Endovenous Radiofrequency Ablation Research Articles

Clinical Efficacy of Endovenous Radiofrequency Ablation (RFA) for Superficial Varicose Veins of the Lower Extremities.

Objective To investigate the clinical efficacy of intravenous radiofrequency ablation (RFA) in the treatment of patients with superficial varicose veins of lower extremities. Methods From January 1, 2021, to January 1, 2022, 62 patients with superficial lower extremity varicose veins were selected and divided into two groups according to the treatment plan. 31 patients underwent high saphenous vein ligation and dissection as control. Thirty-one patients received RFA treatment as the experimental group. The operation-related indicators, clinical efficacy, and postoperative complications were compared. Results The intraoperative blood loss in the experimental group was significantly less than that in the control group. The clinical efficacy of the experimental group was significantly better than that of the control group. The incidence of postoperative complications in the experimental group was lower than that in the control group. Conclusion RFA has a good clinical effect in the treatment of patients with superficial lower extremity varicose veins, with less postoperative complications, and has a high therapeutic value.

Compression versus no compression after endovenous radiofrequency ablation: A meta-analysis of randomized controlled trials.

The aim of this meta-analysis was to compare compression with no-compression, after radiofrequency endothermal ablation of a truncal varicose vein. Databases, such as PubMed, Embase, Cochran Library, and Web of Science, were independently searched by two researchers for relevant literature, preliminary screening was performed, and the full text was read to select studies that met the inclusion criteria. The quality of the included literature was evaluated using the Cochrane Risk of Bias tool, and meta-analysis was performed using Review Manager 5.4. A total of four randomized controlled trials were included and a total of 552 patients were involved. Among them, 273 patients were in the compression group and 279 in the no-compression group. Meta-analysis results showed that the pain using the 100mm Visual Analogue Scale was lower in the compression group than the pain in the no-compression group (MD = -4.22, 95% CI = -7.95 - -0.49, p = 0.03). No significant differences in terms of occlusion rate (RR = 0.99, 95% CI = 0.96-1.02, p = 0.55), Aberdeen Varicose Vein Questionnaire (MD = 0.46, 95% CI = -0.80-1.73, p = 0.47), and complications (OR = 1.33, 95% CI = 0.61-2.94, p = 0.47) were observed between groups. This meta-analysis suggests that compression therapy reduced post-operative pain compared to the no-compression group. However, no additional advantages were observed in terms of occlusion rates, quality of life scores and complications.

Reducing tumescent anesthetic injection pain by topical anesthesia pretreatment among patients undergoing endovenous radiofrequency ablation of varicose veins: A double-blind randomized controlled trial.

Tumescent anesthesia frequently causes the intraoperative and postoperative pain during radiofrequency ablation (RFA) of varicose veins. We have to find a way to reduce pain caused by these injections. This randomized controlled trial investigated the effectiveness of topical anesthesia pretreatment (TAP) on relieving needle puncture pain during administration of tumescent anesthesia among patients undergoing RFA of varicose veins. Eligible patients treated with RFA were recruited and randomized to either application of TAP with lidocaine-prilocaine cream (EMLA) or water-based cream (placebo). The primary outcome was patient described pain scores on the visual analogue scale (VAS) at different time points during the procedure. Secondary outcomes were technical success rate, complications, satisfaction level, expense, and extra analgesia use. Sixty-two patients were randomized: 32 to EMLA and 30 to placebo. Both groups had comparable baseline demographics, CEAP classification, and Venous Clinical Severity Score (VCSS). Less tumescent anesthetic needle puncture pain was found in the EMLA group (22 ± 7 vs 42 ± 8, p < .01). Pain scores of other time points were equivalent. There was less pain in EMLA pretreated area compared to non-pretreated area in the same patient during needle puncture (22 ± 7 vs 45 ± 7, p < .01), and similar phenomena did not appear in the placebo group. There was no statistical difference in complications, satisfaction level, expense, and technical success between the two groups. And no extra analgesia was used in all patients. We recommend the routine use of TAP to reduce the needle puncture pain during tumescent anesthesia in RFA of lower extremity varicose veins.

