Radiofrequency Ablation of Saphenous Veins: 5-year Clinical Results

Introduction, Objectives, and/or Purpose:

Introduction: In Japan, insurance coverage for radiofrequency ablation (RFA) began in 2014. There have been many reports that the early results were excellent, but the long-term results have rarely been reported. Therefore, the purpose of this study was to examine the results up to 5 years after RFA, which was the only means of endovascular treatment at my facility, and to evaluate recurrent varices after surgery (REVAS), re-operation, and complications.

Methods: Patients and methods: In 2017, 275 consecutive cases (male 83, female 192; age 67.5±10.0 years), 350 limbs (C2, 3, 4a, 4b, 5, 6=217, 18, 89, 18, 1, 7), 354 veins (great saphenous vein [GSV] 290, short saphenous vein [SSV] 64), underwent RFA. Postoperative follow-up was usually performed 3 days (100%), 1 week (100%), 1 month (99.4%), and 6 months (93.5%) after RFA. Of the 334 veins of the patients contacted 5 years later, the patients were interviewed regarding 327 veins (92.4%), excluding those who died from other diseases, about re-operation, recurrence, and neuropathy. Of these, 223 veins (63%; GSV 180, SSV 43) underwent ultrasound examination.

Results: Endovenous heat induced thrombus grade >2 occurred in 5.9% (GSV 6.6%, SSV 3.1%) and regressed within 1 month in all cases with anticoagulant therapy. Neuropathy occurred in 6.3%, mainly in GSV full-length ablation cases, and 41% of them disappeared completely between 6 months and 5 years after RFA. The re-operation rate up to 5 years after RFA was 10.7% (GSV 9.7%, SSV 15.6%). In the re-operation cases after GSV-RFA, the sites of reflux were 14 incompetent perforator veins (IPVs), 7 deep venous junction-related, 6 distal GSVs, etc. In cases after SSV-RFA, there were 5 IPVs, 3 isolated branch varices, etc. The time of diagnosis of recurrence by ultrasound examination was within 6 months of regular follow-up in 61% of GSVs and 79% of SSVs. The occlusion rate after 5 years was 98.9% for GSVs and 95.3% for SSVs. Only 1 recanalized vein was symptomatic and underwent retreatment. After GSV-RFA, 80% of accessory saphenous veins were retained at 5 years.

Conclusion(s): The 5-year results after RFA were generally good. IPV played the most important role in re-operation cases by REVAS after RFA of saphenous veins. The majority of postoperative recurrences could be identified by follow-up to 6 months. Neuropathy after RFA disappeared completely in half of cases within 5 years. After GSV-RFA, accessory saphenous vein blood flow persisted in most cases.