Radiofrequency obliteration of veins in surgical treatment of varicose disease

Shaidakov E.V.¹, Petukhov A.V.², Ilyukhin E.A.³, Grigoryan A.G.⁴

1) Scientific Research Institute for Experimental Medicine under the Russian Academy of Medical Sciences,
2) Clinic for Phlebology and Medical Cosmetology "Artmedia",
3) Clinic "Medalp",
4) Clinic of Surgery and Advanced Medical Training No1 named after I.A. Kupriyanov under the Military Medical Academy, St. Petersburg, Russia

Objectives: 1) To show the role and place of endovenous radiofrequency obliteration (RFO) in removing the vertical reflux in the varicose major superficial large-diameter veins. 2) To assess the outcomes of treatment of patients with varicose disease and to determine their correlation with the scales VCSS, VSDS and CEAP.

Materials and methods. Endovascular methods, the technique of endovascular radiofrequency (RFO) ClosureFAST belongs to, are intended to within the shortest terms remove reflux without disturbing the patient’s habitual way of life and along with it to improve the main aspects of quality of life.From 2009 to 2011, we operated on 110 patients (a total of 135 extremities). The mean age amounted to 41 years. Patients with an ostium-adjacent venous diameter of less than 1.3 cm were excluded from the sample, 37% of patients had various trophic impairments, 41% of patients had various concomitant somatic pathology, and 17% of patients had the body weight index (BWI) exceeding 30. Diagnosis and severity of the disease were formed with due regard for the scales of disease severity VCSS, VSDS and CEAP, as well as the worked out diagnostic algorithm. The venous status was evaluated by the findings of the objective examination and triplex angioscanning. The groups of patients with reflux along the altered venous segments were distributed as follows: 32.6% of patients – the superior vena cava with the classical course, 8% – the inferior vena cava, 7% – vein of Giacomini, 16% – the anterior accessory vein, 8% – the anterior lateral inflow, 28.4% – the extrafascial course of the vessel. The pain factor according to the analogue scale amounted to 0.8. In the postoperative period, the patients were followed up and examined on day 3, day 10 and then after 1, 3, 6, 12 months and more.

Results. RFO was successfully used in patients in all venous basins irrespective of the diameter and anatomical course of the venous structures. In 98% of cases we managed to achieve occlusion with the removal of the reflux within the terms of up to one year. Regress of clinical symptoms and improvement of quality of life were reflected in the VCSS. 100% of patients returned to the habitual activity on the day of operation.

Conclusion. RFO with obvious efficacy may be used in various topographical areas of lower limbs regardless of the veins’ diameter and their anatomical course. RFO is a method of choice in patients with high BMI and accompanying somatic pathology. Ambulatory follow up of patients with severe somatic pathology is possible, independently of decompensation of venous pathology. Clinical scales of the disease severity VCSS and VSDS are convenient in use, clearly reflecting the dynamics of the disease in the pre- and postoperative periods, which makes it possible to recommend them for wide application along with other scales on studying quality of life.

KEY WORDS: radiofrequency obliteration, varicose disease.

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