Comparison of radiofrequency ablation combined with transilluminated powered phlebectomy and high ligation and stripping combined with transilluminated powered phlebectomy in patients with varicose veins of lower limbs_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

LIAO Chuanjun ,  ZHANG Wangde

Department of Vascular Surgery, Beijing Chaoyang Hospital, The Affiliated Hospital of Capital Medical University, Beijing 100020,P. R. China;

Corresponding author：

ZHANG Wangde, Email: zhangwang_de@163.com

Keywords：

varicose veins of lower limb; radiofrequency ablation; high ligation and stripping; transilluminated powered phlebectomy; venous clinical severity score; chronic venous insufficiency questionnaire

DOI：

10.7507/1007-9424.202008046

Video：

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Objective To compare the effectiveness of radiofrequency ablation (RFA) combined with transilluminated powered phlebectomy (TIPP) vs. high ligation and stripping (HLS) combined with TIPP in patients with varicose veins of lower limbs.Methods A retrospective analysis was made on the clinical data of 190 patients (206 limbs) of varicose veins of lower limbs who underwent surgical treatment in our hospital from December 2017 to July 2018, of them 88 patients (96 limbs) in RFA combined with TIPP group and other 102 patients (110 limbs) in HLS combined with TIPP group. The treatment effectiveness and quality of life was assessed with venous clinical severity score (VCSS) and chronic venous insufficiency questionnaire (CIVIQ-14) in three months and one year after surgery. Doppler ultrasound was used to evaluate the closure of great saphenous vein.Results Baseline characteristics were similar between the two groups (P>0.05). The RFA combined with TIPP group was better than the HLS combined with TIPP group in operation time, intraoperative bleeding, hospital stay time, postoperative bed time, resumption time of activities, as well as incidences of skin induration and limb numb (P<0.05). Occlusion rates of great saphenous vein in 3 months was 93.8% (90/96) in the RFA combined with TIPP group and 97.3% (107/110) in the HLS combined with TIPP group, and in one year was 91.7% (88/96) and 97.3% (107/110) respectively, there was no significant difference between the two groups at the same time point (P>0.05). The VCSS scores and CIVIQ-14 scores also improved significantly in two groups in 3 months and 1 year follow up (P<0.05), but there was no significant differences between the two groups at the same time point (P>0.05).Conclusions RFA combined with TIPP is an effective method for the treatment of varicose veins of lower limbs. Compared with HLS, RFA has the same good effectiveness and quality of life, but it has the advantages of short operation time, rapid postoperative recovery, and less postoperative complications.

Citation： LIAO Chuanjun, ZHANG Wangde. Comparison of radiofrequency ablation combined with transilluminated powered phlebectomy and high ligation and stripping combined with transilluminated powered phlebectomy in patients with varicose veins of lower limbs. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(5): 631-635. doi: 10.7507/1007-9424.202008046 Copy

