Recurrence types 3 years after endovenous thermal ablation in insufficient saphenofemoral junctions

• Published in: Journal of vascular surgery. Venous and lymphatic disorders (New York, NY) NY), 2021-01, Vol.9 (1), p.137-145
• Main Authors: Zollmann, Maria, Zollmann, Christine, Zollmann, Philipp, Veltman, Jüergen, Cramer, Philipp, Stüecker, Markus
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Catheter Ablation - adverse effects; Endoluminal therapy; Endovascular Procedures - adverse effects; Female; Femoral Vein - diagnostic imaging; Femoral Vein - physiopathology; Femoral Vein - surgery; Humans; Male; Middle Aged; Prospective Studies; Recurrence; Risk Assessment; Risk Factors; Saphenofemoral junction; Saphenous Vein - diagnostic imaging; Saphenous Vein - physiopathology; Saphenous Vein - surgery; Time Factors; Treatment Outcome; Varicose veins; Varicose Veins - diagnostic imaging; Varicose Veins - physiopathology; Varicose Veins - surgery; Venous Insufficiency - diagnostic imaging; Venous Insufficiency - physiopathology; Venous Insufficiency - surgery; Young Adult
• ISSN: 2213-333X; 2213-3348
• DOI: 10.1016/j.jvsv.2020.04.021

Although many studies have demonstrated that endovenous therapies have comparable efficacy to crossectomy and stripping, few studies have been published regarding the classification and recurrence patterns of varicose veins after endovenous therapy. This study attempted to provide an objective scheme for the definition and classification of recurrence. Moreover, it describes the types and rates of recurrence after endovenous thermal ablation, as well as factors associated with recurrence. This prospective cohort study comprised a cohort of 449 patients with saphenofemoral junction (SFJ) insufficiency who underwent endoluminal varicose vein treatment for the first time in the limb between October 2013 and January 2015. The treatments were performed by a team of three experienced phlebologists. For endovenous laser ablation, Biolitec ELVeS was used with bare, radial or radial slim fibers. Radiofrequency ablation was performed with VNUS ClosureFAST (Medtronic, Deggendorf, Germany). The patients were consecutively scheduled for 3-year follow-up examinations. Detailed ultrasound findings were collected by two experienced phlebologists who classified the observed duplex ultrasound recurrence into different recurrence types. Clinically relevant recurrence was found in only 5.1% of cases. Examining only the recanalizations requiring reintervention resulted in a recurrence rate of 2.6%. However, if every new varicose vein that occurred postoperatively was considered a recurrence, the resultant recurrence rate was almost 54%. Preliminarily, we defined a recurrence as newly developed varicose veins within the region of the SFJ or along the course of the former treated vein distal to the SFJ. According to this definition, we obtained a clinically relevant recurrence rate of 5.3%, thus indicating that neovascular vessels were the largest recurrence type (57.7% within the region of the SFJ and 9.9% distal to the SFJ), followed by recanalization (8.9% within the region of the SFJ and 9.4% distal to the SFJ) and a refluxing anterior accessory saphenous vein (7.5%). We also developed a modified classification of progression to better understand recurrence after treatment of chronic venous insufficiency; the scheme included method failure (recanalization), neovascularizations, and disease progression (refluxing untreated vessels and new varicose veins occurring outside the treated region). The diameter of the treated vein (P = .001) and the clinical class according to CEAP