Efficacy and safety of endovenous microwave ablation versus laser ablation for great saphenous vein varicosis: study protocol for a multicentre, randomised controlled non-inferiority trial

Li, Yongjun; Wu, Weiwei; Li, Younan; Li, Jing; Sun, Miao

doi:10.1136/bmjopen-2021-059213

Cited by 10 publications

(12 citation statements)

References 31 publications

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“…In a previous study compared between EMA and ELVA and they stated that EMA resulted in lower ecchymosis complications, but higher skin burns compared to EVLA [10] . Mao et al, [24] conducted a retrospective study comparing between EVLA and EMA and their results showed that EMA resulted in lower ecchymosis incidence, but higher skin burn than EVLA.…”

Section: Discussionmentioning

confidence: 99%

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Assessment of Endovenous Microwave Ablation with High Tie versus Traditional Surgery for Primary Varicose Veins

Ghweeba

2022

Medicine Updates

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Background:The high ligation and stripping (HLS) of great saphenous vein (GSV) is the traditional method for surgical treatment of varicose vein (VVs) with high postoperative recurrence rate up to 60%, slow recovery, and obvious scar. Endovenous microwave ablation (EMA) with high tie is considered a new technique of thermal ablation. We aimed to compare between (EMA) with high tie versus traditional surgery for lower limb VVs regarding return to activity, complications, recurrence rate, and affection the Quality of Life (QoL).Methods: This prospective comparative study was conducted on 50 cases, presented with symptomatic VVs, classified into two equal groups, EMA with high tie group and traditional surgery group. The complications and possibility of recurrence were evaluated during 3, 6, and 12 m post intervention. The effect on QoL was assessed by the Aberdeen Varicose Vein Questionnaire. Results:Operative incision was significantly fewer in EMA with high tie group (P value <0.001). Return to activity was significantly faster in microwave ablation group (P value <0.001). Incidence of Ecchymosis and sensory impairment were significantly lower in MA with high tie group. EMA is more Recurrence at 12 m was significantly lower in MA with high tie group compared to traditional surgery group with hazard ratio (95% confidence interval) 0.2836 (0.08855 to 0.9085) (P =0.033). AVVQ was insignificant between both groups during assessment.Conclusions: MA with high tie is an effective ablation method for VVs patients, that provides shorter time with less incisions, faster recovery with lower thermalrelated complications, and recurrence rate.

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Section: Discussionmentioning

confidence: 99%

“…The other techniques such as microwaves has considered to be safe with good clinical outcomes in treatment of VVs. EMA is a relatively new technique for thermal ablation therapy that produces thermal energy in a manner differ from EVLA [10] .…”

Section: Introductionmentioning

confidence: 99%

Assessment of Endovenous Microwave Ablation with High Tie versus Traditional Surgery for Primary Varicose Veins

Ghweeba

2022

Medicine Updates

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“…Endovenous microwave ablation (EMWA) is a relatively new catheter-based EVTA system. Although reasonable ablation rates have been reported 95-100% at 12 months [4][5][6] and even 98% at 5 years, 7 the power parameters currently used vary widely, from 20 W-65 W, [4][5][6][7] with a future multicentre randomised controlled study planning to use a power of 65 W. 8 Doctors working with EVLA report the energy used for ablation as the Linear Endovenous Energy Density (LEED) 9 the energy used per cm of vein treated. However, the wide variation of power, pullback and intermittent ablation and rest cycle combinations reported by those using EMWA have not included the LEED, 4-8, making comparing devices and reported outcomes challenging.…”

Section: Introductionmentioning

confidence: 99%

Defining the Parameters for Endovenous Microwave Ablation to Achieve Equivalence With Endovenous Laser Ablation, Using the Porcine Liver Model

