Postoperative pain and early quality of life after radiofrequency ablation and mechanochemical endovenous ablation of incompetent great saphenous veins

Eekeren, Ramon R.J.P. van; Boersma, Doeke; Konijn, Vincent; Vries, J.P.P.M. de; Reijnen, Michel

doi:10.1016/j.jvs.2012.07.049

Cited by 94 publications

(91 citation statements)

References 21 publications

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“…Relatively more post-procedural pain, ecchymosis, and persistent cannulation site numbness of the skin were reported in some patients of the RFA treatment arm of the study, which seem inherent to heat-based therapies [19]. Sclerotherapy arm subjects had self-limiting mild post-procedural pain and cordlike induration along the GSV with slightly higher incidence of thrombophlebitis as reported in previous studies [13].…”

Section: Discussionsupporting

confidence: 56%

Comparative Study of Outcome of Duplex Ultrasound-Guided, Catheter-Directed Foam Sclerotherapy and Radio-frequency Ablation in the Management of Great Saphenous Varicose Veins

et al. 2016

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Chronic venous insufficiency of lower limbs is a common problem in adults. We compared the two modalities, namely duplex ultrasound-guided, catheter-directed foam sclerotherapy (UGFS) and radio-frequency ablation (RFA), in the management of great saphenous varicose veins using clinical assessment (Venous Clinical Severity Score, Venous Disability Score) and duplex imaging. Patients presenting with great saphenous vein (GSV) varicosity due to incompetent saphenofemoral junction (SFJ) were selected and randomly assigned in each arm, i.e., duplex UGFS group and RFA group. Patients were assessed on days 7, 30, and 90 both clinically and sonologically. Clinical assessment was based on the Venous Clinical Severity Score (VCSS) and Venous Disability Score (VDS). Obliteration of the treated GSV segment was noted in all the limbs of the RFA group (31/31) on duplex sonography on days 7, 30, and 90, while in the UGFS group, out of 30 limbs, obliteration was successful in 28 (28/ 30) and 2 had treatment failure. However, outcome of both the groups were statistically comparable (P value > 0.05). After the procedure, improvement in the VCSS was noted in both the study arms in every follow-up and both the modalities were found to be equally effective. Improvement in the Venous Disability Score was there on every follow-up, but maximum improvement was seen on the second visit, i.e., post-treatment day 30. Improvement was statistically significant and equal in both arms after the initial 1 week. Foam sclerotherapy, especially catheter-directed, is as effective as radio-frequency ablation in achieving anatomical obliteration and yielding relief in clinical signs and symptoms in patients with GSV varicosity with SFJ incompetence.

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Section: Discussionsupporting

confidence: 56%

Comparative Study of Outcome of Duplex Ultrasound-Guided, Catheter-Directed Foam Sclerotherapy and Radio-frequency Ablation in the Management of Great Saphenous Varicose Veins

et al. 2016

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“…In addition, tumescent anaesthesia is poorly tolerated by some patients, while the risk of injury to the saphenous or sural nerves is quite high during below-the-knee thermal ablations [6,8]. After minimally invasive surgical procedures the patient should be able to go back to work and be fully active during everyday activities (such as driving a car).…”

Section: Discussionmentioning

confidence: 99%

“…Final follow-ups were scheduled 6 and 12 months after the MOCA. We did not measure postprocedural pain with a visual analogue scale, since previous studies revealed a very low level of pain associated with this procedure [8].…”

Section: Methodsmentioning

confidence: 99%

One-year results of fifty consecutive patients treated with mechanochemical ablation of great and small saphenous vein

