Abstract：
Endovenous closure of truncal veins with a large diameter (LD) (≥8 mm) has been associated with higher risk of post ablation thrombus propagation into the deep venous system. Similar findings after Varithena microfoam ablation (MFA) have not been characterized. The study objective was to analyze outcomes after both radiofrequency ablation (RFA) and MFA and of LD truncal veins.
A retrospective review of a prospectively maintained database was performed. All patients who underwent MFA and RFA for LD symptomatic truncal vein reflux (≥8 mm) were identified. All patients had postoperative duplex (48-72 hours) scanning. Patients underwent subsequent clinical follow-up at 3 to 6 weeks. Demographic data, CEAP Classification, Venous Clinical Severity Score, procedure details, adverse thrombotic events, and follow-up data were abstracted.
Between June 2018 and September 2022, 784 consecutive limbs (RFA, n = 560; MFA, n = 224) underwent truncal vein (great, accessory, and small saphenous) closure for symptomatic reflux. Sixty-six limbs in the MFA group met inclusion criteria. Sixty-six consecutive limbs treated with RFA during the same time period were included as a comparison group. The mean truncal vein diameter treated was 10.5 mm (RFA, 10.0 mm; MFA, 10.9 mm). Twenty-nine limbs (44%) in the RFA group underwent concomitant phlebectomy. Tributary veins were concomitantly sclerosed in 34 MFA limbs (52%). Total procedural times were shorter in the MFA group (MFA, 31.6 minutes vs RFA, 55.7 minutes) (P < .001). Immediate closure rates were 100% and 95% in the RFA and MFA groups, respectively. Venous Clinical Severity Scores improved after treatment in both groups (RFA, from 9.5 to 7.8; P ≤ .001) (MFA, from 11.3 to 9.0; P ≤ .001). In the RFA and MFA groups, 83% and 79% of venous ulcers healed during the study period, respectively. Symptomatic superficial phlebitis occurred after RFA in 11% and 17% MFA. The incidence of postablation proximal deep venous thrombus extension was 3.0% in the RFA group and 6.1% in the MFA group, which was not statistically significant. All resolved with short-term oral anticoagulant therapy. No remote deep venous thromboses or pulmonary emboli occurred in either group.
High early closure rates, symptom relief and ulcer healing rates can be achieved after RFA and MFA of LD saphenous veins. Both techniques can be used safely across a wide array of CEAP classes. Longer term studies are required to characterize the durability of MFA closure and sustained symptom relief in LD truncal veins.
A retrospective review of a prospectively maintained database was performed. All patients who underwent MFA and RFA for LD symptomatic truncal vein reflux (≥8 mm) were identified. All patients had postoperative duplex (48-72 hours) scanning. Patients underwent subsequent clinical follow-up at 3 to 6 weeks. Demographic data, CEAP Classification, Venous Clinical Severity Score, procedure details, adverse thrombotic events, and follow-up data were abstracted.
Between June 2018 and September 2022, 784 consecutive limbs (RFA, n = 560; MFA, n = 224) underwent truncal vein (great, accessory, and small saphenous) closure for symptomatic reflux. Sixty-six limbs in the MFA group met inclusion criteria. Sixty-six consecutive limbs treated with RFA during the same time period were included as a comparison group. The mean truncal vein diameter treated was 10.5 mm (RFA, 10.0 mm; MFA, 10.9 mm). Twenty-nine limbs (44%) in the RFA group underwent concomitant phlebectomy. Tributary veins were concomitantly sclerosed in 34 MFA limbs (52%). Total procedural times were shorter in the MFA group (MFA, 31.6 minutes vs RFA, 55.7 minutes) (P < .001). Immediate closure rates were 100% and 95% in the RFA and MFA groups, respectively. Venous Clinical Severity Scores improved after treatment in both groups (RFA, from 9.5 to 7.8; P ≤ .001) (MFA, from 11.3 to 9.0; P ≤ .001). In the RFA and MFA groups, 83% and 79% of venous ulcers healed during the study period, respectively. Symptomatic superficial phlebitis occurred after RFA in 11% and 17% MFA. The incidence of postablation proximal deep venous thrombus extension was 3.0% in the RFA group and 6.1% in the MFA group, which was not statistically significant. All resolved with short-term oral anticoagulant therapy. No remote deep venous thromboses or pulmonary emboli occurred in either group.
