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Factors associated with recurrence of varicose veins after thermal ablation: Results of the REVATA (Recurrent Veins After Thermal Ablation) Study
Author Block: R. G. Bush
1
, P. Bush
1
, T. Brassel
1,
J. Flanagan
2
, R. Fritz
3
, T. Gueldner
4
, J. Koziarski
5
, K. McMullen
6
, G. Zumbro
7
.
1
Midwest Vein & Laser Center, Centerville, OH,
2
Delaware Valley Vein Center, Phoenixville, PA,
3
Advanced Vein Center of North Texas, Irving, TX,
4
Wisconsin Vein Center, Manitowoc,
WI,
5
Family Surgical, Battle Creek, MI,
6
Varicose Vein Clinics of Oklahoma, Oklahoma City, OK,
7
Vein Specialists of Augusta, Martinez, GA.
BACKGROUND:
Factors contributing to recurrence of varicose veins after thermal ablation are not well known. The goal of this prospective, non-randomized, multi-center trial was to determine the
site, source, and contributory factors of varicose vein recurrence after radiofrequency (RF) and laser ablation.
METHODS:
Seven centers enrolled patients into the study during a twelve-month period, from January 1st, to December 31st, 2010. All patients underwent previous thermal ablation of the great
saphenous vein (GSV), small saphenous vein (SSV) or anterior accessory great saphenous vein (AAGSV). Patients with high ligation of the GSV and/or stripping were excluded
from the study. From a specific designed study tool, recurrence was identified as to site, etiology, and primary mode of treatment (RF, laser)
RESULTS:
2,380 patients were evaluated during this time frame. A total of 164 patients, (7%), 3 with bilateral limb involvement, had varicose vein recurrence at a median of 3 years after
treatment (range: less than 6 months to 6+ years) This group of 164 patients with varicose vein recurrence were the subjects of this study. 33% were between the age of 51 and
60, median age range was 51-60, and 83% were women. A history of deep venous thrombosis (DVT) was present in 5% of the patients and deep venous insufficiency was present
in 17%. GSV ablation was the initial treatment in 159 patients (RF: 33, laser: 126, 52 of these patients had either SSV or AAGSV ablation concurrently. Total or partial GSV
recanalization occurred in 47 patients (29%). Of these 47 patients, 27 had RF ablation, and 20 had laser thermal ablation. New AAGSV reflux occurred in 40 patients (24%), and
new SSV reflux occurred in 24 patients (16%) Primary or associated perforator pathology was present in 64% of patients.
CONCLUSION:
Recurrence of varicose veins occurred at a median of 3 years after thermal ablation, which was 7% of the 2,380 patients evaluated for venous disease in 2010. The four most important
factors associated with varicose vein recurrence included new or recurrent perforating veins; recanalized GSV, new AAGSV reflux, and new SSV reflux in decreasing frequency. In
this study, patients who underwent RF treatment had a higher rate of GSV recanalization than those treated with laser, which was statistically significant.