Comparative 3-year results of phlebectomy and thermal ablation for lower limb varicose veins

Burleva E.P.¹, Tyurin S.A.², Smirnov O.A.³, Faskhiev R.R.²

1) Ural State Medical University of the RF Ministry of Public Health,
2) Municipal Clinical Hospital No40,
3) Medical Centre "Olmed", Yekaterinburg, Russia

Objective. The study was aimed at comparing clinical and ultrasonographic results during 3 years of postoperative follow up of patients presenting with lower limb varicose veins (LLVV) and subjected to either surgical or thermal-ablation procedures for removal of pathological reflux along the great saphenous vein (GSV) within the femur

The study included a total of 185 patients with clinical class C2–3 LLVV in the system of the GSV. The patients were divided into three groups: Group One consisted of 63 patients subjected to short stripping of the GSV trunk + treatment of the perforant veins (66.7%); Group Two comprised 61 patients undergoing endovenous laser coagulation (EVLC) of the GSV trunk + EVLC of the perforant veins (73.7%); Group Three was composed of 61 patients undergoing radiofrequency ablation of the GSV trunk + ELVC of the perforant veins (70.4%). Complaints were dynamically assessed by the VCSS scale with ultrasonographic duplex scanning.

It was revealed that pathological reflux along the GSV trunk on the crus at 1, 2 and 3 years of follow up was registered: in Group One in 33.3, 36.3 and 39.1% of cases, respectively; in Group Two in 15, 14.2 and 25% of cases, respectively; and in Group Three – in 11, 18.1 and 23.8% of cases, respectively. Group One patients at 1 year were found to have developed vertical refluxes emerging on the femur along the GSV tributaries (22.1% of cases), the presence of horizontal refluxes along newly-formed perforant veins (44.4% of cases). The diameter of the GSV trunk on the crus statistically significantly increased with years in all groups. The average diameter of the perforant veins increased at the same time periods of follow up. Alterations of venous haemodynamics revealed on ultrasonographic examination were accompanied by varicose syndrome but exerted no significant effect on subjective symptomatology in patients during 3 years of follow up.

The obtained findings are indicative of progression of LLVV in part of surgically treated patients, which requires dynamic follow up and carrying out systemic pharmacotherapy.

KEY WORDS: lower limb varicose veins, great saphenous vein, stripping, endovenous laser coagulation, radiofrequency ablation, venous bed of the crus.

P. 91

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