Radiofrequency Ablation for Axial Reflux Associated with Foam Sclerotherapy for Varicosities in One-Step Approach: A Prospective Cohort Study Comprising Large Diameters Saphenous Veins

Abstract

Objective This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV). Design Prospective, single-centre, analytical cohort. Materials and Methods Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked. Results The sample was divided into two groups: (Group 1) GSV diameter ≥13.0 mm (median 19.0 [14–24]), 17 subjects, and (Group 2) GSV diameter ≤12.9 mm (median 10.3 [10–12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time. Conclusion Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.

Impact of Ultrasound-Guided Foam Sclerotherapy for Pain Control in Patients with Chronic Venous Disease and Great Saphenous Vein Reflux

“…The authors suggest that the reduction in axial reflux is a possible explanation for why individuals with partially occluded saphenous veins also achieved a complete reduction in symptoms. 4 23 These findings were observed in this study, since both groups obtained the same clinical benefits, regardless of whether the result of saphenous occlusion pattern was complete or partial.…”

“…3 However, it has already been suggested that the saphenous vein's pattern of lumen occlusion is not the sole responsible for the clinical improvement in these patients, despite the lack of studies in the literature directly accessing this association. 4 This study evaluates the impact of UGFS treatment for insufficient GSV, its's occlusion outcomes, and the relation to limb venous pain control, accessed by the visual analogue scale (VAS).…”

Ablação térmica total assistida: apresentação da técnica ATTA

“…While they have been described in the literature, in our practice we have not observed sickness; rash; allergy; cervical constriction; coughing; thoracic or neurological symptoms; residual varicose veins; edema; fiber rupture, whether detected during the procedure or afterwards; EHIT; DVT; arteriovenous fistulas; pulmonary embolism; or death. 27 , 28 …”

“…Ainda que tenham sido descritas na literatura, não foram observadas em nossa experiência ocorrências de mal-estar; rash ; alergia; constrição cervical; tosse; sintomas torácicos ou neurológicos; varizes residuais; edema; ruptura da fibra, flagrada no momento do procedimento ou posteriormente; EHIT; TVP; fístulas arteriovenosas; embolia pulmonar; ou óbito 27 , 28 .…”

Assisted total thermal ablation: presentation of the ATTA technique

“…7,16 While they have been described in the literature, in our practice we have not observed sickness; rash; allergy; cervical constriction; coughing; thoracic or neurological symptoms; residual varicose veins; edema; fiber rupture, whether detected during the procedure or afterwards; EHIT; DVT; arteriovenous fistulas; pulmonary embolism; or death. 27,28…”