Endovenous Radiofrequency Ablation Research Articles

Inflammatory Responses in Varicose VeinsSurgery: Conventional Venous Stripping andEndovenous Radiofrequency Ablation (EV-RFA)

Background: Varicose veins surgery was evolved in the past decade. Many studies showed that endovenous ra-diofrequency ablation (EV-RFA), a novel method for varicose veins treatment, produced complications fewer than conventional venous stripping, particularly postoperative pain and ecchymosis. There were a lot of studies reported about inflammatory response but there were few studies compare inflammatory response between procedures. This study purpose compares preoperative and postoperative level of serum Interleukin 6 (IL-6) and C-reactive protein (CRP) to determine the inflammatory response of EV-RFA and conventional venous stripping. This study also compares visual analogue scale (VAS) and ecchymoses between these two procedures. Methods: A prospective cohort study measuring IL-6 and CRP level at before and 24-hour after surgery in sympto-matic varicose vines patients who underwent either EV-RFA or conventional venous stripping. Results: Fifty-nine patients were included, 27 patients were treated by conventional venous stripping and 32 pa-tients were treated by EV-RFA. There was no different in demographic characteristics among two groups. Twenty-four hour postoperative level of IL-6 and CRP significantly increased (p<0.001 and<0.001, respectively) in both EV-RFA group (p<0.001 and<0.001, respectively) and venous stripping group (p=0.043 and <0.001, respectively) com-pare to preoperative level. Increasing in 24 h postoperative level of IL-6 and CRP in EV-RFA group was significantly lower than in venous stripping group (p<0.001 and p=0.045, respectively). Postoperative VAS and ecchymosis were also significantly different between EV-RFA group and venous stripping group (p<0.001 and p<0.001, respectively). Conclusions: EV-RFA produced inflammatory response, VAS and ecchymosis significantly lower than conventional venous stripping.

Evaluation of radiofrequency ablation for primary varicose veins: A preliminary study

Background: Endovenous radiofrequency ablation is gaining popularity as an alternative to conventional surgical treatment of varicose veins. The initial experience with this treatment modality is presented along with review of literature. Methods: A prospective study of 31 consecutive patients with primary great saphenous vein varicosities was undertaken. The procedure was performed under spinal anesthesia using bipolar radiofrequency induced thermotherapy CELON (Olympus) system with continuous pull-back technique. Additionally, multiple stab phlebectomies were performed to deal with tributary varices. Post-operatively; at one, four, twelve and twenty four weeks, the patients were followed up in out-patient department with clinical examination and ultrasound duplex imaging. The occlusion of great saphenous vein trunk, length of residual patent proximal great saphenous vein and improvement in quality of life using revised Venous Clinical Severity Score and Aberdeen Varicose Vein Questionnaire were recorded and analysed using appropriate statistical methods. Results: The mean (SD) age of patients was 41.8 (14.1) years with an average BMI of 23.4 kg/m2. Ten patients had C2 disease, four C3, thirteen C4, and two each; C5 and C6 disease. Average length of great saphenous vein ablated was 41.9 cm with a mean ablation time of 62.3 (18.6) seconds. Post procedure total occlusion rate at 24 weeks follow-up, was 93.1% and the quality of life indices showed a statistically significant improvement. Conclusion: Endovenous radiofrequency ablation holds immense promise as a safe and effective modality for the treatment of varicose veins of lower limbs.

Efficacy and safety of radiofrequency ablation for lower limb varicose veins

Background: Endovenous Radiofrequency Ablation (RFA) is gradually gaining widespread acceptance as a minimally invasive modality for treatment of varicose veins (VV). The objective of this study was to evaluate the efficacy based on Venous Doppler and Venous Clinical Severity Score (VCSS) and the safety of radiofrequency ablation for varicose veins.Methods: This is a prospective study of 58 consecutive patients who underwent Radiofrequency ablation of Varicose veins from January 2015 to January 2017 in a single unit of a Multispecialty Tertiary Care Hospital. The mean age was 44.10±13.74 years (19-75 years). A total of 78 limbs were treated in 58 patients. RFA was performed using Closure FastTM catheter according to the manufacturer’s recommendation. Treatment outcomes were estimated 15 days, 3 months, 6 months and 1 year after the procedure using Doppler scan and VCSS score.Results: There was 100% occlusion of the treated veins with no evidence of partial/complete recanalization. However, 2 (2.56%) patients had a GSV stump length &gt; 3cm on Doppler at 6 months, without evidence of significant reflux. Minor complications such as ecchymosis erythema, pain and induration rapidly improved over short term. One patient (1.3%) had evidence of Deep Vein thrombosis (DVT) on follow up Venous Doppler. The mean VCSS improved from mean of 7.98 preoperatively to 2.24 after 1 year (P value &lt;0.001).Conclusions: Radiofrequency ablation is a safe and effective procedure with minimal major complications. The minor complications were early and resolved rapidly.

