Single-Center Study Evaluates One-Step Treatment for Venous Insufficiency

August 6, 2015—A single-center investigation of combining radiofrequency ablation (RFA) with ultrasound-guided foam sclerotherapy (UGFS) in an office practice to treat venous insufficiency concluded that this therapy lowers the incidence of thrombophlebitis in the tributary veins. The findings were published by George Nahhas, MD, with colleagues Farah Jarjous, BS, and Rafi Jarjous, BS, in the Journal of Clinical Medicine Research (JCMR; 2015;7:681–684).

The investigators concluded that using this one-step approach with RFA and UGFS allowed for more complete resolution of venous reflux disease with lower complication rates in comparison with a traditional office-based staged strategy. They advised that this could have implications for cost savings to both the patient and the health care system.

For the study, all refluxing veins presenting to the investigators were treated in one office-based procedure of combined RFA and UGFS to compare this approach to a traditional two-step treatment of first ablating the great saphenous vein (GSV) and the short saphenous vein (SSV) with RFA. In the second step during a later session, the remaining refluxing tributaries are treated with UGFS or microphlebectomy. This traditional approach is associated with an increased risk of thrombophlebitis while awaiting the second procedure, noted the investigators.

As summarized in JCMR, this controlled, nonrandomized clinical trial evaluated the treatment of 72 extremities with vein incompetence in 63 consecutive patients aged 26 to 78 years. Sixty-three extremities (87.5%) received treatment for reflux in the GSV, 10 extremities (13.9%) were treated for reflux in the SSV, and 11 extremities (15.3%) were treated for reflux in the perforators. Reflux duration of more than 1 second to increase specificity and truncal vein diameter > 5 mm were identified in the treated limbs.

The single-procedure treatments involved delivering thermal energy via RFA to the truncal vein and perforating vein, then using UGSF to close the tributary and accessory veins. 

The results were monitored at 1 week and 6 weeks postoperatively by venous duplex ultrasound.

The investigators found that 100% of the treated GSV and SSV and 91.7% of tributary veins were completely closed after the index procedure. Additionally, only 10 of 72 extremities (13.9%) needed a follow-up treatment to achieve closure of the perforator and accessory veins. By combining RFA with UGFS, the patient cohort did not experience thrombophlebitis or deep vein thrombosis postoperatively. No major or minor complications were found upon follow-up evaluation, reported the investigators in JCMR.