A Comparison of Radiofrequency Ablation and Microfoam Sclerotherapy of Large Diameter Truncal Veins Results in Excellent Early Closure Rates and Symptomatic Relief

Endovenous closure of truncal veins with a large diameter (LD) (≥8 mm) has been associated with higher risk of postprocedure 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 after MFA and radiofrequency ablation (RFA) 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 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, procedure details, adverse thrombotic events, and follow-up data were abstracted. Beginning in June 2018, consecutive limbs that underwent RFA (n = 62) and MFA (n = 62) were compared. Preoperative demographics are presented in the Table. The overall mean truncal vein diameter was 10.5 mm (RFA, 10.1 mm; MFA, 11.0; P = .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 after treatment in both groups (RFA, 9.3 to 7.7 [P ≤ .001]; MFA, 11.3 to 9.0 [P ≤ .001]). The incidence of postprocedure 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. Postprocedure phlebitis occurred in 11.3% of patients in the RFA and MFA groups. Excellent early closure rates and symptom relief can be achieved after 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.TableDemographic data for patients undergoing radiofrequency ablation (RFA) and microfoam ablation of large diameter (LD) truncal veinsMFARFAOverallLimbsN = 62N = 62N = 124Mean age, years65.1 ± 12.360.6 ± 15.162.9 ± 13.9Female62.9%64.5%63.7%CEAP clinical class C225.8%30.0%27.9% C311.3%36.7%23.8% C424.2%23.3%23.8% C516.1%0.0%8.2% C622.6%10.0%16.4%Veins treated, n GSV5055 AASV112 SSV55 Total6662 Open table in a new tab