Evaluation of Efficacy of Endovenous Radio Frequency Ablation for Varicose Veins in Industrial Workers—A Prospective Study

AbstractIntroduction The disease of varicose veins is a common vascular condition affecting one out of five in world population. Although conventional surgical treatments were considered the gold standard, they were fraught with many complications. Endovenous thermal interventions like endovenous radio frequency ablation (RFA) have largely superseded traditional surgery as the gold standard treatment as it is minimally invasive. Our initial experience with this treatment modality is presented along with the review of literature.Aim Our aim was to evaluate the efficacy, safety, clinical outcomes, and health economic benefits of endovenous RFA for varicose veins in our setup.Materials and Methods It was a prospective observational study conducted by the Department of General surgery at ESIC Medical College and Hospital, Hyderabad, India, from September 2020 to February 2021. Thirty consecutive patients with primary varicose veins were evaluated by detailed history, clinical examination, and venous Doppler study of the lower limbs. The procedure was performed under spinal anesthesia and Doppler ultrasound guidance using the ClosureFast (Medtronic) radio frequency segmental ablation system. Additionally, multiple stab phlebectomies were performed to deal with tributary varices in required cases. Various intraoperative (length of vein ablated and operative time) and postoperative (complications and return to work) variables were studied. Postoperative follow-up at 1,8,24 weeks was done clinically and using Doppler ultrasound to look for the recanalization of vein. The collected data were entered in Microsoft Excel spreadsheet and analyzed using descriptive statistics.Results The mean (standard deviation) age of patients was 39.1 (8.7) years. Ten patients had C2 disease, six C3, eleven C4, and three had C6 disease. The mean postoperative visual analog scale score on day 1 was 1.4. Mean return to normal activity time was 1.3 days. Average return to work time was 2.1 days. The post-procedure total occlusion rate at 24 weeks follow-up was 96%.Conclusion Endovenous RFA is a safe and effective minimally invasive modality for treating lower limb varicose veins, providing health economic benefits to patients.

Quality-of-life assessment in patients treated with radiofrequency ablation with or without great saphenous vein recanalization.

Quality of life (QoL) in patients with chronic venous disorders has a central role to decide the correct treatment approach. In particular, in case of mini-invasive therapy, such as endovenous radiofrequency ablation (RFA), the postoperative QoL improvement remains one of the most important outcome to be reached. Despite this, very few data are published on the long-term QoL modifications after RFA. The aim of this brief report is to describe and analyze the role of QoL scales in a population of patients treated with RFA of the great saphenous vein and phlebectomies, highlighting results in short- and long-term follow-up period, and differences between recanalized and non-recanalized patients.

A systematic review and meta-analysis of treatment modalities for anterior accessory saphenous vein insufficiency

To investigate and compare the outcomes of the available treatment modalities for anterior accessory saphenous vein (AASV) incompetence. A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Studies reporting the outcomes of patients who were treated for primary AASV incompetence were included. The methodologic quality of the articles was assessed using the Methodological Index for Non-Randomized Studies (MINORS). A random-effects model was used to estimate anatomic success, defined as AASV occlusion. The secondary outcomes were pain during and after treatment, venous clinical severity score, quality of life, esthetic result, time to return to daily activities, and complications. The search identified 860 articles, of which 16 met the inclusion criteria. A total of 609 AASVs were reported. The included studies were of poor or moderate quality according to MINORS score. The pooled anatomic success rates were 91.8% after endovenous laser ablation and radiofrequency ablation (EVLA, RFA, 11 studies), 93.6% after cyanoacrylate closure (3 studies), and 79.8% after sclerotherapy (2 studies). The non-pooled anatomic success rate was 97.9% after phlebectomy and 82% after CHIVA. Paresthesia was seen after EVLA in 0.7% of patients (6 studies). Phlebitis was seen in 2.6% of patients after RFA (2 studies), 27% after sclerotherapy (1 study), and 12% after the phlebectomy (1 study). Deep venous thrombosis and skin burn did not occur. Treatment of AASV incompetence is safe and effective. Despite limited evidence, occlusion of the AASV can be achieved with endovenous thermal ablation and cyanoacrylate. There does not appear to be a benefit of EVLA compared to RFA regarding treatment efficacy. Phlebectomy shows promising results if the saphenofemoral junction is competent. Lower results are seen after sclerotherapy and CHIVA. However, studies with sufficient sample sizes of solely treatment of AASV incompetence are needed to draw firm conclusions.

