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Recanalization after Endovenous Thermal Ablation
Ahmad A. Alsheekh, M.D, Anil Hingorani, M.D, natalie marks, M.D, enrico ascher, M.D.
Total Vascular Care, Brooklyn, NY, USA.
Endovenous thermal ablation in the form of radiofrequency or laser therapy has quickly ascended to a prime position in the treatment of reflux within the lower extremity superficial venous system.While there is good data examining the rates of thrombotic complications, there is a relative paucity of data examining their rates of recurrence.
Data analysis was performed for1475thermal ablations in485patients from2012-2015with superficial venous reflux.Data were collected from office visits and duplex venous scans one week after the procedure and every3months for the first year and every 6 months thereafter.Recanalization was defined by duplex demonstrated patency of targeted vein with > 500ms.RFA used in1027patients and laser in448patients.Targeted veins were:great saphenous vein GSV(778),short saphenous vein SSV(401),accessory vein(140)and calf perforators(156).Data for recurrence were correlated with age,gender,laterality,presenting symptoms,and targeted vein.Analysis performed using X2,student`s T-test.
The overall average classification of the presenting symptoms by CEAP was 3.9.There was a significant difference in the age between RFA (61.1years)and laser(74.6years)(P<.001).We analyzed the results of venous duplex scans on the veins one week after the thermal ablation and found that women(2.6%)had higher failure of obliteration than men(1.9%)(P=.018).Excluding perforator veins,there was no statistical difference at one week between RFA and laser for recurrences(P=.96).At one week,perforator veins had the highest failure of obliteration(16.6%)followed by accessory veins(2.9%),compared to the other veins(P<.001).Failure of obliteration rate for GSV and SSV was0.8%and0.8%respectively(P=.98).There was no significant correlation of failure of obliteration after thermal ablation at one week with age,laterality and presenting symptoms.Excluding perforating veins,after mean follow up period13.5months±12,there was no statistical difference with recurrence rates between RFA(10%)and laser(8.8%)(p=.54).Recanalization rates for GSV and SSV were7.7%and8.5%respectively (P=.63).Perforators and accessory veins had the most recanalization rate41.2%,14.8%respectively(P<.001).Not including the perforator veins,only56%of patients with recanalization after the follow up period were symptomatic(pain, swelling or ulcers).There was no significant correlation of obliteration at time of last follow up with respect to age,gender,laterality,and presenting symptoms.
These data do suggest low overall rates of recurrence after thermal ablation of the GSV and SSV.At midterm follow up,accessory veins had almost double the rate of recurrence as compared to GSV and SSV,and the perforator veins had almost five times the rate of recurrence. Excluding perforator veins,there no significant difference between RFA and laser in terms of recurrence.
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