The effect of increasing catheter distance from the deep junction on the outcomes of radiofrequency vein ablation

Objective: Thermal vein ablation (VA) is the recommended treatment modality for superficial venous reflux, with a recommended positioning of the catheter at 2 to 3 cm from the junction of the deep venous system. In contrast, novel sealing technology for saphenous VA involves treatment starting at 3 to 5 cm distal to the deep junction. This study examines the effect of increasing catheter distance from the junction on the outcomes of VA using radiofrequency.

Methods: A retrospective single-center review of patients treated with VA was performed. Demographics, symptoms, clinical class (Clinical, Etiology, Anatomy, and Pathophysiology classification), and ultrasound data were reviewed. The treatment groups were divided on the basis of the position of the catheter <3 cm (group A) or ≥3 cm (group B) from the deep junction. Clinical success, technical success, complications, and recurrence were compared between the two groups. Long-term follow-up was collected by telephone survey inquiring about intensity of symptoms on a numeric rating scale of 0 to 10 before and after treatment. A multivariable analysis was performed to identify predictors of recurrence.

Results: There were 362 patients with 529 veins treated. The mean age was 59.2 ± 14.4 years (63% women). There was a significantly higher proportion of patients with past medical history of hypertension (P = .02) and deep venous thrombosis (P = .02) in group B compared with group A. Group B also had significantly larger vein diameter on ultrasound (P = .04). The clinical success, technical success, and complication rates were 80%, 95.6%, and 11.5%. There were no significant differences between the two groups in outcomes. After a mean follow-up of 27.5 months, recurrence rate was 22.2%. There was a trend toward higher recurrence in group B that did not, however, reach statistical significance (P = .1). On multivariable analysis, there was no clinical or technical factor that could predict recurrence.

Conclusions: The experience with radiofrequency ablation does not support difference in outcomes when treatment starts at ≥3 cm from the junction. However, there is a trend toward increased long-term recurrence that warrants further investigation with newer technology.