Termoablação por radiofrequência para o refluxo da veia safena magna associado a escleroterapia de varizes com espuma guiada por ultrassonografia em intervenção ambulatorial única: estudo de coorte prospectivo em centro terciário envolvendo safenas de grandes diâmetros

Abstract

This study assessed the outcomes and impact on the quality of life following one-step ambulatory radiofrequency thermal ablation (RTA) and ultrasound guided foam sclerotherapy (USGFS) for large reflux with varicosities in the great saphenous vein (GSV). Thirty symptomatic patients having reflux in the GSV and varicosities (CEAP C3 to C6) were treated with RTA and USGFS simultaneously, in a single-step procedure, from March 2016 to December 2016 in a prospective, single-centre, cohort design. They were followed up at 1 week, 6 months, 1 and 3 years. Clinical outcomes, changes in Quality of Life (QOL) questionnaires SF-36™, VCSS and AVVQ, evolutive vein occlusion rates were assessed by duplex ultrasound, and ulcer closure was checked. The sample was divided in two groups (1) GSV diameter ≥ 13.0 mm (median 19.0 [14–24]), 17 subjects, and (2) GSV diameter ≤ 12.9 mm (median 10.3 [10–12]), 16 subjects. No major adverse event was observed, and the postoperative minor adverse event rates were similar between the two groups. A significant improvement was observed in VCSS and AVVQ from the preoperative levels to the sixth month and the third year follow-up. Twelve of 13 ulcers had healed at 1 year and remained closed until 3 years. The entire sample had a significant increase in all short form 36 domains, except mental health in the group with and GSV ≥ 13.0 mm. Overall seven day occlusion rate for the whole sample was 90.9% and 69.7% at 3-year follow-up. No difference in occlusion rate was observed between the two groups at any time. Ambulatory combined techniques were safe and feasible in this study with no major adverse events, despite the large diameters of the GSV. Within 3 years, both diameter groups showed equivalent improvement in all QOL parameters, satisfactory axial occlusion, and maintained ulcer closure.