Clinical Results 5 Years after Radiofrequency Ablation of Saphenous Veins.

Objectives: In Japan, radiofrequency ablation (RFA) was covered by insurance in 2014. Regarding the early results, there are many reports that it is excellent, but the long-term results are rarely shown. Therefore, the purpose of this study was to examine the results up to 5 years after RFA, which was the only means of endovascular treatment at my facility, and to evaluate recurrent varices after surgery (REVAS), reoperation, and complications.

Methods: In 2017, 275 consecutive cases (male 83, female 192, 67.5 ± 10.0 years old), involving 350 limbs (C2, 3, 4a, 4b, 5, 6 = 217, 18, 89, 18, 1, 7) and 354 veins (great saphenous vein [GSV]: 290, small saphenous vein [SSV]: 64), underwent RFA. Postoperative follow-up was usually performed at 3 days (100%), 1 week (100%), 1 month (99.4%), and 6 months (93.5%) after RFA. Of the 334 patients contacted 5 years later, 327 (92.4%), excluding deaths from other diseases, were interviewed about reoperation, recurrence, and neuropathy. Of these, 223 patients (63%, GSV: 180, SSV: 43) underwent an ultrasound examination.

Results: Endovenous heat-induced thrombosis (EHIT) of more than grade 2 occurred in 5.9% of cases (GSV: 6.6%, SSV: 3.1%) and regressed within 1 month in all cases using anticoagulant therapy. Neuropathy occurred in 6.3%, mainly in GSV full-length ablation cases, and 41% of these disappeared completely between 6 months and 5 years after RFA. The reoperation rate up to 5 years after RFA was 10.7% (GSV: 9.7, SSV: 15.6%). In the reoperation cases after the RFA of GSV, the sites of reflux were 14 incompetent perforating veins (IPVs), 7 deep venous junction-related, and 6 distal GSVs. In the reoperation cases after the RFA of SSV, there were 5 IPVs and 3 isolated branch varices. The time of diagnosis of recurrence by ultrasonography was within 6 months of regular follow-up in 61% of GSVs and 79% of SSVs. The occlusion rate after 5 years was 98.9% for GSV and 95.3% for SSV. Only 1 recanalized vein was symptomatic and underwent retreatment. After RFA of GSV, 80% of accessory saphenous veins were retained at 5 years.

Conclusions: 1) The 5-year results after RFA were generally good. 2) IPV played the most important role in reoperation cases by REVAS after RFA of the saphenous veins. 3) The majority of postoperative recurrences could be identified by follow-up up to 6 months. 4) Neuropathy after RFA disappeared completely in half of the cases within 5 years. 5) After GSV-RFA, accessory saphenous vein blood flow persisted in most cases. (This is a translation of Jpn J Phlebol 2024; 35: 403-408.).