ABSTRACT
Stephanie D. Talutis, MD, MPH
Vascular Surgery Fellow
University of California Los Angeles
Los Angeles, California, United States
Microfoam sclerotherapy (MS) and radiofrequency ablation (RFA) are both approved by the FDA for treatment of proximal saphenous truncal veins. The objective of this study was to compare early post-procedure outcomes between MS and RFA following treatment of incompetent thigh saphenous veins.
Methods:
A retrospective review of a prospectively maintained database was conducted in patients who underwent treatment of incompetent great saphenous (GSV) or accessory saphenous veins (ASV) in the thigh. All patients underwent postoperative duplex ultrasound scanning of the treated leg at 48-72 hours. Patients were excluded from analysis if concomitant stab phlebectomy was performed. Demographic data, CEAP class, venous clinical severity score (VCSS), and adverse events were recorded.
Results:
Two hundred consecutive limbs treated between June 2019 and July 2022 with either RFA (n=100) or MS (n=100) were identified. Patients were predominantly female (72%) with a mean age of 64 years (Table 1). Preoperative CEAP classification was similar between the MS and RFA groups (Table 1). Mean preoperative Venous Clinical Severity Score (VCSS) was 9.3 ± 2.6 in RFA patients and 9.6 ± 3.2 in MS patients (p=0.457). Among RFA patients, the GSV was treated in 98% and ASV in 2%, compared with 82% GSV and 18% ASV in the MS group (p < 0.001). Mean postoperative VCSS score declined to 7.3 ± 2.1 in RFA patients and 7.9 ± 2.6 in MS patients (p=0.10). Early occlusion rates were 100% following RFA and 98% in the MS group (p=0.497). Incidence of superficial tributary phlebitis was significantly higher following MS (14% vs 4%, p=0.024). Deep venous proximal thrombus extension (RFA 1% vs MS 4%, p=0.369) and remote deep venous thrombosis (DVT) (RFA 0% vs MS 2%, p=0.497) were also more frequent following MS, although this did not reach statistical significance. All adverse thrombotic events (ATE’s) occurred after treatment of the GSV in both groups. All were asymptomatic and resolved with short-term anticoagulation.
Conclusions:
Microfoam sclerotherapy and RFA are both safe and effective treatments for treating incompetent thigh saphenous veins resulting in excellent early vein closure rates and improved post-procedure clinical outcomes. There was a trend towards higher risk of superficial thrombophlebitis and proximal deep vein thrombus extension in the MS group but this was not statistically significant. Microfoam sclerotherapy can be safely performed with routine post-procedure ultrasound surveillance. Routine post-procedure imaging is not required following RFA due to the low frequency of ATE’s in this group.