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October 17, 2008
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Mark H Smith, Jr.*1, James P. David2
1LSUHSC-Shreveport, Shreveport, LA;2Vascular Clinic Vein Care Center, Alexandria, LA
Background: Recently, endovascular techniques have become available as an alternative to open surgery for advanced venous stasis disease associated with pain, dermatitis and ulceration. This technique allows immediate ambulatory recovery and reduced morbidity. Much data has been published establishing the safety and effectiveness of radiofrequency ablation (RFA) in incompetent saphenous vein reflux; however, little data exists detailing results of RFA as applied to perforator vein reflux. We present our first treatment experiences and evidence supporting the safety and clinical efficacy for treatment of perforator vein reflux with RFA.
Methods: This was a retrospective cohort study in which lower limbs treated for perforator vein incompetence with RFA were studied. All extremities underwent preoperative clinical examination and standing duplex ultrasound and were found to have incompetent perforator veins. When present, additional locations of venous reflux including saphenous reflux were also identified and addressed. Preoperative and postoperative clinical scoring of venous reflux disease was assessed using the CEAP (Clinical-Etiology-Anatomy-Pathophysiology) system. Postoperatively, patients were followed with duplex ultrasound and clinical examination.
Results: A total of 78 lower limbs were treated in 76 patients (18 men and 58 women) aged 30 through 83 years (mean age 62.17 years) over 29 months. Concomitant venous reflux disease in greater, lesser saphenous or accessory saphenous veins was treated with RFA in 29 of 78 (37.2%) of patients. Perforator vein reflux alone was treated in the remaining 49 of 78 (62.8%) cases. The average number of perforator veins ablated per patient was 3.54. Preoperative CEAP class distribution was C3 56.4%, C4 16.7%, C5 2.6%, C6 24.3% (mean = 3.95). Postoperative CEAP class distribution was C1 44.9%, C2 42.3%, C3 12.8% (mean = 1.68). Three patients’ preoperative CEAP scores (all C3) were unimproved after surgery (3.8%); none worsened. Improvement of CEAP scores was highly statistically significant in all groups: perforator-only (P < 0.0001), perforator and saphenous, (P<0.0001) and both combined (P<0.0001, all by paired samples t test). No cases of postoperative deep venous thrombosis or pulmonary embolism were observed. All patients were treated as outpatient and ambulated immediately after the procedure. No patients required hospitalization.
Conclusion: RFA is a safe, minimally-invasive outpatient procedure with good clinical results and minimal morbidity for treatment of incompetent lower extremity perforator veins, either in conjunction with saphenous vein disease or separately.
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Outpatient Management of Venous Reflux with Radiofrequency Closure of Incompetent Perforator Veins in a Clinical Practice
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Mark H Smith, Jr.*1, James P. David2
1LSUHSC-Shreveport, Shreveport, LA;2Vascular Clinic Vein Care Center, Alexandria, LA
Background: Recently, endovascular techniques have become available as an alternative to open surgery for advanced venous stasis disease associated with pain, dermatitis and ulceration. This technique allows immediate ambulatory recovery and reduced morbidity. Much data has been published establishing the safety and effectiveness of radiofrequency ablation (RFA) in incompetent saphenous vein reflux; however, little data exists detailing results of RFA as applied to perforator vein reflux. We present our first treatment experiences and evidence supporting the safety and clinical efficacy for treatment of perforator vein reflux with RFA.
Methods: This was a retrospective cohort study in which lower limbs treated for perforator vein incompetence with RFA were studied. All extremities underwent preoperative clinical examination and standing duplex ultrasound and were found to have incompetent perforator veins. When present, additional locations of venous reflux including saphenous reflux were also identified and addressed. Preoperative and postoperative clinical scoring of venous reflux disease was assessed using the CEAP (Clinical-Etiology-Anatomy-Pathophysiology) system. Postoperatively, patients were followed with duplex ultrasound and clinical examination.
Results: A total of 78 lower limbs were treated in 76 patients (18 men and 58 women) aged 30 through 83 years (mean age 62.17 years) over 29 months. Concomitant venous reflux disease in greater, lesser saphenous or accessory saphenous veins was treated with RFA in 29 of 78 (37.2%) of patients. Perforator vein reflux alone was treated in the remaining 49 of 78 (62.8%) cases. The average number of perforator veins ablated per patient was 3.54. Preoperative CEAP class distribution was C3 56.4%, C4 16.7%, C5 2.6%, C6 24.3% (mean = 3.95). Postoperative CEAP class distribution was C1 44.9%, C2 42.3%, C3 12.8% (mean = 1.68). Three patients’ preoperative CEAP scores (all C3) were unimproved after surgery (3.8%); none worsened. Improvement of CEAP scores was highly statistically significant in all groups: perforator-only (P < 0.0001), perforator and saphenous, (P<0.0001) and both combined (P<0.0001, all by paired samples t test). No cases of postoperative deep venous thrombosis or pulmonary embolism were observed. All patients were treated as outpatient and ambulated immediately after the procedure. No patients required hospitalization.
Conclusion: RFA is a safe, minimally-invasive outpatient procedure with good clinical results and minimal morbidity for treatment of incompetent lower extremity perforator veins, either in conjunction with saphenous vein disease or separately.
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