Endovenous Celon radiofrequency-induced thermal therapy of great saphenous vein: A retrospective study with a 3-year follow-up

Philippe Quehe, Zarrin Alavi, Tatiana Kurylo-Touz, Anne-Helene Saliou, Ali Badra, Laurent Baudino, Gurven Gladu, Frederik Ledan, Raphaël Haudebourg, Simon Gestin, Luc Bressollette, Philippe Quehe, Zarrin Alavi, Tatiana Kurylo-Touz, Anne-Helene Saliou, Ali Badra, Laurent Baudino, Gurven Gladu, Frederik Ledan, Raphaël Haudebourg, Simon Gestin, Luc Bressollette

Abstract

Objective: Our main objective was to evaluate the short- and long-term efficacy of Celon radiofrequency-induced thermal therapy for endovenous treatment of incompetent great saphenous vein. The secondary objectives were to report on possible short-term side effects and complications.

Methods: This was a retrospective study of 112 consecutive patients included between 2013 and June 2015. These patients were treated (146 great saphenous vein, C2-C6) either at the hemodynamic room using local anesthesia or at the operating theater under general anesthesia with or without phlebectomy. All patients received radiofrequency-induced thermal therapy at 18 W power, 1 s/cm pullback rate and 5-7 pullbacks per segment of 10 cm (i.e. maximum 10 pullbacks). A clinical follow-up via ultrasound monitoring was done at 1 week, 1 month, 6 months, 1 year, 2 years and 3 years.

Results: The 3-year survival occlusion rate was 96.71% and 98% for overall and radiofrequency-induced thermal therapy patients, respectively. No major side effects were observed. A case of endovenous heat-induced thrombosis was reported. Slight neurological disorders were reported (0.88%).

Conclusion: Our unit's endovenous Celon radiofrequency-induced thermal therapy of incompetent great saphenous vein was efficient, well tolerated, without major side effects. Moreover, in order to reduce possible neurological disorders, we advise multiple pullbacks at 1 s/cm and using tumescence anesthesia.

Keywords: Thermal endovenous vein ablation; saphenous vein; varicose vein.

Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Pictogram of RFiTT treatment protocol:– maximum 10 pullbacks per 10 cm vein segment at a withdrawal speed of 1 cm/s (arrow ↔). The arrow shows the tight vein segment: probe insertion-induced spasm of great saphenous vein.
Figure 2.
Figure 2.
B-mode ultrasound, sagittal cup: sclerosis extension in common femoral vein (endovenous heat-induced thrombosis).
Figure 3.
Figure 3.
B-mode ultrasound of great saphenous vein’s sagittal cup after 1 year of Celon RFITT application: obliteration and fibrosis. GSV: great saphenous vein; CFV: common femoral vein.

References

    1. Jacquet R. Treatment of lower limb varicose veins in 2015: the present and the future. Ann Dermatol Venereol 2015; 142: 483–492.
    1. Da Silva A, Widmer LK, Martin H, et al. Varicose veins and chronic venous insufficiency. VASA 1974; 3: 118–125.
    1. Robertson L, Evans C, Fowkes FGR. Epidemiology of chronic venous disease. Phlebology 2008; 23: 103–111.
    1. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the society for vascular surgery and the American Venous Forum. J Vasc Surg 2011; 53: 2S–48S.
    1. National Institute for Health and Clinical Excellence (NICE). Varicose veins in the legs: the diagnosis and management of varicose veins. London: NICE, 2013.
    1. Nicolaides A, Kakkos S, Eklof B, et al. Management of chronic venous disorders of the lower limbs—guidelines according to scientific evidence. Int Angiol 2014; 33: 87–208.
    1. Practice Guidelines: Superficial Venous disease. American College of Phlebology, 2016,
    1. Pavlovic MD, Schuller-Petrovic S, Pichot O, et al. Guidelines of the first international consensus conference on endovenous thermal ablation for varicose vein disease—ETAV consensus meeting 2012. Phlebology 2015; 30(4): 257–273.
    1. Occlusion de la grande veine saphène par radiofréquence par voie veineuse transcutanée. Service évaluation des actes professionnels, Rapport de la Haute Autorité de Santé (HAS), Décembre 2013,
    1. Welch HJ. Endovenous ablation of the great saphenous vein may avert phlebectomy for branch varicose veins. J Vasc Surg 2006; 44: 601–605.
    1. Eklof B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Surg 2004; 40: 1248–1252.
    1. Launois R, Le Moine JG, Lozano FS, et al. Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res 2012; 21: 1051–1058.
    1. De Maesener M, Pichot O, Cavezzi A, et al. Duplex ultrasound investigation of the veins of the lower limbs after treatment for varicose veins. UIP consensus document. Eur J Vasc Endovasc Surg 2011; 42: 89–102.
    1. Watts GT. Endovenous diathermy destruction of internal saphenous. BMJ 1972; 4: 53.
    1. Zierau UT, Lahl W. The endovenous RFITT-treatment of varicose veins, a new method of interventional phlebology. Phlebology 2009; 38: 12–16.
    1. Braithwaite B, Hnatek L, Zierau U, et al. Radiofrequency-induced thermal therapy: results of a European multicentre study of resistive ablation of incompetent truncal varicose veins. Phlebology 2013; 28: 38–46.
    1. Goode SD, Chowdhury A, Crockett M, et al. Laser and radiofrequency ablation study (LARA study): a randomised study comparing radiofrequency ablation and endovenous laser ablation (810 nm). Eur J Vasc Endovasc Surg 2010; 40: 246–253.
    1. Doerler M, Blenkers T, Reich-Schupke S, et al. Occlusion rate, venous symptoms and patient satisfaction after radiofrequency-induced thermotherapy (RFITT®): are there differences between the great and the small saphenous veins? VASA 2015; 44: 203–210.
    1. Poder TG, Fisette JF, Bédard SK, et al. Is radiofrequency ablation of varicose veins a valuable option? A systematic review of the literature with a cost analysis. Can J Surg 2018; 61(2): 128–138.
    1. Carroll C, Hummel S, Leaviss J, et al. Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation. Health Technol Assess 2013; 17(48): 1–141.
    1. Rosales-Velderrain A, Gloviczki P, Said SM, et al. Pulmonary embolism after endovenous thermal ablation of the saphenous vein. Semin Vasc Surg 2013; 26: 14–22.
    1. Sutton PA, El-Dhuwaib Y, Dyer J, et al. The incidence of post operative venous thromboembolism in patients undergoing varicose vein surgery recorded in hospital episode statistics. Ann R Coll Surg Eng 2012; 94: 481–483.
    1. Newman JE, Meecham L, Walker RJ, et al. Optimising treatment parameters for Radiofrequency Induced Thermal Therapy (RFiTT): a comparison of the manufacturer’s treatment guidance with a locally developed treatment protocol. Eur J Vasc Endovasc Surg 2014; 47: 664–669.
    1. Hamel-Desnos C, Desnos P. Thermal ablation of the saphenous veins by bipolar radiofrequency RFITT®. Results of a prospective study on 119 patients with 2 years of follow-up. Technical considerations. Phlébologie 2015; 68: 21–29.

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