physical examinations and color Doppler ultrasound scan at the first week and 6 and 12 months after treatment. After 12 months, the follow-up examinations were performed annually. ResultsA total of 232 patients who had undergone lower limb CVI surgical treatment (EVLA, n = 77; NBCA, n = 73; RFA, n = 82). The mean follow-up time was 67.5 ± 4.7 months. The procedure duration was significantly shorter for the NBCA group (13.5 minutes) vs that for the EVLA (31.7 minutes) and RFA (27.9 minutes) groups (P = .001). The pain score was highest in the EVLA group (P = .001). The EVLA group had also experienced a significantly greater incidence of complications and a longer time to return to daily activities (P = .001). The post hoc analysis revealed comparable occlusion success among the three groups on the first postoperative day and at 6, 12, and 24 months postoperatively. However, significantly better occlusion rates were found for RFA vs EVLA at 3 and 5 years of follow-up (P = .024 and P = .011, respectively). The success of NBCA and RFA was similar at 3 and 5 years of follow-up (P = .123 and P = .330, respectively). ConclusionsThe outcomes showed similar early postoperative occlusion success among all three CVI treatment techniques. However, RFA resulted in a significantly higher success rate compared with EVLA at 3 and 5 years of follow-up. Additionally, the NBCA and RFA procedures achieved comparable long-term success. However, EVLA was associated with significantly greater complication rates and pain scores and a longer time to return to daily activities. The NBCA procedure had a significantly shorter operation time compared with the other procedures.