ClosureFast endovenous radiofrequency ablation for great saphenous vein and small saphenous vein incompetence: Efficacy and anatomical failure patterns.

Recurrence rates and patterns after endovenous radiofrequency ablation (ERFA) are poorly documented. To assess the incidence and anatomical recurrence patterns of saphenous vein reflux after ERFA. Two hundred patients previously treated with ERFA were recalled for clinical assessment and venous-duplex ultrasound at three years post-treatment. A total of 106 patients (68F, 38M) with a mean age of 49.4 years (SD +11.5y) were assessed. Mean follow-up was 42.1 months (SD + 20.1m). Further varicose veins were identified in 31 patients (29.2%). Recanalization/recurrence/failure was diagnosed in 16 patients (15.1%), including 18 trunks (8.7%), 13 great saphenous vein (6.3%) and 5 small saphenous vein (2.4%). Twenty-seven patients (25%) developed neo-incompetence in 31 trunks and 12 non-saphenous veins. All patients with truncal recanalization had a body mass index > 29 (range 29-42). Disease progression was twice as high as the recanalization rate at three years post-treatment using ERFA in this study. Raised body mass index may be a contributing factor; however, further longitudinal studies are required. Patient self-selection bias may have also influenced our results.

Three-Year Follow-up and Quality of Life of Endovenous Radiofrequency Ablation of the Great Saphenous Vein With the ClosureFast™ Procedure: Influence of BMI and CEAP Class

In this large series of patients treated with radiofrequency ablation (RFA) for chronic venous insufficiency (CVI), there was no influence of patient’s body weight on treatment outcome and 3-year follow-up evaluation demonstrated sustained improvements in quality-of-life scores.

Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis after Endovenous Radiofrequency Ablation

The aim was to identify pre-operative color Doppler ultrasound (CDUS) variables predictive of post-operative endovenous heat induced thrombosis (EHIT) after radiofrequency ablation (RFA) of the saphenous veins. This was a single centre, observational study with retrospective analysis of consecutive patients treated from December 2010 to February 2017. Pre-operatively, the diameter of the sapheno-femoral junction (dSFJ), distance between epigastric vein and SFJ (dEV–SFJ), maximum great saphenous vein (GSV) diameter (mdGSV), diameter of the saphenous–popliteal junction (dSPJ), and mean small saphenous vein (SSV) diameter (adSSV) were measured. All patients received low molecular weight heparin (LWMH) at a prophylactic dose for a week. Post-operatively, CDUS was performed after 72 h, 1 week, and 3 months. Venous interventions on 512 patients were performed: 449 (87.7%) underwent RFA of the GSV (Group 1), and 63 (12.3%) of the SSV (Group 2). At Day 3 post-operatively, CDUS documented 100% complete closure of the treated saphenous vein segment. Overall, 40 (7.8%) cases of post-operative EHIT were identified: 29 in Group 1, and 11 in Group 2 (6.4% vs. 17.5%, P = .005). Deep venous thrombosis or pulmonary embolism did not occur in either group. At the 1 month follow up, all cases of EHIT regressed. In Group 1, on multivariate analysis, dEV–SFJ (OR, 1.13, P .036; 95% CI 1.01-1.27) was the only statistically significant predictor for EHIT. A dEV–SFJ distance of 4.5 mm yielded an 84% of sensitivity for EHIT prediction with a 72.4% positive predictive value. In Group 2, univariate analysis did not identify independent risk factors for EHIT occurrence. EHIT was higher than previously reported. The dEV–SFJ was the most significant predictor for EHIT in the GSV group. A greater distance between the tip of the radiofrequency catheter and the SFJ may decrease the risk of developing this complication.

Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis after Endovenous Radiofrequency Ablation

The aim was to identify pre-operative color Doppler ultrasound (CDUS) variables predictive of post-operative endovenous heat induced thrombosis (EHIT) after radiofrequency ablation (RFA) of the saphenous veins. This was a single centre, observational study with retrospective analysis of consecutive patients treated from December 2010 to February 2017. Pre-operatively, the diameter of the sapheno-femoral junction (dSFJ), distance between superficial epigastric vein and SFJ (dSEV-SFJ) [corrected], maximum great saphenous vein (GSV) diameter (mdGSV), diameter of the saphenous-popliteal junction (dSPJ), and mean small saphenous vein (SSV) diameter (adSSV) were measured. All patients received low molecular weight heparin (LWMH) at a prophylactic dose for a week. Post-operatively, CDUS was performed after 72h, 1 week, and 3 months. Venous interventions on 512 patients were performed: 449 (87.7%) underwent RFA of the GSV (Group 1), and 63 (12.3%) of the SSV (Group 2). At Day 3 post-operatively, CDUS documented 100% complete closure of the treated saphenous vein segment. Overall, 40 (7.8%) cases of post-operative EHIT were identified: 29 in Group 1, and 11 in Group 2 (6.4% vs. 17.5%, p=.005). Deep venous thrombosis or pulmonary embolism did not occur in either group. At the 1 month follow up, all cases of EHIT regressed. In Group 1, on multivariate analysis, dSEV-SFJ [corrected] (OR, 1.13, p=.036; 95% CI 1.01-1.27) was the only statistically significant predictor for EHIT. A dSEV-SFJ [corrected] distance of 4.5mm yielded an 84% of sensitivity for EHIT prediction with a 72.4% positive predictive value. In Group 2, univariate analysis did not identify independent risk factors for EHIT occurrence. EHIT was higher than previously reported. The dSEV-SFJ [corrected] was the most significant predictor for EHIT in the GSV group. A greater distance between the tip of the radiofrequency catheter and the SFJ may decrease the risk of developing this complication.

The Recalcitrant Venous Leg Ulcer Unhealed After 1 Year Despite Wound Center Care: Influential Risk Factors for Nonhealing

Venous leg ulcers (VLUs) are associated with a high cost of care, loss of productivity, and reduced quality of life. Despite regular treatment of VLUs, some fail to heal. Several risk factors have previously been identified to be associated with the failure of a VLU to heal, but for the majority of publications, the definition was limited to less than a 24-week period. Furthermore, the currently available literature is sparse and often contradictory. A retrospective cohort study was performed at an academic vascular and wound center. A total of 66 VLUs were included. These patients underwent a variety of treatments based on the Society for Vascular Surgery/American Venous Forum guidelines; these included compression, débridement, skin grafting, endovenous radiofrequency ablation, ligation and stripping, sclerotherapy, perforator surgery, and iliac vein stenting. We examined risk factors in patients who failed to heal their VLU after a 52-week period of treatment in our center. Risk factors were chosen on the basis of clinical opinion and available literature. All of the following were considered: treatment disparity factors—age, sex, and race (white vs nonwhite); condition-centric factors—size of ulcer, superficial venous involvement, deep venous involvement, presence of an incompetent perforator, history of superficial venous procedure in the affected limb, and history of deep venous thrombosis in the affected limb; and potential systemic factors—hypertension, obesity, diabetes mellitus, congestive heart failure, depression, history of smoking, and presence of an inflammatory or autoimmune condition predisposing to chronic steroid use. Both univariate (unadjusted) and multivariate (adjusted) logistic regression were used to assess the magnitude of effect that a given risk factor had on healing. After 52 weeks of treatment in our center, 20 of 66 VLUs (30%) remained unhealed. Further results are shown in the Table. Several risk factors are shown to be associated with the failure to heal a VLU; some are already commonly accepted in practice, such as deep venous involvement and post-thrombotic etiology, and others are novel. The large presence of deep venous involvement in the unhealed vs healed cohort (80% vs 48%) highlights the need for a viable treatment option for deep venous disease. In regard to race, there is no significant difference in the number of visits or appropriate interventions to the superficial or deep system performed on whites vs nonwhites, implying that there is no issue with discrimination in regard to access of care at our wound center. This suggests that an alternative, possibly biologic factor is placing nonwhites at risk for not healing their VLU—a topic that would clearly benefit from future studies. In addition, the influence of depression on poor outcomes, although not significant at the multivariate level in our study, is becoming increasingly prevalent in vascular patients. Overall, it is important to consider all risk factors when evaluating a patient for VLU to coordinate an effective treatment plan.TableUnadjusted (single variable) and adjusted (multivariable) odds ratios (ORs) for risk factorsRisk factorUnadjusted OR (95% CI)PAdjusted OR (95% CI)PAge, years0.99 (0.96-1.03).781.01 (0.94-1.09).78Male0.72 (0.25-2.08).5411.80 (0.43-321.35).14Nonwhite1.38 (0.46-4.08).56189.92 (2.30-1.56 × 104).02Size of ulcer, cm21.02 (0.99-1.04).150.99 (0.95-1.03).71Superficial venous involvement0.39 (0.12-1.29).120.16 (4.9 × l0−3-5.30).31Deep venous involvement4.36 (1.26-15.06).0283.28 (1.74-4.0 × 103).025Incompetent perforator0.47 (0.16-1.37).170.004 (4.7 × l0−5-0.42).02Superficial venous surgery1.76 (0.53-5.86).360.60 (0.04-9.55).72Deep venous thrombosis12.30 (3.39-44.65)<.001492.12 (3.34-7.3 × 104).015Hypertension0.80 (0.27-2.36).691.35 (0.13-14.02).80Obesity1.71 (0.59-4.93).321.63 (0.14-18.84).69Diabetes mellitus1.03 (0.28-3.83).970.11 (2.9 × l0–3-4.23).24Congestive heart failure0.25 (0.03-2.15).210.005 (2.9 × l0–6-10.05).17Depression4.44 (1.29-15.35).01815.72 (0.82-301.96).07Smoking history1.38 (0.46-4.08).563.39 (0.14-82.56).45Inflammatory condition2.44 (0.32-18.71).39145.52 (0.77-2.7 × 104).36CI, Confidence interval. Open table in a new tab