Клинический случай лечения венозной трофической язвы

Introduction. Varicose veins of the lower extremities with clinical form C2 and higher (if we take into account the modern international classification) is a slowly progressive disease. It needs therapy, besause if untreated, some complications can develop, such as: trophic disorders (lipodermatosclerosis, skin hyperpigmentation, trophic ulcers), bleeding from varicose veins with minimal trauma, thrombotic complications (varicothrombophlebitis, deep vein thrombosis, pulmonary embolism). Materials and methods. This article presents a description of a clinical case of an aged patient with a trophic ulcer of the lower third of the left leg against the background of varicose veins of the lower extremities in the saphenous vein system and the presence of concomitant moderate iron deficiency anemia, ischemic heart disease and hypertension. Considering these factors, endovenous radiofrequency ablation of the great saphenous vein and micro-foam echosclerotherapy of incompetent perforating veins of the leg were performed. Results and discussion. Our clinical observation of an aged patient with moderate iron deficiency anemia, ischemic heart disease and hypertension is an example of effective treatment of trophic ulcers against the background of varicose veins of the lower extremities in the saphenous vein system. Without waiting for the complete compensation of the anemia, the patient was operated on with a minimally invasive method, which contributed to the rapid healing of the trophic ulcer. As a result, after 2 weeks, the trophic ulcer decreased by 2 times, and 1 month after surgery and a 14-day course of infusion vascular therapy, the ulcer completely healed. Conclusion. Thus, in patients with an open trophic ulcer, the elimination of reflux (vertical and / or horizontal) at the initial stage of treatment creates ideal conditions for the fastest healing of the ulcer. The combination of minimally invasive methods of treatment (radiofrequency ablation and micro-foam sclerotherapy) and vascular therapy promotes rapid healing of trophic ulcers, shortens the recovery time of the body against the background of comorbid pathology, and provides a good cosmetic effect.

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation.

The aim of this retrospective single-center study is to describe and analyze short-, mid-, and long-term risk factors for great saphenous vein (GSV) recanalization after endovenous radiofrequency ablation (RFA). All consecutive patients with GSV incompetence and varicose veins underwent RFA were enrolled between 2009 and 2018. Data on demographic, pre- and postoperative color Doppler scan (CDUS) findings, perioperative complications, and follow-up were prospectively collected. Primary outcome was GSV recanalization rate at 1week after RFA. Secondary outcomes were postoperative complication rate, as well as GSV recanalization rate at 1, 3, and 5years after RFA. Risk factors for recanalization were also analyzed, for each follow-up assessment, identifying differences in recanalized (Rec) and non-recanalized (nRec) groups. During the study period, 1297 patients were treated. Among these, 1265 had at least 1week of follow-up. Mean follow-up time was 3.0 ± 1.9years. Recanalization rate at 1week, 1, 3, and 5years was 2.4%, 4.3%, 9.3%, and 17.5%, respectively. After multivariate analysis for each follow-up evaluation, CEAP classes C4 and 5, as well as preoperative GSV diameter >6mm and history of smoking were found to be independent predictors of recanalization. Furthermore, age >61years and postoperative complications such as pigmentation, edema, and paresthesia were found to be dependent risk factors. RFA remains a safe and durable technique to ablate incompetent GSV. Despite this, particular attention should be paid to patients with high CEAP classes to avoid short and long-term recanalization.

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation

Risk factors for short and long-term great saphenous vein recanalization in patients treated with endovenous radiofrequency ablation

For adults with great saphenous vein incompetence, how do endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) compare with high ligation and stripping (HL/S)?

For adults with great saphenous vein incompetence, how do endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) compare with high ligation and stripping (HL/S)?

Early Results With a New Endovenous Radio-Frequency Ablation Catheter

Endovenous radio-frequency ablation (RFA) has become a common treatment for chronic venous insufficiency. Up until recently, the Medtronic Closurefast catheter was the only RFA catheter approved for use in this procedure. In 2018, VenClose company's new machine and catheter was approved for use. We examined our results with this new alternative.

