Evaluation of radiofrequency endovenous obliteration of the great saphenous vein as an alternative to conventional stripping in the treatment of primary varicose veins. Assessment of the importance of saphenofemoral disconnection in reducing the rate of recurrence

ABSTRACT

The surgical treatment of primary varicose veins associated with Great saphenous vein GSV reflux has evolved into high ligation of the GSV with ligation and resection of tributaries entering the saphenofemoral junction [SFJ] and stripping of the thigh portion of the GSV with stab-avulsion phlebectomy of clusters fed by incompetent perforating veins. This study evaluates radiofrequency endovenous obliteration of the great saphenous vein as compared to conventional stripping. It also explores the added effect of extended saphenofemoral junction [SFJ] ligation when the GSV has been eliminated .from participating in thigh reflux by means of endovenous obliteration or conventional surgical stripping. GSV obliteration, unlike surgical stripping, can be done with or without SFJ ligation to isolate and study SFJ ligation specific contribution to treatment results. Fifty limbs with primary varicose veins and SFJ reflux were treated. Patients were classified into two groups; group I [n = 35] to whom high ligation of the SFJ and GSI' elimination were done. This group was further subdivided into group la [n = 20] in which conventional stripping of the GSV was done and group lb in which radiofrequency endovenous obliteration of the GSV was done. Group II [n = 15] were treated by radiofrequency endovenous obliteration of the GSV without high ligation of the SFJ. Treatment significantly reduced symptoms and CEAP clinical class in both groups [P = .0001]. The mean hospital stay was shorter in group II. The incidence of postoperative pain, hematoma formation and saphenous nerve affection was higher in group I. Recurrent reflux developed in one [2.8%.] of 35 high-ligation limbs and two. [6.6%] of 15 limbs without high ligation by 6 months [P = .273]. New instances of reflux did not appear thereafter in all 50 limbs followed to 6 months. Recurrent varicose veins occurred in three high-ligation limbs and one limb without high ligation by 6 months. Actuarial recurrence curves were not statistically different with or without SFJ ligation [P > 156], predicting greater than 90% freedom from recurrent reflux and varicosities at 1 year for both groups. Endovenous obliteration of the GSV may offer advantages over the conventional stripping operation in terms of reduced postoperative pain, shorter sick leaves, and faster return to normal activities. The early results also suggest that extended SFJ ligation may add little to effective GSV obliteration, but these findings are not significantly robust to warrant abandonment of SFJ ligation as currently practiced in the management of primary varicose veins associated with GSV vein reflux