Ultrasound-Guided Percutaneous Electrocoagulation of Pathological Perforating Veins in the Treatment of Advanced Chronic Venous Insufficiency of the Lower Extremities: A Retrospective Cohort Study

Abstract

Background

To assess the efficacy and safety of ultrasound-guided electrocoagulation for pathological perforating veins in advanced lower extremity chronic venous insufficiency.

Methods

This study enrolled 455 patients (497 affected limbs) with venous insufficiency. Pathological perforating veins (diameter ≥3.5 mm, reflux duration >500 ms) underwent ultrasound-guided percutaneous trocar-assisted electrocoagulation, while the main trunk of great saphenous vein was treated with endovenous radiofrequency ablation under tumescent anesthesia or local anesthesia. Comparative evaluation of preoperative and postoperative parameters, including Venous Clinical Severity Score (VCSS), ulcer healing status, cutaneous induration, inflammatory markers, pain intensity, and compliance with therapeutic compression therapy, was performed to validate the safety and efficacy of the surgical procedure.

Results

The VCSS of patients at 3, 12, and 24 months postoperatively were (10.30 ± 4.57) points, (4.52 ± 2.00) points and (1.38 ± 1.31) points, respectively, showing a continuous decline compared to the preoperative score of (16.09 ± 6.63) points, with statistically significant differences (P < 0.001). In addition, statistically significant differences were observed in the comparisons between the VCSS at 3 months and 12, 3, and 24 months as well as 12 and 24 months postoperatively (P < 0.001). All patients with lower limb ulcers achieved complete ulcer healing. Four patients experienced ankle pain while walking, which resolved within 2 weeks. No cases of deep vein thrombosis, hematoma, saphenous nerve injury, arterial ischemia, or infection were observed.

Conclusion

Through a retrospective cohort analysis incorporating duplex ultrasonography and standardized clinical outcome metrics, significant improvements in hemodynamic parameters and ulcer healing rates were observed. Ultrasound-guided cannular electro- coagulation of pathological perforating veins demonstrates encouraging safety and efficacy profiles in the management of severe chronic lower extremity venous insufficiency.