Predictive factors of success following radio-frequency stylet (RFS) ablation of incompetent perforating veins (IPV).
OBJECTIVE
To evaluate potential predictive factors associated with success or failure of incompetent perforating veins (IPVs) treated with radio-frequency stylet (RFS).


METHODS
Over the last 12 months in this observational study, 38 consecutive patients with various degrees of venous insufficiency and IPVs underwent 48 office-based radio-frequency ablation procedures (1 - C 3; 7 - C 4; 10 - C 5; 30 - C 6) in 44 limbs. There were 21 females and 17 males with a mean age of 67 +/- 17 years (38-93 years) who had a total of 93 IPVs (40 calf; 53 ankle). Eighteen patients (47%) had ipsilateral great saphenous vein (GSV) radio-frequency closures performed prior to current procedure. The venous flow pattern was classified by spectral waveform analysis as "normal" (spontaneous with respiratory phasicity) in 33 patients and "pulsatile" (with bidirectional cardiac phasicity) in five patients. Follow-up duplex scans were performed from 3 to 7 days postprocedure. Statistical analyses were performed for determining correlation between the various factors such as, age, pulsatile flow, CEAP class, prior GSV ablation, vein diameter, reflux, and patency.


RESULTS
The mean number of ablated IPVs was 1.94 +/- 0.38 ranging from 1-3. Immediate success rate was 88% (82 cases, 32 patients). IPVs had a duplex measured mean diameter of 3.8 +/- 1.1 mm (2-6.6 mm). Eleven IPVs remained patent in six patients. There was no significant difference between the patent and the obliterated IPV groups concerning age (P = 0.75), prior GSV ablation (P = .19), IPV diameter (P = .08) and CEAP classification. Conversely, four of the five procedures (80%) performed in patients with "pulsatile" venous flow failed, while only two of the remaining 43 procedures (4.7%) in patients with "normal" venous flow failed (P < .001).


CONCLUSIONS
These data show that a pulsatile venous flow pattern is a significant predictor of failure following RFS for IPVs.
Hingorani
Anil P
AP
Division of Vascular Surgery, Maimonides Medical Center, Brooklyn, NY 11219, USA. ahingorani@maimonidesmed.org
Ascher
Enrico
E
Marks
Natalie
N
Shiferson
Alexander
A
Patel
Nirav
N
Gopal
Kapil
K
Jacob
Theresa
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures; D001783:Blood Flow Velocity / Q000502:physiology; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011336:Probability; D018570:Risk Assessment; D012501:Saphenous Vein; D012720:Severity of Illness Index; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex; D014689:Venous Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*