Vascular Health and Risk Management (Jul 2021)
Radiofrequency Ablation for Axial Reflux Associated with Foam Sclerotherapy for Varicosities in One-Step Approach: A Prospective Cohort Study Comprising Large Diameters Saphenous Veins
Abstract
Douglas Poschinger-Figueiredo,1 Carlos Eduardo Virgini-Magalhães,1,2 Luís Cristóvão Porto,3,4 Claudia Salvador Amorim,1 Cristiane Ferreira de Araujo Gomes,1 Cristina Ribeiro Riguetti-Pinto,1,2 Monica Rochedo Mayall,1 Leonardo Silveira de Castro,1 Felipe Borges Fagundes1 1Teaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Rio De Janeiro, Brazil; 2Medical Sciences College (FCM), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil; 3Histocompatibility and Cryopreservation Laboratory (HLA), Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil; 4Roberto Alcantara Gomes Biology Institute (IBRAG), Rio de Janeiro State University (UERJ), Rio de Janeiro, BrazilCorrespondence: Douglas Poschinger-FigueiredoTeaching and Health Care Unit of Vascular and Endovascular Surgery’s Medical Staff, Pedro Ernesto University Hospital (HUPE), Rio de Janeiro State University (UERJ), Boulevard Vinte e Oito de Setembro, N 77, 4th Floor, Vila Isabel, Rio De Janeiro, RJ, 20551– 030, BrazilTel +55 21 2686-8643Fax +55 21 2587-4010Email [email protected]: This study assessed the outcomes and impact on the quality of life following one-step outpatient radiofrequency ablation (RFA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV).Design: Prospective, single-centre, analytical cohort.Materials and Methods: Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RFA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in the Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked.Results: The sample was divided into two groups: (Group 1) GSV diameter ≥ 13.0 mm (median 19.0 [14– 24]), 17 subjects, and (Group 2) GSV diameter ≤ 12.9 mm (median 10.3 [10– 12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third-year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except for mental health in the Group 2 (GSV ≥ 13.0 mm). Overall first week occlusion rate for the whole sample was 90.9% and 69.7% at the 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time.Conclusion: Exclusively outpatient combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV or ulcer presence. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.Keywords: saphenous vein, varicose veins, varicose ulcer, quality of life, catheter ablation, sclerotherapy