1.	Aurshina A, Zhang Y, Zhuo H, et al. Safety and efficacy of venous ablation in octogenarians. J Vasc Surg Venous Lymphat Disord, 2019, 7(5): 685-692.
2.	何培勇, 覃文, 孙丽娜, 等. 不同手术方法治疗下肢静脉曲张的临床效果. 临床医学研究与实践, 2020, 5(25): 99-100, 109.
3.	Tamura K, Maruyama T, Sakurai S. Effectiveness of endovenous radiofrequency ablation for elderly patients with varicose veins of lower extremities. Ann Vasc Dis, 2019, 12(2): 200-204.
4.	李涛, 朱国献, 杨红伟, 等. 下肢静脉曲张伴溃疡的病因分析及治疗. 中国血管外科杂志 (电子版), 2020, 12(1): 47-50.
5.	Wallace T, El-Sheikha J, Nandhra S, et al. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg, 2018, 105(13): 1759-1767.
6.	刘洪, 赵渝. 下肢静脉曲张微创治疗现状. 中国普外基础与临床杂志, 2020, 27(4): 400-403.
7.	李涛, 杨静, 杨红伟, 等. 外科手术联合腔内技术治疗下肢静脉性溃疡的疗效分析. 外科理论与实践, 2020, 25(4): 336-340.
8.	李涵泊, 王彬, 许永楷, 等. 腔内射频闭合术治疗下肢静脉曲张临床疗效. 血管与腔内血管外科杂志, 2020, 6(4): 300-303.
9.	王飞, 吕柏楠. 腔内激光闭合术治疗下肢静脉曲张的现状. 中国血管外科杂志 (电子版), 2020, 12(1): 73-76.
10.	下肢浅静脉曲张诊治共识微循环专家组. 下肢浅静脉曲张诊治微循环专家共识. 中华老年多器官疾病杂志, 2020, 19(1): 1-6.
11.	陆黎, 陆炯, 夏成勇, 等. 大隐静脉射频消融术与大隐静脉高位结扎剥脱术治疗静脉曲张的疗效对比. 局解手术学杂志, 2020, 29(1): 38-42.
12.	Crawford JM, Gasparis A, Amery S, et al. Treatment pattern of consecutive patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord, 2019, 7(3): 344-348.
13.	Bootun R, Onida S, Lane TR, et al. To compress or not to compress: the eternal question of the place of compression after endovenous procedures. Phlebology, 2016, 31(8): 529-531.
14.	张望德, 苑超, 邢彤, 等. TriVex 微创旋切术治疗下肢静脉曲张的临床分析. 中华外科杂志, 2006, 44(9): 588-590.
15.	Jayaraj A, Meissner MH. A comparison of Villalta-Prandoni scale and venous clinical severity score in the assessment of post thrombotic syndrome. Ann Vasc Surg, 2014, 28(2): 313-317.
16.	Launois R, Le Moine JG, Lozano FS, et al. Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res, 2012, 21(6): 1051-1058.
17.	Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med, 2019, 381(10): 912-922.
18.	Kheirelseid EAH, Crowe G, Sehgal R, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord, 2018, 6(2): 256-270.
19.	Goodyear SJ, Nyamekye IK. Radiofrequency ablation of varicose veins: best practice techniques and evidence. Phlebology, 2015, 30(2 Suppl): 9-17.
20.	Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2011, 53(5 Suppl): 2S-48S.
21.	Subramonia S, Lees T. Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Br J Surg, 2010, 97(3): 328-336.
22.	Proebstle T, van den Bos R. Endovenous ablation of refluxing saphenous and perforating veins. Vasa, 2017, 46(3): 159-166.
23.	Sutzko DC, Obi AT, Kimball AS, et al. Clinical outcomes after varicose vein procedures in octogenarians within the Vascular Quality Initiative Varicose Vein Registry. J Vasc Surg Venous Lymphat Disord, 2018, 6(4): 464-470.
24.	Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg, 2010, 52(5): 1387-1396.
25.	Launois R, Mansilha A, Jantet G. International psychometric validation of the Chronic Venous Disease quality of life Questionnaire (CIVIQ-20). Eur J Vasc Endovasc Surg, 2010, 40(6): 783-789.