Radiofrequency ablation of varicose veins: experience at a tertiary hospital

Background and objectives: Radiofrequency ablation (RFA) is a recent modality of treatment of the affected varicose vein. In the present study, the outcome of great saphenous varicose vein disease treated by radiofrequency ablation technique was analyzed.&#x0D; Methods: Patients with varicosities of the lower limb affecting mainly the great saphenous vein were (GSV) included. The procedures were carried out under spinal anesthesia. The target varicose vein was accessed by Seldinger technique and the RFA catheter advanced 2 to 3 cm below sapheno-femoral junction under ultrasonography (USG) guidance. A tumescent anesthetic infiltration was given in a solution of normal saline and sodium bicarbonate before the vein being ablated.&#x0D; Results: The success rate of RFA was 97.5 % (39 out of 40). One patient showed episodic recanalisation of vein at one year duplex colour scan. Though the complications related to procedure were negligible, one patient developed endovenous heat induced thrombosis (EHIT) and non-fatal pulmonary thromboembolism (PTE) which was managed adequately.&#x0D; Conclusion: Endovenous RFA is a useful treatment modality for varicose vein disease primarily due to great saphenous insufficiency with marked symptomatic improvement and least recurrence. Although the complications are minimal, EHIT is a potential and serious complication of heat ablation.&#x0D; Ibrahim Med. Coll. J. 2021; 15(1): 37-40

Risk factors for saphenous vein recanalization after endovenous radiofrequency ablation.

Target vein recanalization is defined as the postoperative detection of blood flow in a venous segment previously ablated. It can be occurred after thermal-tumescent procedures, as radiofrequency (RFA) and endovenous laser (EVLA) ablation techniques. Despite several papers described and analyzed incidence and consequences of recanalization, limited data are published on risk factors for this condition. The aim of this general review is to investigate clinical and instrumental risk factors for great and small saphenous veins recanalization after RFA, indicating their impact in the follow-up period. Articles were obtained through a detailed search of the scientific journal databases (PubMed, Scopus, Web of Science) for those published between January 1, 2011 to December 31, 2020. The term "radiofrequency venous ablation" was combined with "risk factors", "recanalization" and "recurrence", to obtain the first article cluster. Risk factors analysis for saphenous vein recanalization after ablation is not a well-studied problem. Although several studies have analyzed recanalization patterns and anatomical causes of ablation failure, few and disaggregate data are available regarding clinical preoperative risk factors. BMI and saphenous trunk diameter seem to be the only two recognized characteristics that may affect short and long-term recanalization rate, though CVI status, sex, target vein treatment length and others factors may be taken into account. Physicians should consider risk factors for recanalization in patient selection and treatment recommendations, but also recognize that not all "ablation failures" are of clinical relevance.

Abstract No. 225 Venous large animal model for stenosis, thrombosis, and chronic occlusion: short-term results, with biomechanical analysis

Angiographic and biomechanical characterization of an ovine venous stenosis/occlusion model developed for studying translational interventions in venous occlusive disease. Unilateral iliac vein stenosis was created in six adult sheep using established endovenous radiofrequency (RF) ablation technique. Two sheep underwent short-segment RF ablation with the goal of creating chronic stenoses. Four sheep underwent long-segment RF ablation with the goal of inducing thrombosis/occlusion. Ultrasound and angiographic assessment was performed at baseline, immediately after venous stenosis creation, and prior to euthanasia at 2-week follow-up. Vein samples were immediately harvested for biomechanical assessment. Uniaxial longitudinal and circumferential tensile testing was performed with a custom mounting apparatus at a crosshead speed of 4 mm/min (MTS Criterion, Eden Prairie, MN). At 2-week follow-up venogram, the short-segment group (length: 11.5 ± 3.5 mm; stenosis: 64.0 ± 6.0%) showed stable stenosis without thrombosis in all animals. The long-segment group (length: 61.1 ± 12.2 mm; stenosis: 76.4 ± 3.3%) showed complete iliac occlusion/thrombosis with collateralization in all animals. Gross vein specimens showed thickened venous wall (0.28 ± 0.04 mm; contralateral normal control: 0.16 ± 0.02 mm; P< 0.05) and early scar tissue formation in all samples as well as soft non-adherent thrombi in the occlusion samples. Both stenotic and occlusive vein samples showed higher stiffness compared to the contralateral normal controls (P< 0.05), and higher stiffness in the longitudinal compared to the circumferential axis (P< 0.05). RF ablation can produce stable short-segment venous stenosis and long-segment thrombosis/occlusion in short-term survival. Tensile testing showed increased venous wall stiffness, replicating expected post-thrombotic biomechanical changes. Further studies are underway for biomechanical and histologic characterization of chronic fibrosis created in this large animal model. Once validated, this large animal model can be used for studying venous stenosis, thrombosis, chronic occlusion and their associated interventions.

