Comparing local tumescent anesthesia and spinal anesthesia methods during and after endovenous radiofrequency ablation of great saphenous vein

Background and aim The aim of this study was to compare endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) techniques for efficacy and side effects for great saphenous vein (GSV) ablation. Materials and methods Two hundred twenty-one patients and 287 extremities that underwent GSV ablation with EVLA and RFA methods were analysed retrospectively; 135 GSVs were treated with EVLA, 152 GSVs were treated with RFA. Physical examination and Ultrasound (US) records at the first week, first month and third month were evaluated. Recanalization, endothermal heat-induced thrombosis formation, presence of ecchymosis greater than 10 cm and GSV diameter parameters were statistically analyzed. Results In the RFA group, 96.7% of the GSVs that were ablated were occluded at the end of the third month. In the EVLA group, this rate was 92.6%. There was no statistically significant difference between success of ablation ( P = 0.118). In the RFA group, ecchymotic areas, that is larger than 10 cm diameter were observed in 16 extremities, whereas in the EVLA group, 66 of 135 (48.9%) limbs were found to have ecchymotic area larger than 10 cm ( P < 0.001). More recanalizations were observed in GSVs larger than 10 mm in diameter which was statistically significant ( P < 0.001). Conclusion Both EVLA and RFA methods are effective in treating GSV reflux. Compared to the EVLA, less ecchymosis occurs after RFA procedures. Regardless of the type of method used, the GSV diameter is a single predictor of recanalization.

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Radiofrequency ablation of the great saphenous vein, comparing one versus two treatment cycles for the proximal vein segment

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514556142 ◽

2014 ◽

Vol 30 (10) ◽

pp. 724-728 ◽

Cited By ~ 2

Author(s):

S Sufian ◽

A Arnez ◽

N Labropoulos ◽

K Nguyen ◽

V Satwah ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Treatment Group ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Demographic Data ◽

Duplex Ultrasound ◽

Clinical Severity ◽

Severity Scores ◽

Vein Segment ◽

Ceap Classification

Objective To evaluate the results of radiofrequency ablation (RFA) of the great saphenous vein (GSV) using one versus two 20 s energy cycle treatment in the proximal 7 cm segment of the GSV. Methods All patients who underwent RFA of the GSV from 1 May 2013 to 30 September 2013 in eight of our vein centers were included. Duplex ultrasound scans (DUSs) were performed prior to treatment on all patients and 2–3 days, and 1 month after procedure. Demographic data, GSV diameters, and other relevant data were recorded. Clinical, Etiologic, Anatomic, Pathologic (CEAP) classification and Venous Clinical Severity Scores (VCSSs) were determined prior to ablation and one month later. Patients who developed endovenous heat induced thrombosis (EHIT) were followed till resolution. Results A total of 205 patients had one cycle treatment (group A) and 204 had two cycle treatment (group B). The two groups were comparable in their demography, CEAP classification, and VCSS scores. The rate of failure of ablation and incidence of EHIT were also not significantly different. The incidence of complications was low, <5% in both groups and all were minor. Conclusion Two cycle treatment of the proximal GSV for vein ablation does not improve the success rate of vein closure in the short term, compared to one cycle treatment. It also does not increase the risks of DVT, EHIT, major bleeding, and other complications. However, we do not know at what diameter two cycles may be superior to one cycle.

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Comparison of cyanoacrylate embolization and radiofrequency ablation for the treatment of varicose veins

Phlebology The Journal of Venous Disease ◽

10.1177/0268355518794105 ◽

2018 ◽

Vol 34 (4) ◽

pp. 278-283 ◽

Cited By ~ 5

Author(s):

Gary K Yang ◽

Marina Parapini ◽

Joel Gagnon ◽

Jerry C Chen

Keyword(s):

Radiofrequency Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Varicose Veins ◽

Treatment Success ◽

Vancouver General Hospital ◽

Wound Complications ◽

Complication Rates ◽

Success Rates

Objective To review clinical outcomes of varicose vein patients treated with cyanoacrylate embolization and radiofrequency ablation at our institution. Methods A retrospective review of patients who underwent cyanoacrylate embolization and radiofrequency ablation during a three-year period. Patient records were reviewed to assess demographics, location and severity of disease, treatment details and outcome at short- and mid-term follow-ups. Outcome parameters included treatment success and complications. Results Between January 2014 and December 2016, 335 patients with 476 veins were treated with either cyanoacrylate embolization (n = 148) or radiofrequency ablation (n = 328) at the Vancouver General Hospital Vascular Surgery Vein Clinic. The average age of patients were 57 ± 1 years with the majority being female (78%) and an average BMI of 24.8 ± 0.5. CEAP classes were 2 (49%), 3 (26%), 4a (22%) and >4b (3%). Of the veins treated with cyanoacrylate embolization, the vein types were as follows: 76% were great saphenous vein, 16% were small saphenous vein, 5% were anterior accessory great saphenous vein and 1.4% were perforator veins. The vein types for radiofrequency ablation were 88%, 9%, 3% and 0%, respectively. The average amount of cyanoacrylate embolization delivered for great saphenous vein treatment was 1.8 ± 0.1 ml with a treatment length of 43 ± 1 cm. Subgroup comparison was done for great saphenous vein segments. Treatment success was 100% in cyanoacrylate embolization and 99% in radiofrequency ablation. Superficial phlebitis was the most common complication noted at mid-term follow-up in 5% of cyanoacrylate embolization and 16% of radiofrequency ablation treatments (P < 0.05). One patient in each group had asymptomatic proximal thrombus extension treated with anticoagulation for 2–3 weeks. Three superficial infections from glue clumps were noted in the cyanoacrylate embolization group requiring excision and drainage. Five patients in the radiofrequency ablation group had persistent numbness and one wound complications at the access site. Conclusion Cyanoacrylate embolization offers equivalent success rates with lower mid-term complication rates as radiofrequency ablation.

