Comparison of different approaches to small saphenous vein reflux treatment: a retrospective study in two centers

Abstract

BACKGROUND: Diagnosis and treatment of small saphenous vein (SSV) insufficiency is of utmost importance for relieving chronic venous insufficiency symptoms. OBJECTIVES: To investigate the efficacy and safety of five different treatment approaches among patients with SSV insufficiency. DESIGN AND SETTING: Two-center retrospective clinical study, conducted at cardiovascular surgery clinics in a local training and research hospital and a state hospital. METHODS: A total of 282 extremities of 268 patients with SSV insufficiency alone who were treated for symptomatic varicose veins between January 2012 and January 2017 were included in the study. All extremities included in the study were divided into five groups as follows: high ligation + stripping; radiofrequency ablation (RFA); cyanoacrylate closure (CAC); and endovenous laser ablation (EVLA) at the wavelengths 980 nm and 1,470 nm. RESULTS: Although the recurrence rate at six months was similar among the treatment groups, we found significant differences in recurrence rates at one year, with lower rates in the CAC, RFA and 1,470 nm EVLA groups, compared with the other treatments (P = 0.005). No sural neuritis was observed in the CAC group. The pigmentation rate was higher in the two EVLA groups (980 nm and 1,470 nm). CONCLUSIONS: Our study results showed that although CAC, RFA and EVLA at 1,470 nm seemed to be effective methods for treating SSV insufficiency alone, CAC and RFA had better aesthetic results than EVLA at 1,470 nm. We consider that endovenous non-thermal techniques for treating SSV insufficiency may be preferable because of relatively low risk of nerve injury.

Comparison of cyanoacrylate closure and radiofrequency ablation for the treatment of small saphenous veins

“…In a retrospective study comparing the 1-year results of cyanoacrylate, endovenous laser ablation, conventional surgery, and radiofrequency ablation in the treatment of small saphenous insufficiency, they stated that the cyanoacrylate group had a lower recurrence rate and no sural neuritis was observed, while the pigmentation was higher in the laser ablation group. 16 In this study, we did not observe a significant difference in the 1-year results of two important and frequently used minimally invasive techniques such as radiofrequency and cyanoacrylate ablation in vena saphena parva insufficiency. While both techniques can be used with satisfactory and safe results for 1 year, cyanoacrylate ablation may have a better safety profile compared to radiofrequency ablation due to lower complication rates in terms of paresthesia and sural nerve damage with similar occlusion rates.…”

“…The heating apparatus of the device contains a spiral wire that produces a temperature of 120°C in cycles of 20 s. The thermocouple located in the distal part of the heating element regulates the energy and ensures that the temperature is kept at 120°C. Before insertion to SSV, we assessed the sural nerve anatomy in detail by US with high-frequency transducers (15)(16)(17) to avoid the injury and tumescent anesthesia was sufficiently applied to displace the sural nerve from the SSV in the proximal two-third of the calf by confirming with US, concomitantly in the Group 2. After the patients were placed in the prone position, a 6F catheter was placed in the 2/3 proximal of the inferior vena saphenous parva.…”

Complications of cyanoacrylate adhesive closure therapy in chronic venous insufficiency: A single center, single-surgeon study

“…Nerve damage was found to be less in the CAC group compared to RFA and EVLA, and hyperpigmentation was more common in the EVLA group. 23 In a study by Bademci et al, the incidence of tumescent anesthesia-related and procedure-related complications is higher with the RFA technique. 24…”

Cyanoacrylate adhesive closure in the European and American 2022 clinical practice guidelines

“…Оценка безопасности и эффективности ЦКО проведена в ходе нескольких исследований, и кумулятивная частота окклюзии целевых вен оказалась сравнимой с методами термооблитерации в ближайшем и среднесрочном периодах [22][23][24]. При этом частота окклюзии вен после ЦКО, по данным различных авторов, варьировала от 94,4 до 98% в зависимости от сроков послеоперационного наблюдения (от 1 до 5 лет).…”