Endovenous radiofrequency ablation of lower extremity varicose veins: short-term outcomes of the initial experience

Context Radiofrequency ablation (RFA) has proven acceptable efficacy and safety in the treatment of truncal varicose veins. Faulty technique may, however, result in primary failure or serious complications, especially during the early time points of the surgeon's learning curve. Aim The aim of the present study was to evaluate the safety and effectiveness of RFA procedures in the treatment of great saphenous vein reflux during the initial experience in endovenous thermal ablation. Materials and methods A retrospective review was conducted on 47 patients with varicose veins of clinical, etiological, anatomical, physiological (CEAP) class 2-6 who received RFA at the Department of Vascular and Endovascular Surgery, Assiut University Hospitals, to treat refluxing great saphenous veins between 2014 and 2016. Outcome measures were technical success rate and perioperative complications. Short-term outcomes included complete occlusion of the ablated veins and symptom improvement at 1 year. Results RFA achieved a technical success rate of 97.9%. Perioperative complications were paresthesia (10.6%), ecchymosis (6.4%), phlebitis (6.4%), and hyperpigmentation (2.1%). No skin thermal injuries, hematomas, deep venous thrombosis, or endovenous heat-induced thrombosis were detected. One-year complete occlusion rate was 87%. Vascular clinical severity score and venous disability score improved at 1 year to 1.08 +/- 0.85 versus 4.03 +/- 1.88 (P<0.0001) and 0.60 +/- 0.545 versus 1.55 +/- 0.552 (P<0.0001), respectively, compared with preoperative values. All treated CEAP-6 patients showed complete healing of their ulcers postoperatively. Conclusion RFA is an effective and safe procedure, with satisfactory technical success, closure rates, and symptom improvement. The procedure could be performed in centers with initial experience in endovenous thermal ablation, provided careful commitment to the procedure steps and guiding supervision.