Print this pageUltrasound-Guided Percutaneous Radiofrequency Obliteration For Treatment of Perforating Vein Incompetence
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Alan Lumsden, M.D.1, David Chang, M.D.2, Eric Peden, M.D.1, Steve Gale3.
1Baylor College of Medicine, Houston, TX, USA, 2Stanford University School of Medicine, Stanford, CA, USA, 3Jobst Vascular Center, Toledo, OH, USA.
Background: Perforating vein (PV) incompetence affects 50-65% of patients with advanced chronic venous insufficiency. Current available treatments include surgical ligation, SEPS (subfascial endoscopic perforator vein surgery) and sclerosant injection. This study evaluates a new treatment option using percutaneous radiofrequency (RF) obliteration.
Methods: Four centers with institutional review board approval contributed data. Incompetent perforating veins in symptomatic patients were treated with a radiofrequency stylet that was introduced percutaneously using a 12 gauge intravenous access catheter and ultrasound guidance. Perforators were treated subfascially, either intra- or extra-vascularly. Post-operative compression was applied. Patient follow-up included clinical and duplex ultrasound evaluation at 72 hours, 3 weeks, and 6 months.
Results: Ninety seven PVs in 55 limbs (46 patients) were treated and the follow-up is ongoing. When analyzing the relationship between RF treatment time, electrode positioning and treatment efficacy, endovascular treatment with treatment time ≥120sec demonstrated a vein occlusion rate of 91.2% (31/34) at 3wks. Extravascular treatment or treatment time less than 120sec resulted in significantly lower efficacy rate. Asymptomatic calf muscle venous thrombosis was observed under ultrasound in 2 limbs (2 patients), one at 3wk possibly relating to a long distance flight of the patient, and one at 72h, the patient having previous history of superficial thrombophlebitis. Both thromboses were treated with anticoagulant therapy and resolved with no clinical sequelae.
Conclusion: Percutaneous radiofrequency obliteration offers a true minimally invasive option for the treatment of perforator incompetence. An improved treatment protocol was developed from the results this study. The durability of the treatment will be demonstrated by the 6-month follow-up data.
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