Stanišić¹,

Węgrzynowski²,

Pawlaczyk-Gabriel³

2015

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102Mechanochemical ablation (MOCA) of the great saphenous vein (GSV) and small saphenous vein (SSV) is a relatively new method of treatment for superficial venous reflux [1][2][3]. This method is based on mechanical injury of the venous wall by rotating the tip of the catheter with subsequent injection of a sclerosant: polidocanol or sodium tetradecyl sulfate (STS). The method has been developed as an alternative to thermal ablation, such as endovenous laser ablation (EVLA), radiofrequency ablation or ablation with steam [4]. Recently, medical glues have provided a novel alternative to MOCA [5,6]. The rationale to introduce MOCA into medical practice is based on the potential risk of thermal injury of surrounding anatomic structures during EVLA or other methods of thermal ablation [4]. MOCA systems, which are cur- AbstrActObjectives: Mechanochemical ablation (MOCA) of the great saphenous vein (GSV) and the small saphenous vein (SSV) is an alternative to thermal ablation for the treatment of superficial venous reflux. The aim of this study was to assess the efficacy of MOCA for the treatment of incompetent GSV and SSV. Material and methods: We included 50 patients (60 legs) with incompetent GSV or SSV. Patients were aged 22-71 years, with median age of 41 years. Diameters of the saphenous veins treated were 4-16 mm, with median diameter 9 mm. Lengths of incompetent segments of the GSVs were 20-45 cm, with median length 36 cm. Lengths of incompetent segments of the SSVs were 12-25 cm, with median length 17 cm. We performed venous ablation using the ClariVein device with simultaneous injection of 2% polidocanol in the dose of 0.2 ml per cm of the treated vein. All patients completed 12 months follow-up. Results: In all patients the procedure resulted in complete occlusion of the incompetent segment of the saphenous vein. Additional foam sclerotherapy was needed in 41 legs (68.3%). After 12 months partial or complete recanalisation was revealed in one GSV and 3 SSVs. The remaining veins (93.3%) were completely occluded. During the procedure we observed transient signs of polidocanol toxicity in 2 patients. Conclusions: MOCA using the ClariVein device is a safe method for ablation of incompetent truncal veins in patients who prefer to be managed quickly, without pain and with satisfactory results after 1 year.

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“…19,32,46 The improvement in the perioperative period was better with RFA than with open surgery; 18,19,21 however, this difference disappeared after a few weeks. Gale and colleagues 41 reported no significant difference in improvement in quality of life between RFA and laser treatment.…”

Section: Quality Of Life Pain and Satisfactionmentioning

confidence: 98%

Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis

Poder

Fisette

Bédard

et al. 2018

cjs

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Background: Since the 1990s, new techniques for the treatment of varicose veins have emerged, including radiofrequency ablation (RFA) and laser treatment. We performed a study to compare the safety, efficacy and outcomes of RFA compared to those of open surgery and laser ablation for the treatment of varicose veins. We also carried out a cost analysis of RFA compared to open surgery to assess whether RFA could help free up operating room time by being performed in an outpatient context. Methods:We conducted a systematic literature review (publication date May 2010-September 2013 for articles in English, January 1991-September 2013 for those in French). We used several checklists to measure the quality of the studies. We also collected data on costing. Results:The literature search identified 924 publications, of which 38 were retained for analysis: 15 literature reviews, 1 good-practice guideline and 22 new primary studies. The overall level of evidence was low to moderate owing to the limited sample sizes, lack of information on patient characteristics and lack of standardization of the outcome measures. However, the results obtained are consistent from study to study. In the short and medium term, RFA is considered as effective as open surgery or laser treatment (moderate level of evidence) and presents fewer major and minor complications than open surgery (low level of evidence). Radiofrequency ablation can be performed on an outpatient basis. We calculated that RFA would be about $110-$220 more expensive per patient than open surgery. Conclusion:Radiofrequency ablation is a valuable alternative to open surgery and would free up operating room time in a context of low accessibility.

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Postoperative pain and early quality of life after radiofrequency ablation and mechanochemical endovenous ablation of incompetent great saphenous veins

Abstract: MOCA is associated with significantly less postoperative pain, faster recovery, and earlier work resumption compared with RFA in the treatment of GSV incompetence. MOCA and RFA are both related to a rapid improvement in quality of life.

Cited by 94 publications

References 21 publications

Comparative Study of Outcome of Duplex Ultrasound-Guided, Catheter-Directed Foam Sclerotherapy and Radio-frequency Ablation in the Management of Great Saphenous Varicose Veins

Comparative Study of Outcome of Duplex Ultrasound-Guided, Catheter-Directed Foam Sclerotherapy and Radio-frequency Ablation in the Management of Great Saphenous Varicose Veins

One-year results of fifty consecutive patients treated with mechanochemical ablation of great and small saphenous vein

Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis

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