A Prospective Randomized Study Comparing Endovenous Radiofrequency Ablation and Conventional Surgery for Primary Great Saphenous Reflux

Abstract

Follow-up of patients for minimum period of 12 months is useful in early recognition of recurrent cases who may benefit from early re-intervention. To sum up, RFA therapy may be considered better than surgical option, especially regarding the reduction in pain and frequency of complications. However, although a minor complication has been reported with RFA but all of them were self limited; however multi-center studies with a higher number of patients are necessary to determine actual frequencies of minor complications in RFA.

Endovenous thermoablation techniques has been established as the first modality for treatment of primary varicose veins with high success rates (92% to 100%) in most studies. The radiofrequency technique uses a radiofrequency catheter guided by ultrasonographic imaging. The catheter increase the temperature of the vein wall by means of thermal energy delivered by a generator. The rise in temperature causes a denaturation of the intima and the media with contraction and thickening of the collagen fibres. These phenomena lead to fibrosis, gradually leading to occlusion of the venous lumen. Duplex ultrasound on affected limb is essential to determine diameter of GSV, competency of SFJ, site of incompetent perforators in addition to presence of AASV as well as patency of deep venous system. Conventional surgical intervention for GSV incompetency is associated with a high profile of complications such as pain, wound infections, hematomas, risk of adverse events such as femoral artery and/or vein damage, lymphatic complications and nerve damage, in addition to a high rate of recurrence.

Other disadvantages of surgical techniques are the mandatory use of general or epidural anesthesia unlike RFA which can be performed under local anesthesia. Also, presence of at least two long scars, high rate of postoperative pain and long postoperative time to return to work negatively affect quality of life in patient underwent varicose vein surgical stripping. On the other hand, the minimally invasive nature of the RFA and better cosmesis due to absence of scars and wound dehiscence, decreased postoperative pain, early postoperative return to work and decreased incidence of hematomas and pigmentation. This reflected positively on the morale and activity of the patients improving health related quality of life. Pathophysiology of recurrence included residual veins within one-month, true recurrent varicosities after one month and new non truncal varicosities due to disease progression. Neovascularization was reported more often following surgery compared to recanalization which was reported more often after RFA.