Comparison of Outcomes in Patients Treated by Monopolar and Segmental Radiofrequency Ablation (RFA) in Treatment of Varicose Veins – a South Indian Perspective

Endovenous thermal ablation is now recognized as the first-line treatment of incompetent truncal or axial varicose veins associated with symptoms or signs of venous disease. In Radiofrequency ablation (RFA), devices can be either monopolar or segmental (bipolar). There are very limited data available comparing the two modalities of treatment. This study varies from those reported by modifying the technique and adding adjunctive procedures like phlebectomy and sclerotherapy.

Methods:

This is a prospective, non- randomized comparative cohort study comparing monopolar (F-Care) with segmental/bipolar (ClosureFast) RFA procedure. All the patients were followed up for 1 year and the end points analyzed were closure rates, complications, patient recuperation and recurrence between the two methods.

 

Results: Sixty-six limbs (subjects) in 52 patients were divided into 2 groups. 41.5% in the ClosureFast group and 60.6% in the F-Care group had C4 varicose veins. Preoperative VCSS ranged from 3 to 21 (mean 7.48±3.53) in both groups. In addition to GSV, 21 subjects (10 in the ClosureFast group and 11 in the F-Care group) also had AASV treated. The time taken for the procedure ranged from 5 to 23 min in the ClosureFast group and 8 to 38 min in the F-Care group. F-Care fiber had to be removed on an average of 3 times for cleaning the tip. All patients underwent adjuvant treatment with foam sclerotherapy, phlebectomy or both. Post operative pain was more persistent in the F-Care group (39.4% vs 18.2%) and ecchymosis was more seen in the ClosureFast group (15.2% vs 6.1%). Both methods showed 100% occlusion of the GSV at 6 months. Primary outcome at 1 year was 97% occlusion rate in both groups, with complete failure in 1 subject in each group. Partial failure was seen in 3 (9.1%) in the F-Care group and 1 (3.0%) in the ClosureFast group. The secondary outcomes measured by VCSS showed significant improvement in both groups but better improvement in the ClosureFast group.

Conclusions:

Both monopolar and segmental RFA are effective and comparable in primary closure rates for truncal/GSV ablation at 1 year. They are safe and have minimal intraoperative complications. The need for cleaning the charred tip of the F-Care fiber is a disadvantage of this system. However, cleaning the tip improves occlusion rates in patients being treated with F-Care system. Clinical improvement was seen in all patients but was more in patients undergoing the ClosureFast system of RFA when compared to F-Care system.