Superficial Venous Reflux Ablation Carries Low Risk

By Janice Rosenberg

CHICAGO -- Radiofrequency ablation, performed by a dedicated team of vascular surgeons with a high case volume, can improve short-term outcomes and reduce the incidence of deep vein thrombosis and pulmonary embolism in patients with symptomatic superficial venous reflux.

Data reported by Cynthia K. Shortell, M.D., of the University of Rochester (N.Y.), at the Vascular Annual Meeting indicated no increase in the risk of thromboembolic events or other complications in radiofrequency ablation, as well as good short-term success rates, compared with open surgery. "The results were superior to those previously documented, with a 99% success rate and 0.7% incidence of thromboembolic complications," Dr. Shortell said.

Endoluminal therapies for superficial reflux are becoming popular as an alternative to conventional high ligation and stripping. Reductions in pain, bruising, scarring paresthesias, and recovery time have been seen with endoluminal as compared to conventional procedures. The long-term results of the two procedures are comparable with regard to closure, reflux, and recurrence. Yet recent reports have raised concerns that the incidence of venous thromboembolic events might be increased after radiofrequency ablation.

Dr. Shortell reported on the outcomes of 286 patients who underwent radiofrequency ablation in 335 limbs in 2004. Their pre-, peri-, and postoperative evaluation and care were standardized according to institutional protocol and conducted by a study-dedicated staff at the University of Rochester.

The review included 50 men and 236 women, ranging in age from 18 to 71 years. Unilateral treatments were performed in 237 patients, simultaneous bilateral treatments in 31, and staged bilateral treatments in 18. The targeted vessel was the greater saphenous vein in 332 limbs and the long saphenous vein in 3 limbs.

Postoperative duplex ultrasound was performed in all patients to assess possible thrombotic complications and procedural results. One patient with deep venous thrombosis of the popliteal/calf was found to be hypercoagulable and placed on long-term anticoagulation. One patient presented to another hospital and was diagnosed with a pulmonary embolism, but the diagnosis was not documented.

This study is the largest single-academic-center experience involving radiofrequency ablation for greater saphenous vein reflux, said Dr. Shortell, concluding that the good outcomes were likely due to reliance on a standardized protocol by a dedicated surgical team and registered vascular technologists in a high-volume setting. Furthermore, the duplex ultrasonography findings in this series refute the hypothesis that cases of venous thromboembolism were being missed in such patients.

RESULTS WERE SUPERIOR TO THOSE PREVIOUSLY REPORTED: A 99% SUCCESS RATE AND 0.7% INCIDENCE OF THROMBOEMBOLIC COMPLICATIONS.