Clinical outcomes of nonthermal ablation, thermal ablation, and surgical stripping for varicose veins

Hyangkyoung Kim; Nicos Labropoulos; Sungsin Cho; Kwangjin Lee; Jin Hyun Joh

doi:10.1016/j.jvsv.2024.101902

Clinical outcomes of nonthermal ablation, thermal ablation, and surgical stripping for varicose veins

J Vasc Surg Venous Lymphat Disord. 2024 May 15:101902. doi: 10.1016/j.jvsv.2024.101902. Online ahead of print.

Authors

Hyangkyoung Kim¹, Nicos Labropoulos², Sungsin Cho¹, Kwangjin Lee¹, Jin Hyun Joh³

Affiliations

¹ Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea.
² Department of Surgery, Stony Brook University Medical Center, New York, NY.
³ Department of Surgery, Ewha Womans University Mokdong Hospital, Seoul, Korea; Division of Vascular Surgery, Department of Surgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea. Electronic address: jhjoh@khu.ac.kr.

PMID: 38754778
DOI: 10.1016/j.jvsv.2024.101902

Abstract

Objective: The purpose of this study was to compare the clinical outcomes of radiofrequency ablation (RFA), cyanoacrylate closure (CAC), mechanochemical ablation (MOCA), and surgical stripping (SS) for incompetent saphenous veins and to determine a suitable treatment modality for a specific clinical situation.

Methods: We retrospectively reviewed the data of patients with varicose veins who underwent RFA, CAC, MOCA, or SS from January 2012 to June 2023. The clinical outcomes, including postoperative complications and the Aberdeen Varicose Vein Questionnaire score, were assessed.

Results: During the study period, 2866 patients with varicose veins were treated. Among them, 1670 patients (57.9%) were women. The mean age was 55.3 ± 12.9 years. RFA, CAC, MOCA, and SS were performed in 1984 (68.7%), 732 (25.4%), 78 (2.7%), and 88 (3.0%) patients, respectively. The complete target vein closure rate after RFA, CAC, and MOCA was 94.5%, 98%, and 98%, respectively. The absence of a target vein after SS was 98%. Deep vein thrombosis developed in four patients: one in the RFA group and three in CAC group. Surgical or endovenous procedure-induced thrombosis occurred in 2.3%, 4.8%, 6.4%, and 2.3% of the patients after RFA, CAC, MOCA, and SS, respectively. Phlebitis along the target vein occurred in 0.2% and 3.8% of patients after RFA and MOCA, respectively. A hypersensitivity reaction occurred in 3.7% of patients after CAC. Readmission was required for two patients who had undergone SS. Transient nerve symptoms developed in five (0.3%), zero, one (1.3%), and two (2.3%) patients after RFA, CAC, MOCA, and SS, respectively. After treatment, the Aberdeen Varicose Vein Questionnaire score improved significantly in all groups.

Conclusions: The clinical outcomes with improvement in quality of life were comparable among the different treatment modalities. The proximity of the nerve or skin to the target vein is the most important factor in selecting a suitable treatment modality.

Keywords: Mechanochemical ablation; Nonthermal ablation; Quality of life; Radiofrequency ablation; Surgical stripping; Varicose vein.