Endovenous thermal ablation mid-term outcomes for the treatment of large diameter incompetent great saphenous veins.

Christos Karathanos, Konstantinos Spanos, Konstantinos Batzalexis, Athanasios Chaidoulis, Konstantinos Tzimas-Dakis, Georgios Volakakis, George Kouvelos, Miltiadis Matsagas, Athanasios D Giannoukas
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Abstract

Introduction: The aim of this study was to assess the efficacy and safety of endovenous thermal ablation (EVTA) in treating large diameter, ≥12 mm, incompetent great saphenous vein (GSV) in comparison to smaller ones.

Methods: A retrospective comparative study was undertaken including 196 patients (205 limbs) undergoing EVTA. According to maximum GSV diameter patients were divided into two groups (group A <12 mm, group B ≥12 mm). Primary outcome was anatomic success defined as absence of reflux of GSV. Secondary outcomes were complications, postoperative pain using the 10-cm Visual Analog Scale (VAS) and improvement of Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ-20) scores assessed at 7- days, 1 month, 12 months and 24 months postoperatively.

Results: 118 patients with GSV diameter <12 mm (group A) and 87 with GSV diameter ≥12 mm (group B) were included. Patients' demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p = .04 and 5.21 vs 5.77, p = .032, respectively). No differences in adverse events were observed post-operatively among groups. GSV occlusion rate at 1 month was 98.3% (SE 1.3%) in group A and 96.5 % (2.2%) in group B (p = .3), at 12 months 95.7% (SE 2%) and 94.2% (SE 2.8%) (p = .5), and at 24 months 94% (SE 2.4%) and 93.1% (SE 3%) (p = .4) respectively. Both groups experienced significant and similar improvement in their VCSSs and CIVIQ scores postoperatively. In a subgroup analysis among different EVTA and GSV >12 mm, 1470 nm endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) showed comparable results in terms of occlusion rates, complications, VCSS and CIVIQ scores.

Conclusions: Endovenous thermal ablation techniques are efective and safe in the treatment of GSV incompetence regardless the diameter of the GSV. Both 1470 nm EVLA and RFA techniques performed similar outcomes.

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静脉腔内热消融治疗大隐静脉闭塞的中期疗效。
简介本研究旨在评估静脉腔内热消融术(EVTA)治疗直径≥12 毫米的大隐静脉(GSV)与小隐静脉(GSV)的疗效和安全性:方法:对接受 EVTA 的 196 名患者(205 条肢体)进行了回顾性比较研究。根据最大 GSV 直径将患者分为两组(A 组 结果:118 名患者的 GSV 直径 p = 0.5;B 组 结果:118 名患者的 GSV 直径 p = 0.5;C 组 结果:118 名患者的 GSV 直径 p = 0.5:118例患者的GSV直径分别为5.21 vs 5.77,P = .04和5.21 vs 5.77,P = .032)。各组术后不良反应无差异。1 个月时,A 组的 GSV 闭塞率为 98.3%(SE 1.3%),B 组为 96.5%(2.2%)(p = .3);12 个月时,A 组为 95.7%(SE 2%),B 组为 94.2%(SE 2.8%)(p = .5);24 个月时,A 组为 94%(SE 2.4%),B 组为 93.1%(SE 3%)(p = .4)。两组患者的 VCSSs 和 CIVIQ 评分在术后均有明显和相似的改善。在不同 EVTA 和 GSV >12 mm 的亚组分析中,1470 nm 静脉腔内激光消融术(EVLA)和射频消融术(RFA)在闭塞率、并发症、VCSS 和 CIVIQ 评分方面显示出相似的结果:无论 GSV 的直径大小,静脉内热消融技术都能有效、安全地治疗 GSV 闭塞。1470纳米EVLA和RFA技术的疗效相似。
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