Time Course of Leg Edema after Endovenous Radiofrequency Ablation for Saphenous Varicose Veins

The objectives of the study were to quantitatively evaluate leg edema in patients undergoing endovenous radiofrequency ablation (RFA) for saphenous varicose veins using bioelectrical impedance analysis (BIA) and to elucidate the time course of leg edema after RFA. The data of 87 patients with 128 limbs undergoing RFA for saphenous varicose veins in Eniwa Midorino Clinic from April 2018 to November 2019 were retrospectively analyzed. Saphenous vein reflux was evaluated by duplex scan. Extracellular water/total body water ratio (ECW/TBW) of the leg was measured by BIA. Moderate to severe leg edema (ECW/TBW ≥ 0.400) was defined as significant leg edema. Venous reflux was evaluated as a venous filling index (VFI) using air plethysmography. BIA revealed that 26 legs (20.3%) had significant edema and 102 legs (79.7%) did not before RFA. The proportion of patients with significant leg edema increased significantly from preoperative to 1week after RFA (P<0.05) and decreased 1month after RFA (P<0.01). The ECW/TBW increased significantly from preoperative (0.393±0.008) to 1week after RFA (0.394±0.008, P<0.05), whereas it decreased significantly before or 1week to 1month after RFA (0.391±0.008, P<0.05). There was a significant, moderate correlation between the decrease of the VFI and that of ECW/TBW (r=0.34, P<0.001). This is the first study to quantitatively elucidate the time course of leg edema after RFA. Leg edema worsens one week after RFA, but it is improved one month after RFA, compared with that preoperatively.

Virtual reality can reduce anxiety during office-based great saphenous vein radiofrequency ablation

ObjectiveOffice-based treatment of venous pathology is common and frequently involves the use of anxiolytic medication to reduce anxiety. Virtual reality (VR) has been shown to effectively reduce pain and anxiety in a variety of settings. The objective of the present study was to determine whether VR could be smoothly integrated into office-based vascular procedures and to ascertain whether VR could reduce procedural pain or anxiety. MethodsA total of 40 patients undergoing an office-based endovenous radiofrequency ablation were included in the present study. Of the 40 patients, 20 were randomized to the VR group and 20 to the control group. The patients in the VR group were equipped with a Samsung GearVR headset and headphones (Samsung, Suwon, South Korea) running AppliedVR software (AppliedVR Inc, Los Angeles, Calif), which ran throughout the duration of the procedure. All 40 patients underwent unilateral great saphenous vein radiofrequency ablation. After the procedure, the patients were surveyed regarding their preprocedure anxiety and their pain and anxiety during the procedure using the Wong-Baker scale. ResultsAll procedures were successfully completed, and all patients were generally satisfied with their treatment. The average procedure time was not significantly different. No statistically significant differences were present in preprocedure anxiety or procedural pain between the two groups. The anxiety level during the procedure, however, was 4.09 of 10 in the control group vs 2.95 of 10 in the VR group, statistically significant difference using a paired t test. Furthermore, the anxiety level for the control group had increased during the procedure but that of the VR group had decreased. Finally, 85% of the patients in the VR group would recommend using VR to someone undergoing a similar procedure. ConclusionsVR can be safely and efficiently integrated into office-based vascular procedures. VR was generally well liked and recommended by those who used it. Most importantly, our findings suggest that VR can decrease procedural anxiety. Further research should examine whether this might obviate the need for anxiolytic medication.

Pattern of thermal damage and tissue carbonisation from endovenous radiofrequency ablation catheter - Using an in vitro porcine liver model.

