Endovenous Saphenous Ablation Corrects the Hemodynamic Abnormality in Patients with CEAP Clinical Class 3–6 CVI Due to Superficial Reflux

Abstract

This investigation was designed to determine whether minimally invasive radiofrequency or laser ablation of the saphenous vein corrects the hemodynamic impact and clinical symptoms of chronic venous insufficiency (CVI) in CEAP clinical class 3-6 patients with superficial venous reflux. Patients with CEAP clinical class 3-6 CVI were evaluated with duplex ultrasound and air plethysmography (APG) to determine anatomic and hemodynamic venous abnormalities. Patients with an abnormal (>2 mL/second) venous filling index (VFI) and superficial venous reflux were included in this study. Saphenous ablation was performed utilizing radiofrequency (RF) or endovenous laser treatment (EVLT). Patients were reexamined within 3 months of ablation with duplex to determine anatomic success of the procedure, and with repeat APG to determine the degree of hemodynamic improvement. Venous clinical severity scores (VCSS) were determined before and after saphenous ablation. Eighty-nine limbs in 80 patients were treated with radiofrequency ablation (RFA) (n = 58), or EVLT (n = 31). The average age of patients was 55 years and 66% were women. There were no significant differences in preoperative characteristics between the groups treated with RFA or EVLT. Postoperatively, 86% of limbs demonstrated near total closure of the saphenous vein to within 5 cm of the saphenofemoral junction. Eight percent remained open for 5-10 cm from the junction, and 6% demonstrated minimal or no saphenous ablation. The VFI improved significantly after ablation in both the RF and EVLT groups. Postablation, 78% of the 89 limbs were normal, with a VFI<2 mL/second, and 17% were moderately abnormal, between 2 and 4 mL/second. VCSS scores (11.5 +/-4.5 preablation) decreased significantly after ablation to 4.4 +/-2.3. Minimally invasive saphenous ablation, using either RFA or EVLT, corrects or significantly improved the hemodynamic abnormality and clinical symptoms associated with superficial venous reflux in more than 90% of cases. These techniques are useful for treatment of patients with more severe clinical classes of superficial CVI.

Validation of Venous Clinical Severity Score (VCSS) with other venous severity assessment tools from the American Venous Forum, National Venous Screening Program

“…There was no difference noted in correlation tables between VCSS and VTE risk assessment score comparing VCSS for all limbs and random sampling of VCSS based on one limb per participant. Based on the modified CIVIQ assessment, overall mean score for each participant (n ϭ 2907) as per general category included: Quality of Life (QoL)-Pain 6.04 Ϯ 3.12 (range, 3-15), QoL-Functional 9.90 Ϯ 5.32 (range, , and QoL-Social 5.41 Ϯ 3.09 (range, [3][4][5][6][7][8][9][10][11][12][13][14][15]. Overall correlation between CIVIQ and VCSS for all limbs was moderately strong (r s ϭ 0.43; P Ͻ .0001), with highest correlation noted for pain (r s ϭ 0.55; P Ͻ .0001) and edema (r s ϭ 0.30; P Ͻ .0001; Table V).…”

“…5,6 Despite lack of extended validation, there has been general acceptance and wide dissemination of VCSS for clinical and research purposes. [7][8][9][10][11][12][13][14] With the creation of the AVF, the National Venous Screening Program (NVSP) in 2005, and its expansion in 2007, 15,16 several standard venous assessment tools were incorporated into the screening process as independent determinants of venous disease severity, but correlation between these instruments as a global venous screening tool has not been tested. The scope of this study is to assess the validity of VCSS and its integration with other venous assessment tools as a global venous screening instrument.…”

Long-Term Outcomes of Stent Placement for Symptomatic Nonthrombotic Iliac Vein Compression Lesions in Chronic Venous Disease

“…We performed EVLA not only on the GSV but also on the tributary varicosities of the lower extremities (described in detail in our previous study (12)). This procedure changed the hemodynamics of the ulcer bed, which improved ulcer healing and prevented ulcer reoccurrence (20). Combining EVLA with stent placement can improve outcomes, preventing ulcer recurrence and decreasing the prevalence of ulcers.…”

Revision of the venous clinical severity score: Venous outcomes consensus statement: Special communication of the American Venous Forum Ad Hoc Outcomes Working Group

“…4,22 Use of the current VCSS has proven valuable among patients with milder CEAP class 2 and class 3 disease in several studies. 12,23,24 Nevertheless, significant concerns remain regarding restrictive, misleading, confusing, and/or incomplete clinical descriptors, which primarily led to this revision.…”