Healing and recurrence rates following radiofrequency ablation of the saphenous vein and ultrasound-guided foam sclerotherapy of perforator reflux in patients with venous ulceration

Introduction Ultrasound-guided foam sclerotherapy is a minimally invasive treatment option used for ablation of axial and perforator reflux for chronic venous ulceration. Active ulceration presents a significant health burden in both the primary and secondary care setting. The objective of this study is to determine ulcer healing rates at 24 weeks and 12 months, and ulcer recurrence rates at one year for chronic venous ulcers after ultrasound-guided foam sclerotherapy. Methods Between 2007 and 2012, 54 patients underwent ultrasound-guided foam sclerotherapy for clinical, aetiological, anatomical and pathological C6 ulcers. All patients were followed up clinically, and venous duplex was performed on all legs before and after treatment. A prospectively maintained database was analysed to determine venous truncal occlusion rates, 24-week and 12-month healing and recurrence rates (using Kaplan–Meier survival analysis). Results Fifty-seven ulcerated legs, 39 primary and 18 with recurrent superficial venous reflux were analysed. Median time of active ulceration at presentation was 15.2 months (range 5 months to 17 years). At a median follow-up of 2.7 months, 90% (51 legs) achieved full truncal occlusion after one session, 4% (2) short segment occlusion and 5% (3) failed to occlude and one patient died and was lost to follow-up; 13/57 (23%) required a second session of treatment for completion of treatment, recanalisations and to treat perforator disease, 88% (50/57) ulcers healed at a median of 5.3 months (interquartile range 2.9–8.4 months) following their first ultrasound-guided foam sclerotherapy treatment. The 24-week and 12-month estimated healing rates were 53% and 72%, respectively. The estimated 12-month recurrence rate was 9.2%. There were no reported incidences of deep venous thrombosis or neurological symptoms. Conclusion This study affirms the role of ultrasound-guided foam sclerotherapy as a safe and effective option for abolition of superficial reflux.

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For adults with great saphenous vein incompetence, how do endovenous laser ablation (EVLA), radiofrequency ablation (RFA), and ultrasound-guided foam sclerotherapy (UGFS) compare with high ligation and stripping (HL/S)?

Cochrane Clinical Answers ◽

10.1002/cca.3869 ◽

2021 ◽

Author(s):

Sera Tort ◽

Benilde Cosmi

Keyword(s):

Radiofrequency Ablation ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

High Ligation ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation

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Healing and Recurrence Rates Following Ultrasound-guided Foam Sclerotherapy of Superficial Venous Reflux in Patients with Chronic Venous Ulceration

Journal of Vascular Surgery ◽

10.1016/j.jvs.2010.10.048 ◽

2010 ◽

Vol 52 (6) ◽

pp. 1730

Author(s):

K.H. Pang ◽

G.R. Bate ◽

K.A.L. Darvall ◽

D.J. Adam ◽

A.W. Bradbury

Keyword(s):

Venous Reflux ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Recurrence Rates ◽

Venous Ulceration

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Cost-utility analysis of great saphenous vein ablation with radiofrequency, foam and surgery in the emerging health-care setting of Thailand

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515604258 ◽

2016 ◽

Vol 31 (8) ◽

pp. 573-581 ◽

Cited By ~ 4

Author(s):

Boonying Siribumrungwong ◽

Pinit Noorit ◽

Chumpon Wilasrusmee ◽

Pattara Leelahavarong ◽

Ammarin Thakkinstian ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Cost Effective ◽

Quality Adjusted Life Year ◽

Cost Utility ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

One Year ◽

Quality Adjusted Life

Objectives To conduct economic evaluations of radiofrequency ablation, ultrasound-guided foam sclerotherapy and surgery for great saphenous vein ablation. Method A cost-utility and cohort analysis from societal perspective was performed to estimate incremental cost-effectiveness ratio. Transitional probabilities were from meta-analysis. Direct medical, direct non-medical, indirect costs, and utility were from standard Thai costings and cohort. Probabilistic sensitivity analysis was performed to assess parameter uncertainties. Results Seventy-seven patients (31 radiofrequency ablation, 19 ultrasound-guided foam sclerotherapy, and 27 surgeries) were enrolled from October 2011 to February 2013. Compared with surgery, radiofrequency ablation costed 12,935 and 20,872 Baht higher, whereas ultrasound-guided foam sclerotherapy costed 6159 lower and 1558 Bath higher for outpatient and inpatient, respectively. At one year, radiofrequency ablation had slightly lower quality-adjusted life-year, whereas ultrasound-guided foam sclerotherapy yielded additional 0.025 quality-adjusted life-year gained. Because of costing lower and greater quality-adjusted life-year than other compared alternatives, outpatient ultrasound-guided foam sclerotherapy was an option being dominant. Probabilistic sensitivity analysis resulted that at the Thai ceiling threshold of 160,000 Baht/quality-adjusted life-year gained, ultrasound-guided foam sclerotherapy had chances of 0.71 to be cost-effective. Conclusions Ultrasound-guided foam sclerotherapy seems to be cost-effective for treating great saphenous vein reflux compared to surgery in Thailand at one-year results.

