J Korean Surg Soc.  2013 Jan;84(1):48-56.

Prospective nonrandomized comparison of quality of life and recurrence between high ligation and stripping and radiofrequency ablation for varicose veins

• Park HS
• Kwon Y
• Eom BW
• Lee T

Abstract

PURPOSE
Varicose veins are a major problem worldwide and improvement in quality of life (QoL) is the ultimate goal after treatment of this benign disease. However QoL is highly dependent on personal and social factors. This study compares high ligation and stripping (HS) and radiofrequency ablation (RFA) in terms of QoL and recurrence in Korea.
METHODS
A retrospective analysis of prospectively collected data between August 2006 and October 2008 was performed for patients undergoing HS and RFA at a single institution. QoL was assessed with a questionnaire preoperatively, at 3 months postoperatively and annually thereafter. Recurrence was assessed by Duplex ultrasound annually after surgery.
RESULTS
A total of 272 patients completed the questionnaire at 3 months. Among these patients, 155 patients returned for their annual follow-up. There were no significant differences between HS and RFA in global QoL scores, although RFA showed less pain. However, paresthesia rates were also higher after RFA. Recurrence rates were similar between the two modalities, although technical failures were more common after RFA.
CONCLUSION
Overall QoL and recurrence rates were similar between the two modalities. The benefits of RFA do not seem to be enough to overcome the higher costs of HS in Korea.

Keyword

Varicose veins; Radiofrequency catheter ablation; Recurrence; Quality of life

MeSH Terms

Catheter Ablation
Follow-Up Studies
Humans
Korea
Ligation
Paresthesia
Prospective Studies
Quality of Life
Surveys and Questionnaires
Recurrence
Retrospective Studies
Varicose Veins

Reference

1. Eklof B, Perrin M, Delis KT, Rutherford RB, Gloviczki P, et al. American Venous Forum. Updated terminology of chronic venous disorders: the VEIN-TERM transatlantic interdisciplinary consensus document. J Vasc Surg. 2009. 49:498–501.

2. Porter JM, Moneta GL. International Consensus Committee on Chronic Venous Disease. Reporting standards in venous disease: an update. J Vasc Surg. 1995. 21:635–645.

3. Ai L, Yu H, Takabe W, Paraboschi A, Yu F, Kim ES, et al. Optimization of intravascular shear stress assessment in vivo. J Biomech. 2009. 42:1429–1437.

4. Darwood RJ, Gough MJ. Endovenous laser treatment for uncomplicated varicose veins. Phlebology. 2009. 24:Suppl 1. 50–61.

5. Gohel MS, Davies AH. Radiofrequency ablation for uncomplicated varicose veins. Phlebology. 2009. 24:Suppl 1. 42–49.

6. Rasmussen LH, Lawaetz M, Bjoern L, Vennits B, Blemings A, Eklof B. Randomized clinical trial comparing endovenous laser ablation, radiofrequency ablation, foam sclerotherapy and surgical stripping for great saphenous varicose veins. Br J Surg. 2011. 98:1079–1087.

7. Almeida JI, Kaufman J, Gockeritz O, Chopra P, Evans MT, Hoheim DF, et al. Radiofrequency endovenous ClosureFAST versus laser ablation for the treatment of great saphenous reflux: a multicenter, single-blinded, randomized study (RECOVERY study). J Vasc Interv Radiol. 2009. 20:752–759.

8. Nesbitt C, Eifell RK, Coyne P, Badri H, Bhattacharya V, Stansby G. Endovenous ablation (radiofrequency and laser) and foam sclerotherapy versus conventional surgery for great saphenous vein varices. Cochrane Database Syst Rev. 2011. (10):CD005624.

9. Jung IM, Oh EM, Chung JK. Comparative study of postoperative complications of high ligation and stripping with endovenous laser treatment for varicose veins. J Korean Soc Vasc Surg. 2010. 26:36–42.

10. Gloviczki P, Comerota AJ, Dalsing MC, Eklof BG, Gillespie DL, Gloviczki ML, 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. 53:5 Suppl. 2S–48S.

11. Subramonia S, Lees T. Radiofrequency ablation vs conventional surgery for varicose veins: a comparison of treatment costs in a randomised trial. Eur J Vasc Endovasc Surg. 2010. 39:104–111.

12. Launois R, Mansilha A, Jantet G. International psychometric validation of the Chronic Venous Disease quality of life Questionnaire (CIVIQ-20). Eur J Vasc Endovasc Surg. 2010. 40:783–789.

13. Rautio T, Ohinmaa A, Perala J, Ohtonen P, Heikkinen T, Wiik H, et al. Endovenous obliteration versus conventional stripping operation in the treatment of primary varicose veins: a randomized controlled trial with comparison of the costs. J Vasc Surg. 2002. 35:958–965.

14. Subramonia S, Lees T. Randomized clinical trial of radio-frequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Br J Surg. 2010. 97:328–336.

15. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomized study of endovenous radiofrequency obliteration (closure procedure) versus ligation and stripping in a selected patient population (EVOLVeS Study). J Vasc Surg. 2003. 38:207–214.

16. Lurie F, Creton D, Eklof B, Kabnick LS, Kistner RL, Pichot O, et al. Prospective randomised study of endovenous radiofrequency obliteration (closure) versus ligation and vein stripping (EVOLVeS): two-year follow-up. Eur J Vasc Endovasc Surg. 2005. 29:67–73.

17. Barwell JR, Davies CE, Deacon J, Harvey K, Minor J, Sassano A, et al. Comparison of surgery and compression with compression alone in chronic venous ulceration (ESCHAR study): randomised controlled trial. Lancet. 2004. 363:1854–1859.

18. Gohel MS, Barwell JR, Taylor M, Chant T, Foy C, Earnshaw JJ, et al. Long term results of compression therapy alone versus compression plus surgery in chronic venous ulceration (ESCHAR): randomised controlled trial. BMJ. 2007. 335:83.

19. Howard DP, Howard A, Kothari A, Wales L, Guest M, Davies AH. The role of superficial venous surgery in the management of venous ulcers: a systematic review. Eur J Vasc Endovasc Surg. 2008. 36:458–465.

20. Zuniga JM, Hingorani A, Ascher E, Shiferson A, Jung D, Jimenez R, et al. Short-term outcome analysis of radio-frequency ablation using ClosurePlus vs ClosureFast catheters in the treatment of incompetent great saphenous vein. J Vasc Surg. 2012. 55:1048–1051.

21. Perrin M. Endovenous radiofrequency ablation of saphenous vein reflux. The VNUS Closure procedure with Closurefast. An updated review. Int Angiol. 2010. 29:303–307.

22. Baker DM, Turnbull NB, Pearson JC, Makin GS. How successful is varicose vein surgery? A patient outcome study following varicose vein surgery using the SF-36 Health Assessment Questionnaire. Eur J Vasc Endovasc Surg. 1995. 9:299–304.

23. O'Leary DP, Chester JF, Jones SM. Management of varicose veins according to reason for presentation. Ann R Coll Surg Engl. 1996. 78(3 Pt 1):214–216.