Comparison of EVLA and Radiofrequency Results in Venous Insufficiency Treatment

Abstract

Objective: Minimally invasive techniques have begun to replace conventional surgery to a great extent in the treatment of Chronic Venous Insufficiency (CVI). We aimed to compare and evaluate the Radiofrequency and Endo Venous Laser Ablation (EVLA) techniques used for vena saphena magna (VSM) ablation in interventional treatment. Materials and Methods: 240 symptomatic patients who were diagnosed with CVI in the Department of Cardiovascular Surgery of Bozok University Faculty of Medicine during January 2015-October 2020 were included in the study. Patients Those who had EVLA application; Group 1, Those who underwent radiofrequency ablation; Separated as the second group, 120 patients in each group were included in the study. Before the procedure, saphenous vein diameters and reflux times were measured with venous lower extremity color Doppler ultrasonography (CDUS). Saphenous veins over 5.5 mm in diameter and saphenofemoral reflux time 0.5 sec. longer cases were included in the study. In patients, the mean amount of energy to the saphenous vein with EVLA. A power of 10-40 watts was supplied, generating 91.7 J / cm (65-119 J / cm), and RFA 120 ° C. Two groups with similar demographic characteristics were invited to the first week control examination, and the first and sixth months after the procedure for CDUS control. Results: In the CEAP ranking, 78.33% with 94 patients in the RFA group was C2 class, and 13.33% in the EVLA group with 16 patients. While 10% of 12 patients in the RFA group were C3 class, 71 cases in the EVLA group constituted 59.16%. In the postop first month doppler examination in the RFA group, 117 of 120 cases were obliterated with a rate of 97.50% and in the EVLA group with a rate of 98.33%. In the postoperative ultrasound controls, in 111 patients (92.5%) in the RFA group, the saphenous vein was completely closed. In the EVLA group, there was complete closure in 112 cases (93.33%). 3.33% Hematoma, 1.66% paresthesia, 6.66% ecchymosis, 0.83% thrombophlebitis and 1.66% cellulitis in RFA cases, in the EVLA group; 4.16% hematoma, 0.83% paresthesia, 9.16% ecchymosis, 1.66% thrombophlebitis, 2.50% cellulite complications developed medically treated. Surgical procedure time approx. 33.20 minutes in the RFA group. while 35.28 min in the EVLA group. happened. Pain was the most common symptom in both groups in the preoperative period, with 100% in the EVLA group and 99.16% in the RFA group. Our patients who reported full recovery to their pain in the 6th postoperative month after the procedure; It was 85% in EVLA cases and 76% in RFA cases. Conclusions: RFA and EVLA have advantages in terms of high efficiency, low complications and loss of work force, as well as some disadvantages arising from the technical nature of the procedures. We think that individualization according to the case is important in reducing the complication rates, choosing the right patient, effective use of tumescent anesthesia and energy use, and both techniques have close results with high closure rates and low minor complications.