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 PVSS3. Should Endovenous Ablation of Small Diameter Great Saphenous Veins be Performed on Patients with Symptomatic Varicose Veins?

​Steven Perrins, Andrew Cha, Dahlia Plummer, Richard Hsu, Alan M. Dietzek
Surgery, Danbury Hospital, Danbury, CT.

OBJECTIVES: The efficacy of radiofrequency ablation (RFA) for symptomatic varicose veins is well established. Alternatively, there is less consensus and little data on outcomes when treating great saphenous veins (GSV) of small diameter (≤5 mm). To this point, there are national insurance carriers that deny coverage for endovenous ablation for patients with small GSV citing lack of proven benefit. The purpose of this study is to assess clinical and anatomical outcomes of RFA on small diameter, symptomatic GSV at 3 months.

METHODS: A retrospective analysis was performed of our patients who received RFA of incompetent GSV without any concomitant adjunctive procedures between January 2008 and December 2011. Limbs with a maximum GSV thigh diameter ≤ 5 mm on duplex while standing were subject to review. Clinical success was defined as an improvement in Venous Clinical Severity Score (VCSS) at 3 months. Anatomic success was defined as absence of venous flow ≤ 3 cm distal to the saphenofemoral junction (SFJ) on duplex ultrasound examination. Changes in CEAP class were noted.

RESULTS: In 307 patients, 54 limbs in 44 patients met inclusion criteria. Baseline median VCSS was 4 (interquartile range 4, 5). Clinical success was seen in 83% of limbs at 3 months with a median VCSS change of -2 (IQR -3, -1). None of the treated limbs had phlebectomy for symptomatic varicosities prior to 3 month follow-up. One phlebectomy was performed for cosmesis at 78 days post procedure. Anatomic success was achieved in 96% of limbs at 3 months. Baseline median CEAP was 2 (IQR 2, 2). The median CEAP change at 3 months was 0 (IQR -1, 0).The only complication was a thrombus extension into the SFJ at 4 days.

CONCLUSIONS: In our experience, RFA of symptomatic small diameter GSV provides comparable clinical and anatomic outcomes to that of current published data. Our findings suggest that these patients benefit clinically from the RFA procedure and should not be denied this treatment based upon vessel diameter alone.

AUTHOR DISCLOSURES: A. Cha, Nothing to disclose; A. M. Dietzek,: Covidien, Speaker’s bureau; R. Hsu, Nothing to disclose; S. Perrins, Nothing to disclose; D. Plummer, Nothing to disclose.

Posted April 2012

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