Criteria for selection of patients for radiofrequency ablation of major venous trunks in varicose disease, short- and long-term outcomes

Belentsov S.M.^1,2, Veselov B.A.^1,2, Chukin S.A.², Ektova M.V.², Makarov S.E.^1,2

1) Municipal Autonomous Medical Facility City Clinical Hospital No 40
2) Medical Centre "Angioline"”, Ekaterinburg, Russia

Objective: to investigate criteria for selection of patients for radiofrequency ablation (RFA), as well as to assess the immediate and remote outcomes of comprehensive minimally invasive treatment of patients presenting with class C2-C6 chronic venous disease (CVD).

Materials and methods: we performed a total of 604 interventions in 512 patients (554 on the superior vena cava (diameter from 3 to 26 mm), 45 on the inferior vena cava (diameter from 3 to 14 mm), 5 on the anterior accessory veins (4-8 mm in diameter) The varicose veins were removed by means of compression sclerotherapy. The interventions were performed using tumescent anaesthesia in out-patient conditions. The check-up ultrasonographic duplex scanning was carried out within 1-5 days after RFA, then after 6, 12, 24, 36 and 48 months.

Results and discussion. All major veins except two were found to be occluded immediately after the interventions. A complication was observed in one case (0.2%). The remote results were assessed on 514 lower limbs. In all, except two, major trunks of the subjected to RFA saphenous veins were occluded. Recurrent varicose veins were observed on 82 (13.9%) lower limbs.

Using two ports was required in tortuosity of the SVC and with thrombophlebitis of the SVC in the anamesis. A small diameter of the vein may currently not be considered as a limiting factor. Of the 11 patients with a varicose node above the saphenofemoral junction, one patient was found to have a floating thrombus in it which required crossectomy. RFA demonstrated advantages as compared with crossectomy and stripping in obese patients, while in acute ascending superficial thrombophlebitis in a series of cases it made it possible to refuse the traditional surgical operations.

In class C6 CVD conservative therapy was carried out parallel to correction of venous haemodynamics which made it possible to reduce the term of epithelisation of the trophic ulcer. Removal of the deep vertical veno-venous reflux by means of RFA in all cases resulted in SVC occlusion.

Conclusion. Planning of RFA requires a thorough clinical and ultrasonographic assessment, ideally an ultrasonographic examination should be performed by the operating surgeon. Technical obstacles in the majority of cases may be overcome. RFA is a method of choice in obese patients with a deep vertical veno-venous reflux. Early application thereof in class C6 CVD reduces the term of epithelisation of trophic ulcers. 99.7% of cases showed occlusion of the vein immediately after the intervention and 99.6% of cases within the term of up to 48 months.

KEY WORDS: varicose disease, radiofrequency ablation, outcome.

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