Venous Ulcer: Could Endovenous Radiofrequency Ablation Improve Ulcer Healing? Preliminary Results of a Randomized Controlled Trial

Venous leg ulcers can take several weeks or months to heal and typically present with repeated cycles of ulceration, healing, and recurrence that result in high treatment costs and have a negative impact on patients’ quality of life. The multicomponent compression bandage system is still regarded as the “gold standard” to treat venous ulceration since previous randomized controlled trials failed to show improvement in ulcer healing rates by venous insufficiency surgical treatment despite decrease of ulcer recurrence risk. The current study was designed to investigate whether radiofrequency endovenous ablation of saphenous and perforating insufficient veins could increase venous ulcer healing rates. We did a prospective, controlled, randomized, open-label trial at a single center in Brazil. Participants had venous leg ulcer related to saphenous and perforating vein insufficiency with no sign of current or previous deep venous thrombosis. We randomly assigned participants to receive a weekly-changed two-layer compression bandage system alone or surgical radiofrequency ablation of insufficient saphenous and perforating veins before starting to receive the same compression system. Participants were stratified by ulcer duration (>6 months or <6 months) and ulcer area (>5 cm2 or <5 cm2). The primary end points were ulcer healing rates 6, 12, and 24 weeks after start of treatment. From January 2015 to August 2017, there were 77 patients considered eligible for the study, but 21 participants were excluded before randomization because of treatment abandonment, pretreatment wound healing, ultrasound evidence of previous unknown deep venous thrombosis, and clinical deterioration. The 56 remaining patients were randomly allocated to two treatment groups: 29 to multicomponent compression bandage alone and 27 to combined surgical and compressive treatment. The study is still ongoing, and 24 patients have been under intervention. We have therefore considered for analysis 15 participants from the surgical group and 17 participants from the isolated compressive treatment group. There are no statistically significant differences between groups in ulcer healing rates after 6 weeks. However, after 12 weeks, 73% of surgically treated patients have their ulcers healed vs 65% of compression alone-treated patients (hazard ratio, 4.968; 95% confidence interval, 1.053-23.42; P = .043). After 24 weeks, ulcer healing rate differences are even more evident (100% vs 76%), with the chance of healing greater for the surgical group (hazard ratio, 6.278; 95% confidence interval, 1.693-23.28; P = .006). Until now, 12- and 24-week venous ulcer healing rates were significantly greater in participants treated by endovenous radiofrequency ablation of saphenous and perforating veins plus two-layer compressive bandages than in patients who were treated with compression alone. We expect this difference to be maintained until the end of the study.

