COMPARATIVE STUDY BETWEEN CONVENTIONAL SURGERY & ENDOVENOUS RADIOFREQUENCY ABLATION IN MANAGEMENT OF PATIENTS WITH PRIMARY VARICOSE VEINS

Abstract

Background: Conventional surgery has been used for a long time for treatment of varicose veins with variable degrees of minor to major complications. Endovenous RFA of VV has emerged as a practical and effective alternative to conventional surgery. Methods: This is a single center, non-randomized, non-blinded prospective study in which we evaluated short term results of both endovenous radiofrequency ablation & conventional surgery in management of truncal varicosities in patients with lower extremity primary venous insufficiency. The patients were divided into two groups; 50 patients in each group. The 1st group underwent conventional surgery in the form of high ligation of the saphenofemoral junction with short stripping to just below the knee.The 2nd group underwent endovenous radiofrequency ablation using the VNUS® radiofrequency generator and the closure fast® catheter (VNUS Medical Technologies, San Jose, CA) under duplex scan guidance. Results: RFA resulted in shorter duration of hospital stay, faster return to normal activities, less post-operative pain, better improvement of VCSS and CIVIQ2scores 6 months post-operative and less incidence of complications.Recurrence rates in both groups were not significantly different in this short term (6 months) follow up. Conclusion: Segmental radiofrequency ablation actually provides high ablation rates in conjunction with a very moderate side effect profile.. Further follow up ad studies is needed to improve the efficiency and decrease the incidence of complications and recurrence of this well established technique. A spectrum that needs more studies is the use of this technique in difficult, risky or recurrent cases making use of its minimal invasive nature and wide patients' acceptance and satisfaction. Keywords: Ablation, Endovenous, Radiofrequency, Surgery, Varicose, Veins. Abbreviations: BMI:Body Mass Index, CIVIQ2: Chronic Venous Insufficiency Questionnaire 2,DVT: Deep Venous Thrombosis, EHIT: Endothermal Heat Induced Thrombosis, GSV:Great Saphenous Vein, RFA:Radiofrequency Ablation, UGFS:Ultrasound-Guided Foam Sclerotherapy, VAS:Visual Analogue Scale, VCSS:Venous Clinical Severity Score.