Stripping vs endovenous thermal ablation in varicose veins: 5 year clinical and hemodynamic results of a randomized study

Abstract

The aim of the study was to analyze the five-year clinical and hemodynamic results after minimally invasive phlebectomy and endovenous thermal ablation in patients with СVD class C2. The study included three groups of patients that differed in the technique of elimination of vertical GSV reflux within the thigh. The patients were stratified according to a certain hemodynamic profile: 1st group (stripping) included 63 patients; 2nd group (EVLC) — 61 patients; 3rd group (RFA) — 61 patients. A number of ultrasound hemodynamic parameters was studied in each group. The comparative study of the course of the late postoperative period was carried out; it included clinical examination, calculation of the total VCSS score, and ultrasound of the veins of lower extremities. As a result, it was found that in certain VV patients, after the removal of the GSV trunk within the thigh, a significant restructuring of the venous bed was observed in 1 year. It developed according to various scenarios. In the 1st group, medial and lateral overflows appeared on the thigh with drainage into the residual trunk; in the 2nd and 3rd group it was not observed, but the perforating reflux to the residual GSV trunk was gradually increasing. The restructuring of the venous bed caused valvular insufficiency of the trunk in 29 % of patients in the 1st group, 17.2 % in the 2nd group, and in 19.3 % of patients in the 3rd group by the 5th year of follow-up. As the pathological process was developing, the diameter of the GSV trunk on the shin was progressively increasing, and the summarized diameter of the PV of the lower leg was also increasing. By the 5th year of follow-up, perforant insufficiency was registered in 32.2 % of patients in the 1st group, 37.9 % in the 2nd group, and in 38.7 % of patients in the 3rd group. The changes detected during ultrasound had no significant effect on the clinic. The overall VCSS score decreased by the 1st year of follow-up after all interventions, and then remained consistently low in all groups over the years.