Radiofrequency ablation as a method of choice for the treatment of lower extremity varicose veins disease

Abstract

The aim of the work is to improve the radiofrequency ablation (RFA) protocol in order to minimize disease recurrence and to improve the life quality of patients with lower extremity varicose veins disease (LEVVD). Materials and methods. An open-label, prospective study of the effectiveness of a modified RFA protocol for the treatment of 210 consecutive patients with clinical grade C2-C6 of LEVVD was conducted. The effectiveness and safety of the procedure were evaluated by the anatomical success of vein obliteration, the dynamics of the severity of venous pathology according to the VCSS scale, quality of life indicators determined using the AVVQ-UA questionnaire, and development of postoperative complications. Results. Sonographic control was conducted in the first 48 hours, 7 days and 1 month after the RFA procedure and recorded 100 % occlusion of the great saphenous vein, obtaining the effect of “radiofrequency crossectomy” in the jugular area. After 6 months and 1 year of follow-up, 208 (99.1 %) patients experienced vein occlusion and 2 (0.9 %) patients had partial vein occlusion within 1 cm of the sapheno-femoral junction without pathological reflux. After 2 years the partial occlusion was diagnosed in 4 (1.9 %) patients. During the first 2 weeks after treatment, 64 (30.5 %) patients reported complications, which didn’t require treatment. However, in 2 (0.9 %) cases asymptomatic distal DVT and in 1 (0.5 %) EHIT II were diagnosed. Anticoagulant therapy was prescribed. Regression of clinical symptoms with a statistically significant difference in the VCSS score (p < 0.001) was observed 6 months after RFA. The application of the proposed RFA protocol made it possible to statistically significantly improve the quality of life indicators 1 month after treatment by 3.36 ± 0.81 (р < 0.001) with further positive dynamics. Conclusions. The application of the proposed RFA protocol in patients with LEVVD has a good safety profile, allows to minimize disease recurrences, performing the effect of “radiofrequency crossectomy”, and has a positive effect on the regression of clinical symptoms and quality of life indicators.