Factors influencing recurrent varicose vein formation after radiofrequency thermal ablation for truncal reflux performed in two high-volume venous centers.

OBJECTIVE: Recanalization of the saphenous vein trunk after endovenous radiofrequency ablation (RFA) is often associated with recurrent varicose veins or similar. This study aimed to assess the long-term results of RFA of the great saphenous vein (GSV) and identify risk factors for GSV recanalization and RVVs over the follow-up in patients presenting to dedicated outpatient vein centers.

METHODS: All consecutive patients with incompetent GSV who underwent RFA between 2009 and 2019 were retrospectively analyzed. The primary study endpoints were freedom from GSV recanalization and RVV rate over the follow-up. Secondary study endpoints were postoperative complication rate and risk factors for GSV recanalization and RVVs. Univariate and multivariate analyses were performed to identify potential risk factors for GSV recanalization and RVVs.

RESULTS: During the study period, 1568 limbs were treated in 1300 consecutive patients (mean age 53.5 ± 12.9 years; 71.9% women; CEAP 2-6; VCSS > 5). The technical success rate was achieved in 99.7% of cases. At a mean follow-up of 57.2 ± 25.4 months, GSV occlusion and freedom from reintervention rates were: 100% and 100% within 1 week, 97% and 95.7% at 1 year, 95.2% and 93.1% at 3 years, 92.4% and 92.8% at 5 years, respectively. The recurrence rate was 10% (n = 158) over the follow-up. At multivariate analysis, the direct confluence of the accessory saphenous vein (ASV) into the saphenous-femoral junction (SFJ) (OR 1.561; 95% CI 1.0 - 7.04; p =.032), history of pregnancy > 2 (OR 3.68; 95% CI 1.19 - 11.36; p =.023), C4 (OR 6.41; 95% CI 1.36 - 30.28; p =.019), and preoperative GSV diameter > 10 mm (OR 1.82; 95% CI 1.65 - 4.03; p =.043) were found to be risk factors for GSV recanalization. Moreover, age > 70 years (OR 1.04; 95% CI 1.01 - 1.06; p = .014) and incompetent perforators (PVs) (OR 1.17; 95% CI 0.65 - 2.03; p = .018) were found to be risk factors for RVV as well.

CONCLUSIONS: RFA is a safe technique to ablate GSV with a low complication rate and durability over the follow-up. However, patients with high clinical score and those with direct confluence of the ASV into the SFJ experienced higher long-term GSV recanalization and RVVs.