From the Guidelines
Endovenous ablation therapy (EVAT) is indicated in this case, as the great saphenous vein is incompetent with a diameter of 3.8mm and reflux time of 2.5 seconds, indicating significant venous reflux. The findings show that while the sapheno-femoral junction is patent and competent (functioning normally), the great saphenous vein's incompetence suggests venous insufficiency, which can cause symptoms like pain, swelling, and varicose veins. According to the most recent and highest quality study 1, endovenous ablation has largely supplanted surgical ligation and stripping as the main invasive method to treat varicose veins with similar efficacy, improved early quality of life, and reduced hospital recovery. Key benefits of EVAT include:
- Minimally invasive procedure
- Uses heat (laser or radiofrequency) to seal the incompetent vein
- Redirects blood flow through healthier veins
- Preferred over traditional vein stripping due to quicker recovery, less pain, and fewer complications
- Patients typically resume normal activities within 1-2 days after EVAT The short saphenous vein being patent and competent means treatment can focus solely on the great saphenous vein. As noted in 1, current data on RFA versus EVLA is rather limited, although there have been some recent developments, but both treatments have shown similar efficacy and safety profiles. It is essential to follow post-procedure recommendations, such as wearing compression stockings for 1-2 weeks, to improve outcomes and reduce complications. Overall, EVAT is a suitable treatment option for this patient, given the significant venous reflux and incompetence of the great saphenous vein.
From the Research
Indications for Endovenous Ablation Therapy (EVAT)
- The patient's great saphenous vein is patent and incompetent, with a diameter of 3.8mm and a reflux time of 2.5sec, indicating a potential candidate for EVAT 2, 3, 4, 5, 6.
- The sapheno-femoral junction is patent and competent, which is a crucial factor in determining the suitability of EVAT 2, 3, 4, 5, 6.
Treatment Options
- Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are both effective treatments for great saphenous vein incompetence, with comparable technical success rates 2, 5.
- Ultrasound-guided foam sclerotherapy (UGFS) is also a treatment option, but its long-term efficacy is not as well established as EVLA and RFA 2, 5, 6.
- Conventional surgery, such as high ligation and stripping, is also a treatment option, but it may have a higher risk of complications compared to EVAT 2, 6.
Outcomes and Complications
- The technical success rate of EVLA and RFA is high, with occlusion rates of 99.6% and 88.7%, respectively 4, 5.
- The complication rate of EVAT is low, with few major complications reported 3, 4, 6.
- Quality of life improves significantly after EVAT, with improvements in disease-specific and general quality-of-life scores 6.