A Comparison Of Radiofrequency Ablation And Microfoam Sclerotherapy Of Large Diameter Truncal Veins Result In Excellent Early Closure Rates And Symptomatic Relief
Amanda L. Chin, MD, MBA, Stephanie D. Talutis, MD, Peter F. Lawrence, MD, Juan C. Jimenez, MD, MBA.
UCLA, Los Angeles, CA, USA.
OBJECTIVES: Endovenous closure of truncal veins with a large diameter (LD) (> 8 mm) has been associated with higher risk of post-procedure thrombus propagation into the deep venous system. Similar findings following Varithena microfoam ablation (MFA) have not been characterized. The study objective was to analyze outcomes following both MFA and radiofrequency (RFA) of large diameter truncal veins.
METHODS: A retrospective review of a prospectively maintained database was performed. All patients who underwent MFA and RFA for LD symptomatic truncal veins (> 8 mm) were identified. All patients had postoperative duplex (48-72 hours) scanning. Patients underwent subsequent clinical follow up at 3-6 weeks. Demographic data, CEAP Classification, Venous Clinical Severity Score (VCSS), procedure details, adverse thrombotic events and follow up data were abstracted.
RESULTS: Beginning in June 2018, consecutive limbs that underwent RFA (n=62) and MFA (n=62) were compared. Preoperative demographics are presented in Table 1. The overall mean truncal vein diameter was 10.5 mm (RFA, 10.1 mm and MFA, 11.0, p= 0.12). Twenty-eight limbs (45%) in the RFA group underwent concomitant phlebectomy. Tributary veins were concomitantly sclerosed in 31 MFA patients (50%). Immediate closure rates were 98.4% and 95.2% in the RFA and MFA groups, respectively. Venous Clinical Severity Scores significantly improved following treatment in both groups (RFA, 9.3 to 7.7, p= < 0.001) (MFA, 11.3 to 9.0, P= < 0.001). The incidence of post-procedure common femoral extension was 3.2% in the RFA group and 6.5% in the MFA group. This difference was not statistically significant. All resolved with short-term oral anticoagulant therapy. No remote deep venous thromboses or pulmonary emboli were noted in either group. Post-procedure phlebitis occurred in 11.3% in both the RFA and MFA groups.
CONCLUSIONS: Excellent early closure rates and symptom relief can be achieved following both RFA and MFA of LD saphenous veins. With routine ultrasound surveillance of these patients and selective anticoagulation, both techniques can be used safely across a wide array of CEAP classes. Longer term follow up is required to characterize the durability of MFA in LD truncal veins. 
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