Endovenous Thermal Ablation Techniques for the Treatment of Large Diameter Incompetent Great Saphenous Veins

Tuesday, September 19, 2023

8:55 AM – 9:05 AM US EDT

Location: Grand Ballroom A

Introduction, Objectives, and/or Purpose: Endovenous thermal ablation techniques (EVTA) are recommended for the treatment of superficial vein incompetence. The aim of this study was to compare the 2 years outcomes of radiofrequency ablation (RFA) and 1470nm endovenous laser ablation (EVLA) for the treatment of large diameter, ≥12mm, incompetent great saphenous vein (GSV).

Methods: A single center prospective comparative study was undertaken including consecutive patients undergoing EVTA of GSV from February 2017 to December 2020. Patients were treated with either RFA (VNUS® ClosureFAST TM) or EVLA with 1470 nm (radial - ELVes® or linear- VenaCure®) fiber. According to the maximum GSV diameter measured on duplex ultrasound in the standing position, at the level of the thigh, patients were divided into 2 groups (group A < 12mm, group B≥12mm). Demographics, intra-operative details, Clinical classification (CEAP), 10-cm Visual Analog Scale (VAS) for pain, Venous Clinical Severity Score (VCSS) and Chronic Venous Insufficiency Quality-of-Life Questionnaire (CΙVIQ) were prospectively collected and retrospectivelly analyzed. Primary outcome was anatomic success defined as absence of reflux or recanalization of GSV. Secondary outcomes were procedure related complications, postoperative pain using the VAS scale and improvement of VCSS and CΙVIQ scores. assessed at 7- days, 1 month, 12 months and 24 months postoperatively.

Results: 176 patients (185 limbs) were included, 108 (59%) with GSV diameter < 12mm (group A) and 77 (41%) with GSV diameter ≥12mm (group B). Patients’ demographics, CEAP classification and length of ablated vein did not differ between the groups. Preoperative VCSS and VAS pain score were significant greater in group B (6.03 vs 6.94, p=0.04 and 5.21 vs 5.77, p=0.032, respectively). GSV occlusion rate at 1 month was 99% in group A and 97 % in group B (p=0.3), at 12 months 96% and 94% (p=0.5), and at 24 months 94% and 93% (p=0.4) respectively. No differences in adverse events were observed post-operatively among groups. Postoperative pain was similar in both groups (1.7±1.5 vs 2.2±1.9, p=0.06) at 7 days. In a subgroup analysis among different EVTA techniques and GSV diameter, RFA and EVLA showed comparable results in terms of occlusion rates and complications. At 2 years after intervention, a significant improvement in VCSS and CIVIQ scores occurred compared to preoperative assessment (p < 0.05).

Conclusion(s): EVTA techinques are efective and safe in the treatment of GSV incompetent regardless of the diameter of the GSV trunk. No difference was observed between 1470nm EVLA and RFA.

Presenting Author(s)

Christos Karathanos, MD, MSc, PhD

Consultant
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
Larissa, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.

PDF

Co-Author(s)

KS

Konstantinos Spanos, MD, MSc, PhD

Consultant
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
KB

Konstantinos Batzalexis, MD, MSc

Consultant
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
AB

Alexandros Barmpatis, MD

Dr
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
KD

Konstantinos Dakis, MD

Dr
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
GV

Georgios Volakakis, MD

Dr
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
AC

Athanasios Chaidoulis, MD

Dr
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
GK

Georgios Kouvelos, MD, MSc, PhD

Assistant Professor
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.
Athanasios Giannoukas, MD, MSc, PhD

Professor
Department of Vascular Surgery, University Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece, Greece

Disclosure(s):
The forementioned Program Planner, Faculty, Author, Moderator, or Speaker, has declared for this educational activity, having no relevant financial relationship(s) with ineligible companies to disclose.