Venous Hemodynamic Outcomes in Patients with Primary Varicose Vein Treated with High Ligation with Stripping, Endovenous Laser Ablation, and Radio Frequency Ablation

Abstract

Varicose veins Hemodynamic changes High ligation and stripping Endovenous laser ablation Radio frequency ablationObjective To determine hemodynamic changes after surgical treatment for great saphenous vein (GSV) incompetence. Methods According to clinical, etiological, anatomical, and pathophysiological classification, all patients were classified as C2EpAsPr. A total of 976 limbs of 900 patients with primary varicose veins who underwent surgical treatment at the Samsung Medical Center were retrospectively reviewed. Surgical modalities were high ligation (HL) with stripping, endovenous laser ablation (EVLA), and radiofrequency ablation (RFA) of GSV. Hemodynamic changes were measured using air plethysmography preoperatively and 1 and 6 months postoperatively. Duplex scans were performed to evaluate the GSV status after surgery. Results Of the 900 patients, 250, 139, and 511 underwent EVLA, RFA, and HL with stripping, respectively. All groups showed a significant increase in the ejection fraction (EF) and a decrease in the venous volume (VV), venous filling index (VFI), and residual volume fraction (RVF) at 1 month postoperatively, compared with the corresponding preoperative values. When the rate of reduction was compared between the treatment modalities, the 1-month postoperative rate of reduction in the VV was higher in the RFA group and those of the VFI, EF, and RVF were higher in the HL with stripping group, compared with the other groups (p<0.05). The GSV occlusion rates at 1 and 6 months were 85.6% and 97.5% in the EVLA group and 95.7% and 99.4% in the RFA group, respectively. Conclusion All three surgical modalities improved the hemodynamic parameters after treatment for GSV incompetence. Thus, appropriate surgical methods can be selected according to the patient's condition and physician's preference.