1. Aurshina A, Zhang Y, Zhuo H, et al. Safety and efficacy of venous ablation in octogenarians. J Vasc Surg Venous Lymphat Disord, 2019, 7(5): 685-692.
2. 何培勇, 覃文, 孙丽娜, 等. 不同手术方法治疗下肢静脉曲张的临床效果. 临床医学研究与实践, 2020, 5(25): 99-100, 109.
3. Tamura K, Maruyama T, Sakurai S. Effectiveness of endovenous radiofrequency ablation for elderly patients with varicose veins of lower extremities. Ann Vasc Dis, 2019, 12(2): 200-204.
4. 李涛, 朱国献, 杨红伟, 等. 下肢静脉曲张伴溃疡的病因分析及治疗. 中国血管外科杂志 (电子版), 2020, 12(1): 47-50.
5. Wallace T, El-Sheikha J, Nandhra S, et al. Long-term outcomes of endovenous laser ablation and conventional surgery for great saphenous varicose veins. Br J Surg, 2018, 105(13): 1759-1767.
6. 刘洪, 赵渝. 下肢静脉曲张微创治疗现状. 中国普外基础与临床杂志, 2020, 27(4): 400-403.
7. 李涛, 杨静, 杨红伟, 等. 外科手术联合腔内技术治疗下肢静脉性溃疡的疗效分析. 外科理论与实践, 2020, 25(4): 336-340.
8. 李涵泊, 王彬, 许永楷, 等. 腔内射频闭合术治疗下肢静脉曲张临床疗效. 血管与腔内血管外科杂志, 2020, 6(4): 300-303.
9. 王飞, 吕柏楠. 腔内激光闭合术治疗下肢静脉曲张的现状. 中国血管外科杂志 (电子版), 2020, 12(1): 73-76.
10. 下肢浅静脉曲张诊治共识微循环专家组. 下肢浅静脉曲张诊治微循环专家共识. 中华老年多器官疾病杂志, 2020, 19(1): 1-6.
11. 陆黎, 陆炯, 夏成勇, 等. 大隐静脉射频消融术与大隐静脉高位结扎剥脱术治疗静脉曲张的疗效对比. 局解手术学杂志, 2020, 29(1): 38-42.
12. Crawford JM, Gasparis A, Amery S, et al. Treatment pattern of consecutive patients with chronic venous disease. J Vasc Surg Venous Lymphat Disord, 2019, 7(3): 344-348.
13. Bootun R, Onida S, Lane TR, et al. To compress or not to compress: the eternal question of the place of compression after endovenous procedures. Phlebology, 2016, 31(8): 529-531.
14. 张望德, 苑超, 邢彤, 等. TriVex 微创旋切术治疗下肢静脉曲张的临床分析. 中华外科杂志, 2006, 44(9): 588-590.
15. Jayaraj A, Meissner MH. A comparison of Villalta-Prandoni scale and venous clinical severity score in the assessment of post thrombotic syndrome. Ann Vasc Surg, 2014, 28(2): 313-317.
16. Launois R, Le Moine JG, Lozano FS, et al. Construction and international validation of CIVIQ-14 (a short form of CIVIQ-20), a new questionnaire with a stable factorial structure. Qual Life Res, 2012, 21(6): 1051-1058.
17. Brittenden J, Cooper D, Dimitrova M, et al. Five-year outcomes of a randomized trial of treatments for varicose veins. N Engl J Med, 2019, 381(10): 912-922.
18. Kheirelseid EAH, Crowe G, Sehgal R, et al. Systematic review and meta-analysis of randomized controlled trials evaluating long-term outcomes of endovenous management of lower extremity varicose veins. J Vasc Surg Venous Lymphat Disord, 2018, 6(2): 256-270.
19. Goodyear SJ, Nyamekye IK. Radiofrequency ablation of varicose veins: best practice techniques and evidence. Phlebology, 2015, 30(2 Suppl): 9-17.
20. Gloviczki P, Comerota AJ, Dalsing MC, et al. The care of patients with varicose veins and associated chronic venous diseases: clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum. J Vasc Surg, 2011, 53(5 Suppl): 2S-48S.
21. Subramonia S, Lees T. Randomized clinical trial of radiofrequency ablation or conventional high ligation and stripping for great saphenous varicose veins. Br J Surg, 2010, 97(3): 328-336.
22. Proebstle T, van den Bos R. Endovenous ablation of refluxing saphenous and perforating veins. Vasa, 2017, 46(3): 159-166.
23. Sutzko DC, Obi AT, Kimball AS, et al. Clinical outcomes after varicose vein procedures in octogenarians within the Vascular Quality Initiative Varicose Vein Registry. J Vasc Surg Venous Lymphat Disord, 2018, 6(4): 464-470.
24. Vasquez MA, Rabe E, McLafferty RB, et al. Revision of the venous clinical severity score: venous outcomes consensus statement: special communication of the American Venous Forum Ad Hoc Outcomes Working Group. J Vasc Surg, 2010, 52(5): 1387-1396.
25. Launois R, Mansilha A, Jantet G. International psychometric validation of the Chronic Venous Disease quality of life Questionnaire (CIVIQ-20). Eur J Vasc Endovasc Surg, 2010, 40(6): 783-789.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Comparison of radiofrequency ablation combined with transilluminated powered phlebectomy and high ligation and stripping combined with transilluminated powered phlebectomy in patients with varicose veins of lower limbs

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