Rossi Fábio Henrique, Beteli Camila Baumann, Tannus Miguel Monteiro
Dante Pazzanese Cardiovascular Institute, São Paulo, Brazil.
Dante Pazzanese Cardiovascular Institute, São Paulo, Brazil.
J Vasc Surg Venous Lymphat Disord. 2025 Sep;13(5):102245. doi: 10.1016/j.jvsv.2025.102245. Epub 2025 Apr 8.
Thermoablation is increasingly being used as an alternative to traditional surgery for treating primary varicose veins. Electrocoagulation ablation (EA) of the great saphenous vein (GSV) has demonstrated effectiveness and safety comparable with that of radiofrequency ablation (RFA); however, its long-term outcomes have not been investigated previously.
This study involves a long-term follow-up of patients who participated in a double-blind, randomized clinical trial. Individuals with lower limb varicose veins and incompetence of GSV were randomly assigned to two treatment groups: EA and RFA. Follow-up assessments were scheduled at 1 week, 3 months, 6 months, and annually thereafter. The primary outcome measured was GSV occlusion, evaluated through postoperative duplex ultrasound examination. Secondary outcomes included the complication rate and improvements in quality of life, assessed using the Aberdeen Varicose Vein Questionnaire score.
A total of 57 patients were included, which involved a cumulative 85 treated GSVs; 42 veins were treated with EA and 43 with RFA. At the 1-week, 3-month, and 6-month follow-ups, there were no statistically significant differences between the two groups regarding GSV occlusion rates (P = .430, P = .157, and P = .157, respectively), complication rates (P = .717, P = .317, and P = .320, respectively), or improvements in quality-of-life scores (P = .540, P = .786, and P = .401, respectively). After a median follow-up duration of 4.8 years (95% confidence interval, 4.5-5.1 years), data for 59 procedures (69.4%) were available, showing occlusion rates of 89.7% for the EA group (n = 29) and 66.7% for the RFA group (n = 30) (P = .001). There were no procedure-related complications (P = .127) and no significant differences in the Aberdeen Varicose Vein Questionnaire scores (P = .345) between the two groups analyzed.
EA has demonstrated effectiveness and safety for ablation of the GSV, achieving a higher rate of venous occlusion compared with RFA in the long-term follow-up. Additionally, the occurrence of complications and the impact on symptoms and quality of life were comparable between the two methods during long-term follow-up.
热消融正越来越多地被用作治疗原发性静脉曲张的传统手术的替代方法。大隐静脉电凝消融术（EA）已证明其有效性和安全性与射频消融术（RFA）相当；然而，其长期疗效此前尚未得到研究。
本研究对参与一项双盲随机临床试验的患者进行长期随访。患有下肢静脉曲张且大隐静脉功能不全的个体被随机分为两个治疗组：EA组和RFA组。随访评估安排在术后1周、3个月、6个月，此后每年进行一次。主要观察指标是大隐静脉闭塞情况，通过术后双功超声检查进行评估。次要观察指标包括并发症发生率和生活质量改善情况，使用阿伯丁静脉曲张问卷评分进行评估。
共纳入57例患者，涉及85条接受治疗的大隐静脉；42条静脉接受了EA治疗，43条接受了RFA治疗。在1周、3个月和6个月的随访中，两组在大隐静脉闭塞率（分别为P = 0.430、P = 0.157和P = 0.157）、并发症发生率（分别为P = 0.717、P = 0.317和P = 0.320）或生活质量评分改善方面（分别为P = 0.540、P = 0.786和P = 0.401）均无统计学显著差异。在中位随访期4.8年（95%置信区间，4.5 - 5.1年）后，可获得59例手术（69.4%）的数据，显示EA组（n = 29）的闭塞率为89.7%，RFA组（n = 30）为66.7%（P = 0.001）。两组均无手术相关并发症（P = 0.127），且在阿伯丁静脉曲张问卷评分方面无显著差异（P = 0.345）。
EA已证明对大隐静脉消融有效且安全，在长期随访中与RFA相比实现了更高的静脉闭塞率。此外，在长期随访中，两种方法的并发症发生率以及对症状和生活质量的影响相当。
