ABSTRACT
Tomohiro Ogawa, MD
Director
Fukushima Daiichi Hospital
Fukushima, Fukushima, Japan
Inappropriate use of endovenous ablation for varicose veins is a big issue for many phlebological societies. Guidelines for chronic venous disease recommend that symptomatic saphenous varicose veins is a good indication for saphenous ablation. However, the improvement of QOL after surgery for patients with primary varicose mild venous reflux, is unclear. The purpose of this prospective study was to identify the improvement of QOL after endovenous ablation of GSV in patients with mild venous reflux (MVR).
Methods:
129 patients (149 legs) with symptomatic primary varicose veins underwent endovenous ablation (Female/Male ratio 85/44, average age 69 y.o, 1470 nm Diode laser with 2 rings radial fiber for 88 legs, and Venaseal Closure for 61 legs) of GSV, with more than 1 year follow-up, participated in the study. The indication was symptomatic varicose veins with GSV axial reflux from saphenofemoral junction to at least knee level.
Varicose veins where venous filling index by Air plethysmography before surgery was less than 2 ml/sec were defined as MVR. Duplex ultrasound scanning (DUS) of the leg veins was performed before surgery and 1 and 12 months after surgery. Venous Clinical Severity Scoring (VCSS) and Aberdeen questionnaire (AVVQ) assessment were conducted before surgery and 1 and 12 months after surgery. The improvement of VCSS and AVVQ in patients with MVR after operation was compared to patients with moderate to severe reflux (SVR).
Results:
20 legs (C2: 7 legs, C3:13 legs in CEAP classification) were categorized as MVR, 129 legs (C2: 47 legs, C3: 47 legs, C4a: 22 legs, > C4a 13 legs) were categorized as SVR.
2 legs with additional sclerotherapy of varicose vein were found in MVR group. 2 legs of recanalized GSV during follow up and 32 legs with additional sclerotherapy or phlebectomy of varicose veins were found in SVR group.
Pre operative average GSV diameter was 3.53 ±0.79 mm in MVR group, 4.57 ±1.07 mm in SVR group (P < 0.01).
VCSS and AVVQ in both groups improved significantly at post operative 1 and 12 months.
MVR group | Pre | Post 1 M | Post 12 M | Pre vs Post 1M | Post 1M vs 12M |
Average VCSS | 3.04 | 1.28 | 0.14 | P < 0.01 | P < 0.01 |
Average AVVQ (%) | 15.3 | 9.1 | 0.3 | P < 0.01 | P < 0.01 |
SVR group | Pre | Post 1 M | Post 12 M | Pre vs Post 1M | Post 1M vs 12M |
Average VCSS | 4.58 | 1.31 | 0.69 | P < 0.01 | P < 0.01 |
Average AVVQ (%) | 16.9 | 8.9 | 3.5 | P < 0.01 | P < 0.01 |
Endovenous ablation for symptomatic primary varicose vein with mild GSV reflux is considered to be appropriate from the improvement of VCSS and QOL.