Radiofrequency ablation as a method of choice for the treatment of lower extremity varicose veins disease

Authors

DOI:

https://doi.org/10.34287/MMT.2(57).2023.5

Abstract

The aim of the work is to improve the radiofrequency ablation (RFA) protocol in order to minimize disease recurrence and to improve the life quality of patients with lower extremity varicose veins disease (LEVVD).

Materials and methods. An open-label, prospective study of the effectiveness of a modified RFA protocol for the treatment of 210 consecutive patients with clinical grade C2-C6 of LEVVD was conducted. The effectiveness and safety of the procedure were evaluated by the anatomical success of vein obliteration, the dynamics of the severity of venous pathology according to the VCSS scale, quality of life indicators determined using the AVVQ-UA questionnaire, and development of postoperative complications.

Results. Sonographic control was conducted in the first 48 hours, 7 days and 1 month after the RFA procedure and recorded 100 % occlusion of the great saphenous vein, obtaining the effect of “radiofrequency crossectomy” in the jugular area. After 6 months and 1 year of follow-up, 208 (99.1 %) patients experienced vein occlusion and 2 (0.9 %) patients had partial vein occlusion within 1 cm of the sapheno-femoral junction without pathological reflux. After 2 years the partial occlusion was diagnosed in 4 (1.9 %) patients.

During the first 2 weeks after treatment, 64 (30.5 %) patients reported complications, which didn’t require treatment. However, in 2 (0.9 %) cases asymptomatic distal DVT and in 1 (0.5 %) EHIT II were diagnosed. Anticoagulant therapy was prescribed. Regression of clinical symptoms with a statistically significant difference in the VCSS score (p < 0.001) was observed 6 months after RFA. The application of the proposed RFA protocol made it possible to statistically significantly improve the quality of life indicators 1 month after treatment by 3.36 ± 0.81 (р < 0.001) with further positive dynamics.

Conclusions. The application of the proposed RFA protocol in patients with LEVVD has a good safety profile, allows to minimize disease recurrences, performing the effect of “radiofrequency crossectomy”, and has a positive effect on the regression of clinical symptoms and quality of life indicators.

References

Morrison N, Gibson K, Vasquez M, Weiss R, Jones A. Five-year extension study of patients from a randomized clinical trial (VeClose) comparing cyanoacrylate closure versus radiofrequency ablation for the treatment of incompetent great saphenous veins. J Vasc Surg Venous Lymphat Disord. 2020;8(6):978-89. doi: 10.1016/j.jvsv.2019.12.080.

Masuda E, Ozsvath K, Vossler J, Woo K, Kistner R, Lurie F, et al. The 2020 appropriate use criteria for chronic lower extremity venous disease of the American Venous Forum, the Society for Vascular Surgery, the American Vein and Lymphatic Society, and the Society of Interventional Radiology. J Vasc Surg Venous Lymphat Disord. 2020;8(4):505-25.e4. doi: 10.1016/j.jvsv.2020.02.001.

De Maeseneer MG, Kakkos SK, Aherne T, Baekgaard N, Black S, Blomgren L, et al. Editor’s Choice European Society for Vascular Surgery (ESVS) 2022 Clinical Practice Guidelines on the Management of Chronic Venous Disease of the Lower Limbs. Eur J Vasc Endovasc Surg. 2022;63(2):184267. doi: 10.1016/j.ejvs.2021.12.024.

Lawaetz M, Serup J, Lawaetz B, Bjoern L, Blemings A, Eklof B, et al. Comparison of endovenous ablation techniques, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Extended 5-year follow-up of a RCT. Int Angiol. 2017;36(3):281-8. doi: 10.23736/S0392-9590.17.03827-5.

Bozoglan O, Mese B, Eroglu E, Ekerbiçer HC, Yasim A. Comparison of Endovenous Laser and Radiofrequency Ablation in Treating Varices in the Same Patient. J Lasers Med Sci. 2017;8(1):13-6. doi: 10.15171/jlms.2017.03.

Gloviczki P. Handbook of venous and lymphatic disorders. 4th ed. Broken Sound Parkway NW: Taylor & Francis Group; 2017.

Medtronic Instructions for use: ClosureFAST catheter (commercially available), http://medtronicendovenous.com/professionals/closurefast-procedure/ (accessed 18 September 2018).

De Hert S, De Baerdemaeker L, De Maeseneer M. What the phlebologist should know about local anesthetics. Phlebology. 2014;29(7):428-41. doi: 10.1177/0268355513501303.

Lurie F, Passman M, Meisner M, Dalsing M, Masuda E, Welch H, et al. The 2020 update of the CEAP classification system and reporting standards. J Vasc Surg Venous Lymphat Disord. 2020;8(3):342-52. doi: 10.1016/j.jvsv.2019.12.075.

Vasquez MA, Munschauer CE. Venous Clinical Severity Score and quality-of-life assessment tools: application to vein practice. Phlebology. 2008;23(6):259-75. doi: 10.1258/phleb.2008.008018.

Atamaniuk OYu, Skrypko VD, Atamaniuk VM, Trombola OV. Transcultural adaptation and validation of the Ukrainian version of the specialized phlebological questionnaire for quality of life assessment. Art of Medicine. 2022;1(21):9-13. Ukrainian. doi: 10.21802/artm.2022.1.21.9.

Andercou O, Stancu B, Coman HF, Cucuruz B, Noppeney T, Marian D. Radiofrequency Thermal Ablation for the Treatment of Chronic Insufficiency of the Saphenous Vein-A Comparative Retrospective Study. Int J Environ Res Public Health. 2023;20(4):3308. doi: 10.3390/ijerph20043308.

De A, Roy P, Kumar S. Efficacy and safety of radiofrequency ablation for lower limb varicose veins. Int Surg J. 2018;5(11), 3676. doi: 10.18203/2349- 2902.isj20184643.

Kabnick LS, Sadek M, Bjarnason H, Coleman DM, Dillavou ED, Hingorani AP, et al. Classification and treatment of endothermal heat-induced thrombosis: Recommendations from the American Venous Forum and the Society for Vascular Surgery. J Vasc Surg Venous Lymphat Disord. 2021;9(1):6-22. doi: 10.1016/j.jvsv.2020.06.008.

Healy DA, Kimura S, Power D, Elhaj A, Abdeldaim Y, Cross KS, et al. A Systematic Review and Meta-analysis of Thrombotic Events Following Endovenous Thermal Ablation of the Great Saphenous Vein. Eur J Vasc Endovasc Surg. 2018 Sep;56(3):410-24. doi: 10.1016/j.ejvs.2018.05.008.

Wołkowski K, Wołkowski M, Urbanek T. Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins SurgeryProspective Observational Study. J Clin Med. 2020;9(12):3970. doi: 10.3390/jcm9123970.

Downloads

Published

2023-06-20

How to Cite

Atamaniuk, O. Y. ., Skrypko, V. D. ., & Atamaniuk, V. M. . (2023). Radiofrequency ablation as a method of choice for the treatment of lower extremity varicose veins disease. Modern Medical Technology, (2), 27–33. https://doi.org/10.34287/MMT.2(57).2023.5

Issue

Section

Original research