title: Outcomes associated with ablation compared to combined ablation and transilluminated powered phlebectomy in the treatment of venous varicosities.
abstract: BACKGROUND
  Patients with painful varicose veins and venous insufficiency can be treated by eliminating axial reflux only or by eliminating axial reflux plus phlebectomy with transilluminated powered phlebectomy. This study was undertaken with the aim of determining and improving signs and symptoms of venous disease (measured by venous clinical severity score) and complications (by routine surveillance ultrasound and long-term post-operative follow up) for each treatment strategy.
  
  
  METHODS
  We performed a retrospective evaluation of prospectively collected data from 979 limbs undergoing procedures for significant varicose veins and venous insufficiency from March 2008 until June 2014 performed at a single tertiary referral hospital. Patient demographics, Clinical Etiology Anatomy and Pathophysiology classification, venous clinical severity scores pre- and post-procedure, treatment chosen, and peri-operative complications were collected; descriptive statistics were calculated and unadjusted surgical outcomes for patients stratified by the procedure performed. Multivariable logistic regression was used to evaluate the relationship between procedure type and thrombotic complications after adjusting for patient characteristics, severity of disease, pre-operative anticoagulation, and post-operative compression.
  
  
  RESULTS
  Venous clinical severity scores improved more with radiofrequency ablation + transilluminated powered phlebectomy as compared to radiofrequency ablation alone (3.8 ± 3.4 vs. 3.2 ± 3.1, p = 0.018). Regarding deep venous thrombosis, there was no significant difference between radiofrequency ablation + transilluminated powered phlebectomy vs. radiofrequency ablation alone. There was no statistical difference in asymptomatic endovenous heat-induced thrombosis or infection, although there were slightly more hematomas and cases of asymptomatic superficial thrombophlebitis with combined therapy. On multivariable analysis, only procedure type predicted thrombotic complications.
  
  
  CONCLUSIONS
  Ablation of axial reflux plus transilluminated powered phlebectomy produces improved outcomes as measured by venous clinical severity score, with slight increases in minor post-operative complications and should be strongly considered as initial therapy when patients present with significant symptomatic varicose veins and superficial venous insufficiency. Implementation of a standardized thromboprophylaxis protocol with individual risk assessment results in few significant thrombotic complications amongst high-risk patients, thus potentially obviating the need for routine post-operative duplex.
authors.affiliation: University of Michigan, Ann Arbor, MI, USA easta@med.umich.edu.
authors.forename: Andrea T
authors.initials: AT
authors.lastname: Obi
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Bradley N
authors.initials: BN
authors.lastname: Reames
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Trent J
authors.initials: TJ
authors.lastname: Rook
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Sandford O
authors.initials: SO
authors.lastname: Mouch
authors.affiliation: University of California, San Francisco, CA.
authors.forename: Arya
authors.initials: A
authors.lastname: Zarinsefat
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Cathy
authors.initials: C
authors.lastname: Stabler
authors.affiliation: University of Texas Southwestern, Dallas, TX.
authors.forename: John E
authors.initials: JE
authors.lastname: Rectenwald
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Coleman
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wakefield
mesh_terms: D000328:Adult; D000368:Aged; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013927:Thrombosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000517:prevention & control; D014648:Varicose Veins / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D014689:Venous Insufficiency / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery
keywords: Varicose veins; deep venous thrombosis; radiofrequency ablation; transilluminated powered phlebectomy; venous clinical severity score