Successful endovenous thermoablation relies on transmural vein wall ablation. We investigated the pattern of thermal spread and tissue carbonisation from RadioFrequency-induced ThermoTherapy (RFiTT) at different powers and pull back methods, using a porcine liver model. We used a previously validated in-vitro porcine liver model. Different powers from 5-25 W were used to administer 150 J. We compared continuous and pulsed energy delivery. Length, lateral spread, and total area of thermal damage, together with any tissue carbonisation, was measured using digital analysis software. All experiments used 150 J total energy. Total thermal damage area was smaller with lower power and pulsed energy. Continuous energy caused more tissue carbonisation than pulsed except at 25 W. Reduced thermal damage with lower power or pulsed energy results from cooling due to increased time of treatment. Increasing the power increases tissue carbonisation. Optimal treatment is determined by the highest power used continuously that does not cause tissue carbonisation.

Venous Procedures to Treat Venous Leg Ulcers

The purpose of this review is to describe the standard procedures used to treat venous leg ulcers (VLUs), including endovenous laser ablation (EVLA), sclerotherapy, radiofrequency ablation, or other surgical modalities, and discuss the associated literature. Results of relevant studies, including clinical trials, prospective studies, and retrospective chart reviews, will be critically analyzed and integrated with the authors’ clinical experience. We aim to compare the different methods to help guiding clinical decision-making. It is important to consider each patient’s medical comorbidities, age, and preference in considering a surgical intervention. Studies show that EVLA and ultrasound-guided foam sclerotherapy (UGFS) enable ulcers to heal faster and lower the rates of recurrence. Minimally invasive procedures have replaced open surgical techniques as a means of treating VLUs. EVLA and UGFS appear to be safe and effective treatment options for most patients.

Radiofrequency Endovenous Ablation: A Safe and Effective Modality for Varicose Veins Treatment

Varicose veins are dilated, tortuous superficial veins, causing aching pain, swelling, and cramps in the affected lower limb. The key behind having such a problem is venous insufficiency after valve failure in the involved dilated vein. Surgery was the standard procedure for removing these dilated veins. A new era of treatment emerged, where endovenous radiofrequency ablation is applied under local and tumescent anesthesia by the aid of Doppler ultrasound. This study aims to assess the safety and efficacy of radiofrequency ablation in treating varicose veins. Our center is the first center in Baghdad, Iraq using this technique for treating varicose veins. Forty-five patients with varicose veins were enrolled in a prospective study from October 2017, through March 2019, aged 20–56 years; females 27 (60%), and males 18 (40%). Their veins were scanned by Doppler ultrasound and were diagnosed as having venous insufficiency; a total of sixty veins were ablated by radiofrequency, fifty (83%) long saphenous veins, and only ten (17%) short saphenous veins. The patients were scored clinically using comprehensive classification system for chronic venous disorders (CEAP) clinical score, 75% of patients were C2-C4, while only 25% of patients C5-C6. The time for each limb was around 20 minutes. A 100% technical success, and an excellent vein occlusion rate postoperatively. No postoperative complications were noted. After 1-week’, 1-month’, and 6 months’ follow-up, there was an improvement in CEAP clinical score, an early post-procedure return to daily activities. Therefore, endovenous radiofrequency ablation shows excellent results in terms of safety, efficacy, and patient satisfaction.

A randomized clinical trial of the effects of saphenous and perforating veins radiofrequency ablation on venous ulcer healing (VUERT trial).

To investigate whether radiofrequency endovenous ablation (RFA) of saphenous and perforating veins increases venous leg ulcer (VLU) healing rates and prevents ulcer recurrence. This prospective, open-label, randomized, controlled, single-center trial recruited 56 patients with VLU divided into: compression alone (CR, N = 29) and RFA plus compression (RF, N = 27). Primary endpoints were ulcer recurrence rate at 12 months; and ulcer healing rates at 6, 12, and 24 weeks. Secondary endpoints were ulcer healing velocity; and Venous Clinical Severity Score (VCSS). Recurrence was lower in the RF group (p < .001), as well as mean VCSS after treatment (p = .001). There were no significant between-group differences in healing rates. Healing velocity was faster in the RF group (p = 0.049). In the RF group, 2 participants had type 1 endovenous heat-induced thrombosis (EHIT). RFA plus compression is an excellent treatment for VLU because of its safety, effectiveness, and impact on ulcer recurrence reduction and clinical outcome.Registration: Clinicaltrials.gov, NCT03293836, clinicaltrials.gov.