High early closure rates, symptom relief and ulcer healing rates can be achieved after RFA and MFA of LD saphenous veins. Both techniques can be used safely across a wide array of CEAP classes. Longer term studies are required to characterize the durability of MFA closure and sustained symptom relief in LD truncal veins.
摘要：
目的：大直径（LD）（>8mm）的躯干静脉的静脉内闭合与消融后血栓传播到深静脉系统的高风险相关。尚未表征Varithena微泡沫消融（MFA）后的类似发现。研究目的是分析射频（RFA）和MFA以及LD干静脉的结果。
方法：对前瞻性维护的数据库进行回顾性回顾。所有因LD症状性干静脉反流(>8mm)而接受MFA和RFA的患者均被确认。所有患者均进行术后双工（48-72小时）扫描。患者随后在3-6周进行临床随访。人口统计数据,CEAPClassification,静脉临床严重程度评分（VCSS），程序详细信息,我们提取了不良血栓事件和随访数据.
结果：在2018年6月至2022年9月之间，连续784条肢体（RFA，n=560；MFAn-224）接受了躯干静脉（大，附件,和小隐）闭合以治疗有症状的反流。MFA组的66条肢体符合纳入标准。在同一时间段内接受RFA治疗的66条连续肢体作为对照组。治疗的平均躯干静脉直径为10.5mm（RFA，10.0mm和MFA，10.9毫米）。RFA组的29条肢体（44％）同时进行了静脉切除术。支流静脉在34条MFA肢体中同时硬化（52％）。MFA组的总手术时间较短（MFA-31.6分钟vs.RFA-55.7分钟)(p<0.001)。RFA和MFA组的即刻闭合率为100%和95%，分别。两组治疗后静脉临床严重程度评分（VCSS）均有所改善（RFA，9.5至7.8，p=<0.001)(MFA，11.3至9.0，P=<0.001）。在RFA和MFA组中，在研究期间，83％和79％的静脉性溃疡治愈。RFA后出现症状性浅表静脉炎的发生率分别为11％和17％。消融后近端深静脉血栓扩展(PDVTE)的发生率在RFA组为3.0%,在MFA组为6.1%,这没有统计学意义。均通过短期口服抗凝治疗解决。两组均未发生远端深静脉血栓（DVT）或肺栓塞（PE）。
结论：早期闭合率高，LD隐静脉RFA和MFA均可达到症状缓解和溃疡愈合率。这两种技术都可以在广泛的CEAP类中安全地使用。需要更长期的研究来描述MFA闭合的持久性和LD躯干静脉的持续症状缓解。
方法：对前瞻性维护的数据库进行回顾性回顾。所有因LD症状性干静脉反流(>8mm)而接受MFA和RFA的患者均被确认。所有患者均进行术后双工（48-72小时）扫描。患者随后在3-6周进行临床随访。人口统计数据,CEAPClassification,静脉临床严重程度评分（VCSS），程序详细信息,我们提取了不良血栓事件和随访数据.
结果：在2018年6月至2022年9月之间，连续784条肢体（RFA，n=560；MFAn-224）接受了躯干静脉（大，附件,和小隐）闭合以治疗有症状的反流。MFA组的66条肢体符合纳入标准。在同一时间段内接受RFA治疗的66条连续肢体作为对照组。治疗的平均躯干静脉直径为10.5mm（RFA，10.0mm和MFA，10.9毫米）。RFA组的29条肢体（44％）同时进行了静脉切除术。支流静脉在34条MFA肢体中同时硬化（52％）。MFA组的总手术时间较短（MFA-31.6分钟vs.RFA-55.7分钟)(p<0.001)。RFA和MFA组的即刻闭合率为100%和95%，分别。两组治疗后静脉临床严重程度评分（VCSS）均有所改善（RFA，9.5至7.8，p=<0.001)(MFA，11.3至9.0，P=<0.001）。在RFA和MFA组中，在研究期间，83％和79％的静脉性溃疡治愈。RFA后出现症状性浅表静脉炎的发生率分别为11％和17％。消融后近端深静脉血栓扩展(PDVTE)的发生率在RFA组为3.0%,在MFA组为6.1%,这没有统计学意义。均通过短期口服抗凝治疗解决。两组均未发生远端深静脉血栓（DVT）或肺栓塞（PE）。
结论：早期闭合率高，LD隐静脉RFA和MFA均可达到症状缓解和溃疡愈合率。这两种技术都可以在广泛的CEAP类中安全地使用。需要更长期的研究来描述MFA闭合的持久性和LD躯干静脉的持续症状缓解。
