Abstract
Objectives In addition to combined crossectomy and stripping or pure sclerotherapy, various
endovenous thermal procedures are now available for treatment, which are compared
in the present study.
Methods Between 2009 and 2013, the GSV was ablated in 297 patients using one of four methods:
EVLA 1470 nm, ClosureFast, RFITT or superheated steam. The recurrence rate after treatment
was defined as the primary endpoint. Follow-up examinations with duplex ultrasound
took place 14 days, 3 months and 1 year post-operatively, and thereafter annually
with average follow-up time of 3.8 years and a follow-up rate of 81 %.
Results At the time of the last follow-up examination, the following complete closure rates
of treated GSV were found: ClosureFast 95 %, EVLA 97 %, RFITT 79 % and superheated
steam 71 %. Serious complications occurred only with superheated steam (necrosis at
the puncture site). The median pain intensity recorded 14 days post-operatively was
1–3 on a scale of 1–10. Both the CIVIQ score and the VCSS were significantly improved
by all endovenous thermal methods. In 5–12 % of cases, reflux was found in the previously
non-refluxive AASV.
Conclusions EVLA and ClosureFast are indicated for the treatment of GSV incompetence with high
success rates, comparable to the results with crossectomy and stripping. The RFITT
and superheated steam methods present significantly lower closure rates. Particular
attention should be paid to the presence of an initially non-refluxive AASV. Since
there was an increased recurrence rate over this vein, it seems reasonable to treat
the AASV primarily.
Key words varicose veins - great saphenous vein - endothermal ablation - recurrence rate
Schlüsselwörter Varikose - Vena saphena magna - endothermale Ablation - Rezidivhäufigkeit