Three-year follow-up and quality of life of endovenous radiofrequency ablation of the great saphenous vein with the ClosureFast™ procedure: Influence of BMI and CEAP class.

Purpose Endovascular ablation of the great saphenous vein has been proposed as a less invasive alternative to conventional ligation and stripping of varicose veins. Outcomes of patients treated with the radiofrequency ablation ClosureFast™ system over an eight-year period from a single-center were evaluated. Methods Three-year follow-up data included duplex ultrasound scan, complication rate, and questionnaires to assess patients' QOL, level of pain, and days off work. Results A total of 1080 consecutive patients (49.5 ± 18.6 years, 72% female, mean body mass index: 25.44 ± 4.1 kg m-2) underwent radiofrequency ablation for incompetent saphenous veins in a single institution. Occlusion of the great saphenous vein was obtained in 98.6% and 93.8% cases at the end of the procedures and within 36 months, respectively. Only three deep venous thromboses and minor complications occurred in this series throughout the first week from the procedure. A decrease of the external vein diameter, equal to 72.7% and 31.1% of the pretreatment diameter, was observed at 1 week and 36 months, respectively. The average Aberdeen Varicose Vein Questionnaire score improved from 18.06 ± 9.47 before treatment to 11.56 ± 10.23 at 12 months, with no significant differences in the subsequent follow-up. SF-36 QOL scores significantly improved after the procedure in all domains, while there were no changes over time. Patients reported a prompt return to normal daily activities (1.5 ± 0.7 days) and work (3.1 ± 1.9 days). Body mass index influenced QOL scores, while it did not affect great saphenous vein diameter reduction during the follow-up. On the contrary, Clinical Etiologic Anatomic Pathophysiologic class significantly influenced both great saphenous vein diameter reduction after the treatment and QOL scores within 36 months. Conclusion Results of this retrospective monocentric, large patients study suggest that radiofrequency ablation of the great saphenous vein may be a safe and efficient alternative to conventional surgery.

Treatment of chronic venous insufficiency with great saphenous vein endovenous radiofrequency ablation and miniphlebectomy in a single session

Treatment of chronic venous insufficiency with great saphenous vein endovenous radiofrequency ablation and miniphlebectomy in a single session

Mid-term results of endovenous radiofrequency ablation therapy on small saphenous vein

Mid-term results of endovenous radiofrequency ablation therapy on small saphenous vein

Endovenous laser versus radiofrequency ablation of great saphenous vein: early postoperative results

Background Minimally invasive endovenous thermal ablation therapy has revolutionized the treatment of varicose veins. Comparison of radiofrequency ablation (RFA) versus Endovenous Laser Ablation (EVLA) needs to be more elaborated in the context of better management of patients. Patients and methods A total of 50 young patients (10 patient bilateral and 40 patients unilateral) were enrolled in a prospective interventional study over a period of 2 years starting from June 2014. All patients were blinded to the chosen method to achieve a single-blinded study, with two groups. Exclusion criteria included deep vein thrombosis, peripheral arterial disease, severe tortuosity of Great saphenous Vein (GSV), and refusal of consent. All patients were assessed for deep system patency and flow in ablated segment by duplex immediately after procedure and 1 month later. Results Overall, 60 limbs were equally allocated to two groups. There was no significant difference between both groups concerning the demography and clinical, etiologic, anatomic, and pathophysiologic classification. All patients were blinded to the method of venous ablation. Postoperative duplex shows no failed recanalization or deep vein thrombosis. Pain, ecchymosis, and superficial thrombophlebitis were significantly higher in EVLA group versus RFA group (P Conclusion Both thermal ablative techniques performed well concerning high occlusion rates for incompetent GSV. Less postoperative complications were observed with RFA as compared with EVLA, namely, postoperative pain, ecchymosis, superficial thrombophlebitis, and first-degree burn. However, such complications were deemed to be benign and managed conservatively.

