Factors Influencing Early Recanalization (ER) of the Great Saphenous Vein (GSV) After Radiofrequency Ablation

OBJECTIVES:
ER of the GSV after endovenous ablation can be observed in up to 10% of cases. Our aim was to investigate potential predictive factors associated with this adverse outcome.
METHODS:
From April 2003 to September 2006, 269 limbs in 254 patients (67% females) had RFA of the GSV. The mean age was 60 ± 15 years. Pre- and post-procedure (one week) duplex scans were obtained. Factors analyzed included probe temperature, CEAP classification, GSV diameter and presence of deep venous insufficiency (DVI). In the first 10 months of the study the mean temperature target for the probe was 85 °C (100 limbs =37%), while during the remaining 30 months it was 90 °C (169 limbs =63%). There were 80 limbs in CEAP class C5-6 (30%). Thirty large GSVs ≥10mm that ranged from 10mm to 20.3mm (mean 1.25±0.27mm) were compared to 199 smaller GSVs <10mm that ranged from 0.2mm to 0.99mm (mean 0.66±0.155mm). Ipsilateral DVI was documented in 183 cases (68%).
RESULTS:
ER after RFA was detected in 42 cases (16%). Of these, 26 were complete (62%), and 16 were partial (38%). Univariate analysis revealed that use of a higher probe temperature (90 °C) was significantly associated with ER (p=0.01). The absence of DVI (p=0.05) bordered significance. Larger vein diameter and CEAP classification did not significantly impact early outcome (p=0.12 and p=0.14, respectively).
CONCLUSIONS:
This experience confirms the observation that RFA of the GSV is associated with a significant number ER (16%). Mean probe temperature of 85 °C is more effective than higher temperatures to prevent ER.