Jack L. Eidson1, Deepa Raghunathan1, Marvin D. Atkins1, Clifford J. Buckley1, Ruth L. Bush2, William T. Bohannon1
1Vascular Surgery, Scott and White, Temple, TX; 2Central Texas VA Hospital, Temple, TX.
OBJECTIVES: Endovenous ablation of the great and small saphenous veins has become the standard surgical therapy for the treatment of chronic venous insufficiency (CVI). Vein recanalization following radiofrequency ablation (RFA) has been described. This study reviewed the incidence of and risk factors for developing recanalization after successful ablation.
METHODS: This two-center retrospective study reviewed 249 limbs that underwent RFA of either the great (GSV) or small saphenous vein (SSV) over a three-year period, and for which an intermediate duplex ultrasound was available. All cases of saphenous recanalization (n=16, 6.4%), were identified and the associated patient data, including comorbidities and need for additional interventions, were analyzed.
RESULTS: Seventeen limbs demonstrated either segmental (9, 53%) or complete (8, 47%) recanalization of the GSV after initial successful ablation. Recanalization was associated with higher rate of symptom recurrence (41% vs. 21%, RR 2.75, 95% CI, 0.99-7.6) and need for a second vein procedure in the affected limb (35% vs. 12%, RR 3.96, 95% CI 1.3-11.7). Two GSVs required a second endovenous ablation for persistent venous ulcers. Concomitant diabetes, hyperlipidemia, anticoagulation use, antiplatelet use, presence of deep reflux, or tobacco use did not increase the risk of recanalization. Comparatively, patients with GSV recanalization had a longer mean follow-up (63.3 vs. 41.6 weeks) but no difference in disease severity (C4, 35% vs. 17%; C5, 18% vs. 15%; C6, 6% vs. 8%, NS).
CONCLUSIONS: GSV recanalization following RFA for the treatment of CVI appears to be a sporadic phenomenon without clearly associated risk factors. Recanalization, although often involving an isolated segment of the great saphenous vein, is associated with a two-fold increase in symptom recurrence and the need for interval vein procedures. Follow-up ultrasound interrogation is recommended especially in patients with persistent or recurrent symptoms or ulceration.
AUTHOR DISCLOSURES: M. D. Atkins, Nothing to disclose; W. T. Bohannon, Nothing to disclose; C. J. Buckley, Nothing to disclose; R. L. Bush, Nothing to disclose; J. L. Eidson, Nothing to disclose; D. Raghunathan, Nothing to disclose.
Posted April 2012