Prospective randomized trial comparing radiofrequency ablation and complete saphenous vein stripping in patients with mild to moderate chronic venous disease with a 3-year follow-up / Ensaio clínico randomizado prospectivo comparando a ablação por radiofrequência e a retirada completa de veia safena em pacientes com doença venosa crônica leve à moderada com seguimento de 3 anos

ABSTRACT Objective: To compare the use of the radiofrequency thermoablation of the saphenous vein with the ligation technique, and complete removal of the saphenous vein, from the saphenofemoral junction to the ankle. Methods: A total of 49 patients with chronic venous disease in the Comprehensive Classification System for Chronic Venous Disorders (CEAP) classes 2 to 4 for clinical signs, etiology, anatomic distribution and pathophysiology, were assessed at baseline, after 4 weeks, and after 1 year. The parameters assessed were complications, period of absence from activities, Venous Clinical Severity Score (VCSS) and quality of life scores according to Aberdeen Varicose Veins Questionnaire (AVVQ). They were re-examined 1 and 3 years after treatment to evaluate recurrence rates. Results: The success rate per limb (p=0.540), VCSS (p=0.636), AVVQ (p=0.163), and clinical complications were similar in the two treatment groups. Nevertheless, the radiofrequency thermoablation group had significant shorter length of hospital stay (0.69±0.47) and absence from activities (8.62±4.53), p<000.1. Conclusion: Patients submitted to radiofrequency thermoablation had an occlusion rate, clinical recurrence and improvement in quality of life comparable to removal of the saphenous vein. However, these patients spent less time hospitalized and away from their daily activities during recovering.

RESUMO Objetivo: Comparar o uso da termoablação por radiofrequência da veia safena com a técnica de ligação e retirada completa da veia safena da junção safeno-femoral ao tornozelo. Métodos: Foram avaliados 49 pacientes com doença venosa crônica nas categorias 2 a 4 (Comprehensive Classification System for Chronic Venous Disorders − CEAP) para classificação clínica, etiológica, anatômica e fisiopatológica, no início do estudo, 4 semanas e 1 ano após o procedimento. Os parâmetros analisados foram complicações, período de ausência de atividades,(Venous Clinical Severity) Score revisado (R-VCSS) e escore de qualidade de vida de acordo com o Aberdeen Varicose Veins Questionnaire(AVVQ). Os pacientes foram reexaminados 1 e 3 anos após o tratamento, para avaliar as taxas de recorrência. Resultados: As taxas de sucesso por membro (p=0,540), VCSS (p=0,636), AVVQ (p=0,163) e complicações clínicas foram semelhantes nos dois grupos. No entanto, o grupo termoablação por radiofrequência teve períodos de internação significativamente mais curtos (0,69±0,47) e ausência de atividades (8,62±4,53), com p<000,1. Conclusão: Pacientes submetidos à termoablação por radiofrequência apresentaram taxa de oclusão, recidiva clínica e melhora da qualidade de vida comparáveis à retirada completa da veia safena. No entanto, esses pacientes passaram menos tempo internados e ausentes de suas atividades diárias durante a recuperação.

Thrombosis of the Saphenous Vein Stump after Varicose Vein Surgery.

We evaluated thrombus extension in the proximal stump of the saphenous vein at 6 days, 4 weeks, and 16 weeks after saphenous vein surgery performed between July 2013 and March 2014 (18 patients, 29 limbs, and 31 stumps) using duplex ultrasonography. All thrombotic events were classified as endovenous heat-induced thrombosis (EHIT). Thrombus was observed in 27 stumps (87.1%), with only four (12.9%) stumps remaining without thrombus on postoperative day 6. Thrombus as EHIT class 2 was observed in one stump and as EHIT class 3 in another; in the remaining 25 stumps, it was observed as EHIT class 1 postoperatively. No further extension of thrombus was found at 4 and 16 weeks after surgery. The rate of thrombus formation in the proximal stump of the saphenous vein after conventional surgery is comparatively higher than that after thermoablation techniques. Further studies are required to determine adequate evaluation methods and appropriate therapies for stump thrombosis after varicose vein surgery. (This article is a translation of J Jpn Coll Angiol 2015; 55: 105-110).

Efficacy of varicose vein surgery with preservation of the great safenous vein / Eficácia do tratamento cirúrgico das varizes com preservação de veia safena interna

OBJECTIVE: To evaluate the efficacy of surgical treatment of varicose veins with preservation of the great saphenous vein. METHODS: We conducted a prospective study of 15 female patients between 25 and 55 years of age with clinical, etiologic, anatomic and pathophysiologic (CEAP) classification 2, 3 and 4. The patients underwent surgical treatment of primary varicose veins with great saphenous vein (GSV) preservation. Doppler ultrasonography exams were carried out in the first and third months postoperatively. The form of clinical severity of venous disease, Venous Clinical Severity Score (VCSS) was completed before and after surgery. We excluded patients with history of deep vein thrombosis, smoking or postoperatively use of elastic stockings or phlebotonics. RESULTS: All patients had improved VCSS (p <0.001) and reduction in the diameter of the great saphenous vein (p <0.001). There was a relationship between VCSS and the GSV caliber, as well as with preoperative CEAP. There was improvement in CEAP class in nine patients when compared with the preoperative period (p <0.001). CONCLUSION: The varicose vein surgery with preservation of the great saphenous vein had beneficial effects to the GSV itself, with decreasing caliber, and to the symptoms when the vein had maximum caliber of 7.5 mm, correlating directly with the CEAP. The decrease in GSV caliber, even without complete abolition of reflux, leads to clinical improvement by decreasing the reflux volume.

OBJETIVO: Avaliar a eficácia do tratamento cirúrgico das varizes de membros inferiores com preservação da veia safena magna. MÉTODOS: estudo prospectivo realizado em 15 pacientes do sexo feminino entre 25 e 55 anos com a classificação clínica, etiológica, anatômica e patofisiológica (CEAP) 2, 3 e 4. Os pacientes foram submetidos ao tratamento cirúrgico das varizes primárias dos membros inferiores com preservação da veia safena magna (VSM). Foram realizados exames com eco-Doppler no primeiro e terceiro meses de pós-operatório. O formulário da gravidade clinica da doença venosa, Venous Clinical Severity Score (VCSS) foi preenchido no pré e pós-operatório para graduá-la. Foram excluídos pacientes com historia de trombose venosa profunda, tabagismo, uso de meia elástica ou flebotômicos no pós-operatório. RESULTADOS: todos os pacientes obtiveram melhora do VCSS (P<0,001) e redução do calibre da veia safena magna (P<0,001). Houve relação do VCSS com o calibre da VSM, assim como, com o CEAP no pré-operatório. Houve melhora da classe CEAP em nove pacientes comparado com o pré-operatório (P<0,001). CONCLUSÃO: a operação de varizes com preservação da veia safena magna teve efeito benéfico à própria VSM, com a diminuição de calibre, e à sintomatologia quando a veia apresentava calibre máximo de 7,5mm, correlacionando-se diretamente com a CEAP. A diminuição do calibre da VSM mesmo sem abolição total do refluxo leva a melhora clinica por diminuição do volume de refluxo.