Bachetta,

Cheung,

Moore

et al. 2024

Vasc Endovascular Surg

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Aims Endovenous microwave ablation (EMWA) is an endovenous thermoablation (EVTA) system to ablate incompetent truncal veins. Early results suggest that EMWA uses more power than endovenous laser ablation (EVLA) to get the same results. We aimed to define the parameters for EMWA, which give the same tissue ablation as EVLA, using the validated porcine liver model. Methods EVLA (1470 nm 600 micron radial fibre) treatments were performed at 6 W, 8 W and 10 W, at pullback speeds of 6, 7, 8 and 9 s/cm, giving Linear Endovenous Energy Densities (LEEDs) between 36 - 90 J/cm. Each combination of power and pullback was repeated 5 times. We then used EMWA in the same model. Powers of 35-75 W and pullback speeds of 4-9 s/cm were used (LEEDs 140-675 J/cm). Ablation tracts from both devices were analysed by 2 blinded observers, noting thermal spread and carbonisation. Results For each commonly used parameter for EVLA, we identified a range of parameters for EMWA that produced similar tissue ablation in the porcine liver model. To keep the pullback speeds within the usual range, powers of 35-75 W were needed with EMWA, with mean EMWA LEEDs 3.9 - 5.8 times higher than EVLA LEEDs. We found the quicker the pullback speed, the higher the multiple of EMWA LEED we needed to get the same effect. Conclusion We have identified parameters for EMWA that gave equivalent tissue ablation in the porcine liver model to commonly used parameters used for EVLA. These need to be validated clinically, but as the model used has already been validated against clinical outcome in endovenous thermal ablation, there is little reason to suspect that these results would not be valid. As the power during EMWA is higher than EVLA, EVMA LEEDs are approximately 4-6 times higher than EVLA LEEDs to achieve the same thermal effect on the tissues.

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“…The UMA for varicose veins presents as a promising alternative to conventional surgery, mainly due to its minimally invasive approach which significantly reduces the risk of postoperative wound infections. Additionally, UMA offers the advantages of shorter procedure times and reduced hospital stays, enhancing patient recovery and comfort 6,7 …”

Section: Introductionmentioning

confidence: 99%

Assessing postoperative wound infection rates in ultrasound‐guided microwave ablation versus conventional surgery for varicose veins

Wu,

Lu,

Cheng

et al. 2023

International Wound Journal

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Varicose veins are the prevalent vascular disorder that has conventionally been managed via risky postoperative wound infections and conventional surgery. While ultrasound‐guided microwave ablation (UMA) has gained attention as a minimally invasive alternative, there is still a lack of research examining its comparative effectiveness. A prospective comparative investigation was undertaken in the Zhejiang region of China from January to November 2023, involving 140 patients who had received the diagnosis of primary varicose veins. An equal number of 70 patients underwent UMA and conventional surgery. Exclusion criteria for the study encompassed adult patients aged 18–65, with the exception of those who had undergone prior venous surgery, deep vein thrombosis or peripheral arterial disease. The demographical characteristics, procedural details and complication profiles of patients who developed postoperative wound infections within 30 days were analysed statistically. The outcomes demonstrated that postoperative wound infections were significantly diminished (5.7%) with UMA in comparison to conventional surgery (17.1%). In addition, the average duration of procedures and length of hospital stay for UMA patients were both reduced, although neither of these differences was found to be statistically significant (p > 0.05). Infection management, age and gender distribution of varicose veins were comparable between the two groups (p > 0.05). A significant inverse correlation was observed between the severity of varicose veins and postoperative outcomes, as determined by the regression analysis (p < 0.05). Using UMA to treat varicose veins showed promise as an alternative to conventional surgery, specifically in minimizing the incidence of postoperative wound infections. Additional research and clinical consideration are needed regarding the potential transition toward minimally invasive techniques in treatment of varicose veins, as suggested by these results.

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Efficacy and safety of endovenous microwave ablation versus laser ablation for great saphenous vein varicosis: study protocol for a multicentre, randomised controlled non-inferiority trial

Cited by 10 publications

References 31 publications

Assessment of Endovenous Microwave Ablation with High Tie versus Traditional Surgery for Primary Varicose Veins

Assessment of Endovenous Microwave Ablation with High Tie versus Traditional Surgery for Primary Varicose Veins

Defining the Parameters for Endovenous Microwave Ablation to Achieve Equivalence With Endovenous Laser Ablation, Using the Porcine Liver Model

Assessing postoperative wound infection rates in ultrasound‐guided microwave ablation versus conventional surgery for varicose veins

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