Comparative Study between Ultrasound-Guided Foam Sclerotherapy, Radiofrequency Ablation & Endo-Venous Laser Ablation in Treatment of Great Saphenous Vein Reflux

Abstract Background: The main goal in the treatment of varicose veins is to reduce the symptoms and complications of chronic venous insufficiency and to improve health related quality of life (QoL) of patients. Surgery has been the standard of care in the treatment of saphenous varicose veins for more than a century. Aim of Study: The aim of this work is to compare between the outcome after UGFS, RFA & EVLA concerning the treat-ment of great saphenous vein reflux, regarding success rate, recurrence rate and complications rate. Subjects and Methods: This study was carried out at the Vascular Surgery Department, Zagazig University Hospitals during the period from August 2016 to August 2018, included a total of 51 treated lower limbs in 39 patients were divided into three different groups: Endovenous Laser Ablation (EVLA group) (n=18 legs in 13 patients; 1470nm, continuous mode, radial fiber), Radiofrequency Ablation (RFA group) (n=16 legs in 13 patients) and Ultrasound Guided Foam Sclerotherapy (UGFS group) (n=17 legs in 13 patients). All patients were subjected to complete clinical examination and laboratory investigations. Post procedure follow-up was done after one week, three month, six months & one year following treatment and all limbs were assessed clinically and by using DUS. Results: All the three treatment modalities significantly improved VCSS and QoL as reflected by significant improve-ments in VCSS and CIVIQ; with no significant differences in the outcome between the groups. The improvements per-sisted throughout the 2 years and showed that EVLA, RFA and UGFS are efficient treatments with longerterm beneficial effects in patients with GSV varicose veins. This is true even though some patients in the UGFS group developed recanal-ization of the GSV. UGFS group was significantly longer regarding duration to return to work (p < 0.01) than EVLA and RFA group which both had non-significant difference between them.
Conclusion: Our study demonstrated that EVLA & RFA are efficient modalities for the treatment of GSV varicose veins in the medium term. Notinga moderate rate of recanal-ization after UGFS, it appears that EVLA & RFA are superior to UGFS regarding clinical recurrence, VCSS and QoL. Post-operative patient comfort and the outcome of EVLA & RFA in short & medium-terms are superior to those after UGFS in terms of recanalization & effective ablation.