Endovenous radiofrequency ablation of lower extremity varicose veins: short-term outcomes of the initial experience

Context Radiofrequency ablation (RFA) has proven acceptable efficacy and safety in the treatment of truncal varicose veins. Faulty technique may, however, result in primary failure or serious complications, especially during the early time points of the surgeon’s learning curve. Aim The aim of the present study was to evaluate the safety and effectiveness of RFA procedures in the treatment of great saphenous vein reflux during the initial experience in endovenous thermal ablation. Materials and methods A retrospective review was conducted on 47 patients with varicose veins of clinical, etiological, anatomical, physiological (CEAP) class 2–6 who received RFA at the Department of Vascular and Endovascular Surgery, Assiut University Hospitals, to treat refluxing great saphenous veins between 2014 and 2016. Outcome measures were technical success rate and perioperative complications. Short-term outcomes included complete occlusion of the ablated veins and symptom improvement at 1 year. Results RFA achieved a technical success rate of 97.9%. Perioperative complications were paresthesia (10.6%), ecchymosis (6.4%), phlebitis (6.4%), and hyperpigmentation (2.1%). No skin thermal injuries, hematomas, deep venous thrombosis, or endovenous heat-induced thrombosis were detected. One-year complete occlusion rate was 87%. Vascular clinical severity score and venous disability score improved at 1 year to 1.08±0.85 versus 4.03±1.88 (P Conclusion RFA is an effective and safe procedure, with satisfactory technical success, closure rates, and symptom improvement. The procedure could be performed in centers with initial experience in endovenous thermal ablation, provided careful commitment to the procedure steps and guiding supervision.

Use of venoactive drugs after surgery for varicose veins: a preliminary study.

The aim of this paper was to assess the use of venoactive drugs (VADs) after surgery for chronic venous disease in our operative unit in terms of patients' compliance to the therapy and a possible effect on the postoperative pain and quality of life (QoL). Data of consecutive patients who underwent surgery were retrospectively analyzed. All patients, through telephone interview 90 days after the operation, were asked about taking the VAD (either sulodexide or MPFF) which was recommended during the postoperative period. Data were collected about the duration of therapy, the intensity of perceived pain (0-10 scale) at 1st, 7th and 30th postoperative days (POD), the length of rest from their daily activities and QoL during the first postoperative month (through Italian SF-12 questionnaire). P values <0.05 were considered significant. Results of patients who took the VAD were compared to those of patients who did not take the VAD (case-controlled study). A total of 132 patients were operated on (43 with endovenous radiofrequency ablation, RFA; 43 with stripping or crossectomy; 46 with phlebectomies). The proportion of patients who took VADs was two thirds, similar among the three groups. Of those, 24% took VADs for less than 30 days. No significant differences were recorded between those who took and those who didn't take any drugs in terms of intensity of pain at 1st, 7th and 30th POD, days of rest from daily activities and QoL. Irrespectively of the groups, about one third of the patients did not take the recommended VAD postoperatively. No significant difference was recorded between those who took the therapy and those who did not in terms of intensity of postoperative pain, length of rest from daily activities and QoL.

Proteus Syndrome: Report of a Case with Vascular Malformation Successfully Treated with Endovenous Radiofrequency Ablation

We reported a case of a 10 year-old Thai boy diagnosed as Proteus syndrome, presented with progressive enlarging of extremities with asymmetric distorting of the feet and toes. Skin examination showed marked thickening of the soles without characteristic cerebriform appearance, and well-defined purplish plaques with capillary-microcystic lymphatic malformation on the right hip and thigh. MRI/MRA of extremities showed disproportionate overgrowth with combined lymphatic-venous malformation at the right VNUS® Radiofrequency Generator Model RFG2 (VNUS Medical Technologies Inc., San Jose, California, USA and foam sclerotherapy after ablation as an adjunctive treatment for the venous malformation of the right leg with favorable outcomes.

One-year results of the use of endovenous radiofrequency ablation utilising an optimised radiofrequency-induced thermotherapy protocol for the treatment of truncal superficial venous reflux

Background In previous invitro and ex vivo studies, we have shown increased thermal spread can be achieved with radiofrequency-induced thermotherapy when using a low power and slower, discontinuous pullback. We aimed to determine the clinical success rate of radiofrequency-induced thermotherapy using this optimised protocol for the treatment of superficial venous reflux in truncal veins. Methods Sixty-three patients were treated with radiofrequency-induced thermotherapy using the optimised protocol and were followed up after one year (mean 16.3 months). Thirty-five patients returned for audit, giving a response rate of 56%. Duplex ultrasonography was employed to check for truncal reflux and compared to initial scans. Results In the 35 patients studied, there were 48 legs, with 64 truncal veins treated by radiofrequency-induced thermotherapy (34 great saphenous, 15 small saphenous and 15 anterior accessory saphenous veins). One year post-treatment, complete closure of all previously refluxing truncal veins was demonstrated on ultrasound, giving a success rate of 100%. Conclusions Using a previously reported optimised, low power/slow pullback radiofrequency-induced thermotherapy protocol, we have shown it is possible to achieve a 100% ablation at one year. This compares favourably with results reported at one year post-procedure using the high power/fast pullback protocols that are currently recommended for this device.