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Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review

Vascular ◽

10.1177/1708538116648035 ◽

2016 ◽

Vol 24 (6) ◽

pp. 649-657 ◽

Cited By ~ 12

Author(s):

Renata Balint ◽

Akos Farics ◽

Krisztina Parti ◽

Laszlo Vizsy ◽

Jozsef Batorfi ◽

...

Keyword(s):

Radiofrequency Ablation ◽

Laser Ablation ◽

Saphenous Vein ◽

Great Saphenous Vein ◽

Success Rates ◽

Technical Success ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Endovenous Laser Ablation

Objective The aim of this review article was to evaluate the long-term technical success rates of the known endovenous ablation procedures in the treatment of the incompetence of the great saphenous vein. Methods A literature search was conducted in the PubMed-database until the 5 January 2016. All publications with four to five years follow-up were eligible. Meta-analysis was performed by the IVhet-model. Results Eight hundred and sixty-two unique publications were found; 17 of them were appropriate for meta-analysis. Overall, 1420 limbs were included in the trial, 939 for endovenous laser ablation, 353 for radiofrequency ablation and 128 for ultrasound guided foam sclerotherapy. Overall, technical success rates were 84.8% for endovenous laser ablation, 88.7% for radiofrequency ablation and 32.8% for ultrasound guided foam sclerotherapy. There were no significant differences between endovenous laser ablation, radiofrequency ablation and ultrasound guided foam sclerotherapy regarding the great saphenous vein reopening ( p = 0.66; OR: 0.22; 95% of CI: 0.08–0.62 for radiofrequency ablation vs. endovenous laser ablation; p = 0.96; OR: 0.11; 95% of CI: 0.06–0.20 for endovenous laser ablation vs. ultrasound guided foam sclerotherapy; p = 0.93; OR: 3.20; 95% of CI: 0.54–18.90 for ultrasound guided foam sclerotherapy vs. radiofrequency ablation). Conclusion Both endovenous laser ablation and radiofrequency ablation are efficient in great saphenous vein occlusion on the long term. Lacking long-conducted large trials, the efficacy and reliability of ultrasound guided foam sclerotherapy to treat great saphenous vein-reflux is not affirmed.

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Recanalisation and ulcer recurrence rates following ultrasound-guided foam sclerotherapy

Phlebology The Journal of Venous Disease ◽

10.1177/0268355515598450 ◽

2016 ◽

Vol 31 (7) ◽

pp. 506-513 ◽

Cited By ~ 7

Author(s):

Julia K Howard ◽

Fiona JA Slim ◽

Margaret C Wakely ◽

Lorraine G Emerson ◽

Colin E Davies ◽

...

Keyword(s):

Survival Analysis ◽

Ulcer Recurrence ◽

Ultrasound Guided ◽

Foam Sclerotherapy ◽

Recurrence Rates ◽

Short Segment ◽

Venous Ulceration ◽

Kaplan Meier ◽

One Year

Objectives The aim was to assess vein recanalisation and ulcer recurrence in patients with chronic venous ulceration following ultrasound-guided foam sclerotherapy. Method Open (CEAP 6) or recently healed (CEAP 5) chronic venous leg ulcers were treated with foam sclerotherapy between July 2010 and August 2012. Venous duplex scans were performed two weeks and one and two years post treatment, recording recanalisation and reflux. One- and two-year ulcer recurrence rates were calculated using Kaplan–Meier survival analysis. Results A total of 100 legs were treated in 92 patients; 86 were CEAP 5 and 14 were CEAP 6. At two weeks complete or short segment occlusion was demonstrated in 99/100 legs. Complete follow-up was 93% at one year and 88% at two years. Complete and segmental recanalisation with new reflux was recorded in 11/93 (12%) legs and 25/93 (27%) legs, respectively (overall 36/93; 39%) at one year; and 6/88 (7%) legs and 15/88 (17%) legs, respectively (overall 21/88; 24%) at two years. Kaplan–Meier survival analysis shows 64% ulcers healed at 24 weeks and 86% at one year. Ulcer recurrence rate at one and two years was 2.3% and 5.1%. Conclusions Over one-third of superficial veins treated with foam sclerotherapy recanalised at one year and just under a quarter of superficial veins recanalised at two years. Despite this, ulcer recurrence rates were low, and recanalisation failed to predict recurrence.

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