Success Rate and Predictive Factors for Redo Radiofrequency Ablation of Perforator Veins
Afsha Aurshina, MBBS, Enrico Ascher, MD, Ahmad Alsheekh, MD, Anil Hingorani, MD, Amrit Hingorani, Sheila Blumberg, MD, Natalie Marks, MD.
Total Vascular Care, Brooklyn, NY, USA.
Objectives:Radiofrequency ablation (RFA) has become the primary modality of treating perforator vein insufficiency. Previous studies have shown a closure rate of 60-80% in incompetent perforator veins (IPVs) with RFA. The purpose of the study was to determine utility of redo RFA for symptomatic recanalized perforators and predict factors associated with recanalization. Methods: A retrospective analysis of 642 procedures in 256 patients with venous insufficiency due to IPVs from 2009-2015 was conducted. A redo ablation was done in 52 IPVs (28 patients) including 13 women, with mean age of 65 years (SDą 15). The patients had presenting symptoms of CEAP: 0-C1, 0- C2, 5-C3, 13-C4a, 9-C4b, 0-C5 and 25-C6. The 52 IPVs were distributed in calf(40) and ankle(12). The mean maximum diameter of targeted veins was 4.6 mm (SDą 1.1). Post-operative duplex scans were performed after 3-7 days. Successful obliteration was defined as lack of color flow. Follow-ups were conducted every 3 months in the first year and 6 monthly thereafter. Results: The initial success rate was 64.9%. Repeat procedure done in the 52 recanalized IPVs had an early closure rate of 67.3 %. At follow-up after a mean duration of 24 months(SDą16.8), the closure rates were 65.38%. No complications (burns, skin necrosis, wound infection, arterial/nerve injury) were observed. The rate of deep venous thrombosis was < 1% and involved only focal segments of the tibial veins. No clinical correlation observed between successful obliteration in the redo and age (P=.54), gender (P=.14), presenting symptoms of CEAP (P=.82), laterality (P=.84) or location of the vein (P=.54). When data was compared to predict factors, IPVs located in mid and distal calf areas tended to recanalize more compared to ankle (P=.04). Temperature of RFS probe showed linear association with patients treated at 85C having higher probability of recanalization compared to 90C and 95C (P=.01). Otherwise, age (P=.90), gender (P=.66), presenting CEAP symptoms (P=.36), laterality (P=.38) and vein diameter (P=.36) were not predictive for recanalization. Conclusions: The rate of successful closure for incompetent perforator veins on initial and redo procedure are comparable. The data validates utility of redo perforator vein closures and indicates temperature of the RFS probe and location of IPVs may be predictive of a successful outcome or recanalization.
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