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Venous Clinical Severity Scores and RF Saphenous Vein Ablation in 580 Limbs

Michael Vasquez, MD
SUNY Buffalo, Buffalo, NY

Objective(s):
The goal of endovenous ablation is to abolish reflux, thereby, reducing the symptoms associated with chronic venous insufficiency. We report a prospective study comparing patients’ signs and symptoms of venous insufficiency using the Venous Clinical Severity Score (VCSS), before and after endovenous saphenous vein radiofrequency ablation (SVRFA).
Methods:
Between September 2003 and March 2005, 435 patients underwent 580 SVRFA procedures. Pre-operative venous clinical severity scores (VCSS) were documented. All SVRFA procedures were performed with local anesthesia and/or IV sedation. Follow-up clinical and duplex examinations were routinely performed 4 days, 4 weeks and 4 months after SVRFA and at 6 or more months thereafter. At follow-up visits patients were rescored and also asked to evaluate their level of satisfaction with the procedure.
Results:
The mean age of the patients was 54.3 years (range 28.3 - 86.7); 69.9% were female. Pretreatment CEAP clinical class C3/C4 comprised 80.0% (464/580) of limbs. Pre-operative, 4 day, 4 week and 4 month VCSS values were 8.9 ± 3.7, 5.2 ± 3.1 (n=572 limbs), 4.1 ± 2.5 (n=475) and 3.2 ± 1.7 (n=414), respectively. Pretreatment venous stasis ulcers were present in 43 limbs with a healing rate of 72.1% (31/43) and average time to heal of 36.5 ± 38.4 days. Complications included thrombophlebitis in 2.8% (16/580), paresthesias 0.2% (1/580), and non-occlusive thrombus extension 0.2% (1/580). Less than 2% (5/398) of patients reported dissatisfaction with the outcome of the procedure. Follow-up examinations at a mean of 11.0 ± 2.0 months on 142 limbs revealed an average VCSS of 2.5 ± 1.3 and saphenous vein closure in 94.4% (134/142).
Conclusions:
Treatment of saphenous vein reflux with endovenous radiofrequency ablation results in the clinical improvement of patients symptoms as determined by Venous Clinical Severity Scoring, and aids in the healing of venous ulcers.