Abstract：
Microfoam ablation (MFA) and radiofrequency ablation (RFA) are both approved by the Food and Drug Administration for treatment of proximal saphenous truncal veins. The objective of our study was to compare early postoperative outcomes between MFA and RFA following treatment of incompetent thigh saphenous veins.
A retrospective review of a prospectively maintained database was conducted of patients who underwent treatment of incompetent great saphenous veins (GSVs) or anterior accessory saphenous veins (AASVs) in the thigh. All the patients underwent duplex ultrasound of the treated leg at 48 to 72 hours postoperatively. Patients were excluded from analysis if concomitant stab phlebectomy was performed. Demographic data, CEAP (clinical, etiologic, anatomic, pathophysiologic) class, venous clinical severity score (VCSS), and adverse events were recorded.
Between June 2018 and September 2022, 784 consecutive limbs (RFA, n = 560; MFA, n = 224) underwent venous closure for symptomatic reflux. A total of 200 consecutive thigh GSVs and ASVs treated within the study period using either MFA (n = 100) or RFA (n = 100) were identified. The patients were predominantly women (69%) with a mean age of 64 years. The preoperative CEAP classification was similar between the MFA and RFA groups. The mean preoperative VCSS was 9.4 ± 2.6 for the RFA patients and 9.9 ± 3.3 for the MFA patients. Among the RFA patients, the GSV was treated in 98% and the AASV in 2% compared with the GSV in 83% and the AASV in 17% in the MFA group (P < .001). The mean operative time was 42.4 ± 15.4 minutes in the RFA group and 33.8 ±16.9 minutes in the MFA group (P < .001). The median follow-up was 64 days for the study cohort. The mean postoperative VCSS declined to 7.3 ± 2.1 in the RFA group and 7.8 ± 2.9 in the MFA group. Complete closure occurred in 100% of the limbs after RFA and 90% after MFA (P = .005). Eight veins were partially closed and two remained patent following MFA. The incidence of superficial phlebitis was 6% and 15% (P = .06) after RFA and MFA, respectively. Overall, symptomatic relief was 90% following RFA and 89.5% following MFA. The complete ulcer healing rate for the entire cohort was 77.8%. Deep venous proximal thrombus extension (RFA, 1%; vs MFA, 4%; P = .37) and remote deep vein thrombosis (RFA, 0%; vs MFA, 2%; P = .5) showed a trend toward being higher following MFA but the difference did not reach statistical significance. All were asymptomatic and resolved with short-term anticoagulation therapy.
MFA and RFA are both safe and effective for treating incompetent thigh saphenous veins, with excellent symptomatic relief and a low incidence of postprocedure adverse thrombotic events. RFA resulted in improved complete closure rates following initial treatment compared with MFA. The operative times were shorter with MFA. Both modalities can be used for patients with active venous ulcers with good healing rates. Longer term studies are required to characterize the durability of MFA closure for above knee truncal veins.
A retrospective review of a prospectively maintained database was conducted of patients who underwent treatment of incompetent great saphenous veins (GSVs) or anterior accessory saphenous veins (AASVs) in the thigh. All the patients underwent duplex ultrasound of the treated leg at 48 to 72 hours postoperatively. Patients were excluded from analysis if concomitant stab phlebectomy was performed. Demographic data, CEAP (clinical, etiologic, anatomic, pathophysiologic) class, venous clinical severity score (VCSS), and adverse events were recorded.
Between June 2018 and September 2022, 784 consecutive limbs (RFA, n = 560; MFA, n = 224) underwent venous closure for symptomatic reflux. A total of 200 consecutive thigh GSVs and ASVs treated within the study period using either MFA (n = 100) or RFA (n = 100) were identified. The patients were predominantly women (69%) with a mean age of 64 years. The preoperative CEAP classification was similar between the MFA and RFA groups. The mean preoperative VCSS was 9.4 ± 2.6 for the RFA patients and 9.9 ± 3.3 for the MFA patients. Among the RFA patients, the GSV was treated in 98% and the AASV in 2% compared with the GSV in 83% and the AASV in 17% in the MFA group (P < .001). The mean operative time was 42.4 ± 15.4 minutes in the RFA group and 33.8 ±16.9 minutes in the MFA group (P < .001). The median follow-up was 64 days for the study cohort. The mean postoperative VCSS declined to 7.3 ± 2.1 in the RFA group and 7.8 ± 2.9 in the MFA group. Complete closure occurred in 100% of the limbs after RFA and 90% after MFA (P = .005). Eight veins were partially closed and two remained patent following MFA. The incidence of superficial phlebitis was 6% and 15% (P = .06) after RFA and MFA, respectively. Overall, symptomatic relief was 90% following RFA and 89.5% following MFA. The complete ulcer healing rate for the entire cohort was 77.8%. Deep venous proximal thrombus extension (RFA, 1%; vs MFA, 4%; P = .37) and remote deep vein thrombosis (RFA, 0%; vs MFA, 2%; P = .5) showed a trend toward being higher following MFA but the difference did not reach statistical significance. All were asymptomatic and resolved with short-term anticoagulation therapy.
