European College of Phlebology guideline for truncal ablation

Abstract

Background The purpose of the guideline was to achieve consensus in the care and treatment of patients with chronic venous disease, based on current evidence. Method A systematic literature search was performed in PubMed, Embase, Cinahl, and the Cochrane library up until 1 February 2019. Additional relevant literature were added through checking of references. Level of evidence was graded through the GRADE scale and recommendations were concluded. Results For the treatment of great and small saphenous vein reflux, endovenous ablation with laser or radiofrequency was recommended in preference to surgery or foam sclerotherapy. If tributaries are to be treated it should be done in the same procedure. Treatment with mecanicochemical ablation and glue can be used but we still need long term follow up results. Conclusion For the treatment of truncal varicosities, endovenous ablation with laser or radiofrequency combined with phlebectomies is recommended before surgery or foam.

Segmental saphenous ablation for chronic venous disease treatment

“…The 1 year occlusion rate of the herein described segmental treatment using the saphenous sparing approach is in line with the traditional endovenous ablative outcomes. 6…”

“…In contrast to the previously demonstrated reduced reflux recurrence rate following a surgical saphenous sparing versus ablative approach, 8 at 12 ± 1 months follow–up, the present investigation did not show a drop of reflux recurrence compared to the outcomes reported by endovenous ablation. 6…”

“…Over the years, technical innovations in endovenous saphenous ablation have advanced but without significant changes in the recurrence rate. 6,7…”

Three-year results of a randomized controlled trial comparing mechanochemical and thermal ablation in the treatment of insufficient great saphenous veins

“…They have long-term occlusion rates of 88% or more in randomized controlled trials, confirming that they are at least equal to high ligation and stripping [1][2][3][4][5] . Thermal ablation (EVLA and RFA) is currently recommended as first choice of treatment for saphenous vein incompetence 6 . These techniques, however, require the use of tumescent anaesthesia and carry the risk of thermal injury to adjacent tissues.…”

Patient injuries in the treatment of superficial venous insufficiency registered in Finland between 2004 and 2017

“…It is possible that more recent decisions would not consider patient’s experienced insufficient removal of side branches as a compensable injury as treatment of the truncal disease is, nowadays, considered the main focus of the approach. 21…”