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Endoluminal thermal ablation of the great saphenous vein (GSV) insufficiency

Phlebologie ◽

10.12687/phleb2336-6-2016 ◽

2016 ◽

Vol 45 (06) ◽

pp. 357-362 ◽

Cited By ~ 2

Author(s):

C. Zollmann ◽

P. Zollmann ◽

J. Veltman ◽

A. Gräser ◽

I. Berger ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Laser Ablation ◽

Prospective Study ◽

Saphenous Vein ◽

Thermal Ablation ◽

Great Saphenous Vein ◽

Treatment Technique ◽

Ultrasound Guided ◽

Previously Treated

SummaryTo evaluate and compare the fiveyear outcome after treatment of a varicose GSV by endovenous thermal laser ablation (EVLA) and radiofrequency ablation (RFA).In this non-randomized, prospective study, patients treated in 2007 and 2008 for complete varicosis of the GSV (CEAP: C2–C6) were divided according to the treatment technique used into three groups: RFA (VNUS ClosureFast™), EVLA 980 nm (ELVeS 980™) and EVLA 1470 nm (ELVeS 1470™). Ultrasound-guided follow-up consultations were conducted 3 days, 3 months, 1 year and 5 years after treatment.589 patients with 643 GSVs (223 RFA, 185 EVLA 980, 235 EVLA 1470) were treated under tumescent local anaesthesia. No major complications occurred and minor complications were rare (4.7–12.2 %, p=0.135).66 % (RFA), 15 % (EVLA 980) and 32 % (EVLA 1470) of the patients were pain-free without post-operative analgesics. After 5 years, 86 % (RFA), 90 % (EVLA 980) and 93 % (EVLA 1470) of the veins were occluded (p=0.096). Ultrasound imaging revealed reflux in treated GSVs in 5–8 % of cases (p=0.73). A second ablation of the previously treated GSV was required in 5 % (RFA), 2 % (EVLA 980) and 2 % (EVLA 1470) of the patients (p=0.28).Endoluminal thermal ablation is an easy, safe and well tolerated method for the treatment of varicosis. Radiofrequency ablation is less painful than EVLA. RFA and EVLA 1470 are equally effective for vein closure.

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Long-term results after radiofrequency ablation in 1998

Phlebologie ◽

10.12687/phleb2201-4-2014 ◽

2014 ◽

Vol 43 (04) ◽

pp. 197-200

Author(s):

A. Brunner ◽

J. Noppeney ◽

T. Noppeney

Keyword(s):

Radiofrequency Ablation ◽

Clinical Examination ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Lower Leg ◽

Entire Length ◽

Long Term Results ◽

The Mean

Summary Introduction: In 1998, radiofrequency ablation (VNUS Closure Plus™) was authorised in Germany and Europe for the treatment of superficial reflux. We participated in a clinical registry set up by the manufacturing company in 1998. The aim of this retrospective paper was to analyse the long-term results after radiofrequency ablation. Materials, methods and patients: In 1998, we operated on twelve patients (8 women, 4 men). In accordance with the concept of standard vein stripping surgery, all endovenous ablations were combined with crossectomy or ligature of the saphenopopliteal junction. Each vein was thermally ablated over its entire length and no tumescent anaesthesia was performed. The mean age of the twelve patients was 44.9 years. On ten occasions, the entire length of the great saphenous vein was treated, on one occasion the great saphenous vein at the level of the lower leg and on one occasion the entire length of the small saphenous vein. The mean duration of surgery was 80 minutes. Results: The follow-up period was 3 to 168 months, with a mean duration of 80 months. Six patients were followed up for longer than 120 months. In eight cases, the follow-up examination was performed using duplex ultrasound, in two cases using clinical examination and non-invasive testing, in one case using clinical examination and in one case via a telephone interview.The most frequent perioperative complication, occurring in six cases, was hypaesthesia at the medial malleolus or lower leg. There was one case of perioperative thrombophlebitis of a lateral branch in the lower leg and one case of a third-degree thigh burn with subsequent infection of the great saphenous vein canal. No deep vein thrombosis or pulmonary embolism occurred in any of the operated patients.Of the eleven great saphenous veins treated, one recanalised after 14 months, the others had closed or were no longer detectable on ultrasound. The small saphenous vein treated was also no longer detectable.In one patient, a major recurrence at the saphenofemoral junction with recurrent lateral branches in the thigh and lower leg were determined 168 months after surgery. No recurrent varicosis was determined in the other patients.

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