MFA and RFA are both safe and effective for treating incompetent thigh saphenous veins, with excellent symptomatic relief and a low incidence of postprocedure adverse thrombotic events. RFA resulted in improved complete closure rates following initial treatment compared with MFA. The operative times were shorter with MFA. Both modalities can be used for patients with active venous ulcers with good healing rates. Longer term studies are required to characterize the durability of MFA closure for above knee truncal veins.
摘要：
背景：微泡沫消融（MFA）和射频消融（RFA）均被FDA批准用于治疗近端隐静脉。这项研究的目的是比较MFA和RFA治疗无功能大腿隐静脉后的早期术后结果。
方法：对接受大腿大隐静脉（GSV）或副隐静脉（ASV）治疗的患者进行前瞻性维护数据库的回顾性回顾。所有患者在48-72小时对治疗的腿进行术后双工超声检查。如果同时进行穿刺静脉切除术，则将患者排除在分析之外。人口统计数据,CEAP类，静脉临床严重程度评分（VCSS），并记录不良事件.
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）因症状性回流而进行静脉闭合。在本研究期间，确定了用MFA（n=100）或RFA（n=100）治疗的两百条连续大腿大隐静脉和副隐静脉。患者主要为女性（69％），平均年龄为64岁。MFA和RFA组之间的术前CEAP分类相似。RFA患者术前平均VCSS为9.4±2.6，MFA患者为9.9±3.3。在RFA患者中，GSV治疗98%，ASV治疗2%，与MFA组的83%GSV和17%ASV相比(p<0.001)。RFA组的平均手术时间为42.4±15.4分钟，MFA组为33.8±16.9分钟（p<0.001）。研究队列的中位随访时间为64天。RFA患者术后平均VCSS评分降至7.3±2.1，MFA患者降至7.8±2.9。RFA后100%肢体完全闭合，MFA组90%肢体完全闭合（p=0.005）。MFA后，有8条静脉部分闭合，其中2条仍保留专利。RFA和MFA后浅表静脉炎的发生率分别为6％和15％（p=0.06），分别。RFA后总体症状缓解为90％，MFA后为89.5％。整个队列的溃疡完全愈合率为77.8%。深静脉近端血栓扩展（RFA1％vsMFA4％，p=0.37）和远程深静脉血栓形成（DVT）（RFA0％vsMFA2％，p=0.5）在MFA后趋势更高，但未达到统计学意义。所有患者均无症状，短期抗凝治疗。
结论：Microfoam消融术和RFA都是治疗功能不全的大腿隐静脉的安全有效的治疗方法，可有效缓解症状，降低术后不良血栓事件的发生率。与MFA相比，射频消融在初始治疗后改善了完全闭合率。MFA后手术时间较短。两种方式均可用于活动性静脉性溃疡患者，治愈率良好。需要进行更长期的研究来表征MFA闭合膝盖以上躯干静脉的耐久性。
方法：对接受大腿大隐静脉（GSV）或副隐静脉（ASV）治疗的患者进行前瞻性维护数据库的回顾性回顾。所有患者在48-72小时对治疗的腿进行术后双工超声检查。如果同时进行穿刺静脉切除术，则将患者排除在分析之外。人口统计数据,CEAP类，静脉临床严重程度评分（VCSS），并记录不良事件.
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）因症状性回流而进行静脉闭合。在本研究期间，确定了用MFA（n=100）或RFA（n=100）治疗的两百条连续大腿大隐静脉和副隐静脉。患者主要为女性（69％），平均年龄为64岁。MFA和RFA组之间的术前CEAP分类相似。RFA患者术前平均VCSS为9.4±2.6，MFA患者为9.9±3.3。在RFA患者中，GSV治疗98%，ASV治疗2%，与MFA组的83%GSV和17%ASV相比(p<0.001)。RFA组的平均手术时间为42.4±15.4分钟，MFA组为33.8±16.9分钟（p<0.001）。研究队列的中位随访时间为64天。RFA患者术后平均VCSS评分降至7.3±2.1，MFA患者降至7.8±2.9。RFA后100%肢体完全闭合，MFA组90%肢体完全闭合（p=0.005）。MFA后，有8条静脉部分闭合，其中2条仍保留专利。RFA和MFA后浅表静脉炎的发生率分别为6％和15％（p=0.06），分别。RFA后总体症状缓解为90％，MFA后为89.5％。整个队列的溃疡完全愈合率为77.8%。深静脉近端血栓扩展（RFA1％vsMFA4％，p=0.37）和远程深静脉血栓形成（DVT）（RFA0％vsMFA2％，p=0.5）在MFA后趋势更高，但未达到统计学意义。所有患者均无症状，短期抗凝治疗。
结论：Microfoam消融术和RFA都是治疗功能不全的大腿隐静脉的安全有效的治疗方法，可有效缓解症状，降低术后不良血栓事件的发生率。与MFA相比，射频消融在初始治疗后改善了完全闭合率。MFA后手术时间较短。两种方式均可用于活动性静脉性溃疡患者，治愈率良好。需要进行更长期的研究来表征MFA闭合膝盖以上躯干静脉的耐久性。
