Closure of the greater saphenous vein with endoluminal radiofrequency thermal heating of the vein wall in combination with ambulatory phlebectomy: 50 patients with more than 6-month follow-up.
BACKGROUND: Incompetence of the saphenofemoral junction (SFJ) with reflux into the greater saphenous vein (GSV) is one cause of chronic venous hypertension that may lead to the development of varicose and telangiectatic leg veins. OBJECTIVE: To evaluate with long-term follow-up a novel method for closing the incompetent GSV at its junction with the femoral vein through an endoluminal approach. METHODS: Fifty patient legs with reflux at the SFJ into the GSV were treated with radiofrequency (RF) heating of the vein wall through an endoluminal catheter. Patients were evaluated at 6, 9, 12, and 18-24 months to determine treatment efficacy as well as adverse sequelae. RESULTS: Nine patients could not return for evaluation after 3 months. The remaining 41 patient legs were evaluated. Sixty-eight percent of treated legs achieved complete closure of the SFJ and GSV. Twenty-two percent of legs had an open GSV without reflux. Three patients (four legs) (10%) had an open and refluxing GSV. Three of 41 legs had recurrent varicose veins. Only 1 of 41 legs had recurrent symptoms. Complete treatment took an average of 20 minutes. Adverse sequelae were minimal, with 28 legs showing purpura less than 2 weeks, 5 legs with erythema less than 1 week, and 8 legs with an indurated fibrous cord lasting for up to 6 months posttreatment. CONCLUSION: Endoluminal RF thermal heating of an incompetent GSV has been shown to be easily accomplished and efficacious throughout the 24-month-follow-up period.