Comparison of Endovenous Radiofrequency Ablation, Laser Ablation, Foam Sclerotherapy and Surgical Stripping for Great Saphenous Varicose Veins. Extended 5-Year Follow-up of a RCT

Background: This study compares the outcome 5 years after treatment of varicose veins with endovenous radiofrequency ablation (RFA), endovenous laser ablation (EVLA), ultrasound guided foam sclerotherapy (UGFS) or high ligation and stripping (HL/S) by assessing efficacy, clinical recurrence and the rate of reoperations. Methods: A total of 500 patients (580 legs) with Great Saphenous Vein (GSV) reflux and varicose veins were randomized to one of the 4 treatments. Follow-up included clinical and duplex ultrasound examinations. Results: During 5 years the highest rate of GSV recanalization was seen in the UGFS group. Thus 8 in the RFA group (Kaplan Meier (KM) estimate 5.8 %), 8 in the EVLA group (KM estimate 6.8 %), 37 (KM estimate 31.5 %) in the UGFS group and 8 in the HL/S group (KM estimate 6.3 %) of GSVs recanalized or had a failed stripping procedure (P < .001). Nineteen (KM estimate 18.7 %), 42 (KM estimate 38.6 %), 28 (KM estimate 31.7 %) and 38 (KM estimate 34.6 %) legs developed recurrent varicose veins, respectively (P < 0.001). Within 5 years after treatment, 19 (KM estimate 17 %), 19 (KM estimate 18.7 %), 43 (KM estimate 37.7 %) and 25 (KM estimate 23.4 %) legs were retreated in the RFA, EVLA, UGFS and HL/S groups (P < .001). Conclusion: Our study showed, that more recanalizations of the GSV occurred after UGFS and no difference in the technical efficacy was found between the other modalities during a 5-year follow-up period. The higher frequency of clinical recurrence after EVLA requires confirmation in other studies.

Avoiding aesthetic complications after endovenous radiofrequency ablation

SummaryRadiofrequency endovenous ablation treatment is a safe, effective and durable technique for the treatment of great saphenous vein truncal incompetence. However, it is associated with relatively rare complications, such as ecchymosis, paresthesia, hyperpigmentation, phlebitis, haematoma, deep vein thrombosis and pulmonary embolism. Among these, aesthetic complications are the most frequent minor complications occurred after the procedure. This brief review defines and describes aesthetic complications after endovenous radiofrequency ablation of great saphenous vein and provides useful tips to minimize their incidence. Aesthetic complications can be avoided with a careful and accurate preoperative patient and vein evaluation, proper operative indication, adherence to procedure and device instruction for use and best postoperative management.

Mid-Term Report on the Safety and Effectiveness of Endovenous Radiofrequency Ablation for Varicose Veins.

Objective: Endovenous radiofrequency ablation (RFA), a relatively new technique for treating great saphenous varicose veins, is less invasive compared with stripping surgery. This study examined the mid-term safety and effectiveness of RFA for varicose veins.Materials and Methods: We enrolled 104 patients (147 limbs) who underwent RFA for varicose veins of the lower extremities (females, 67; 64.4%). The mean age was 68.9±9.2 years (39–85 years). In 121 limbs (82.3%), there were great saphenous veins. All patients were observed as outpatients for 12 months after the procedure. RFA was performed using ClosureFast™ catheters with tumescent local anesthesia.Results: There was 99.4% occlusion of the treated veins, and partial recanalization was observed in one limb. Endovenous heat-induced thrombosis (EHIT) was identified in five limbs (3.4%). All EHITs were class 1 according to the Kabnick classification, and they disappeared within 1 month of the intervention without antithrombotic therapy. No other major complications were observed. Mean venous clinical severity scores improved from 5.31 at the baseline to 1.10, 0.39, 0.14, and 0.06 at 1, 3, 6, and 12 months, respectively.Conclusion: RFA is a safe and effective strategy for varicose veins of the lower extremities.