High ligation of sapheno-femoral junction and thermal ablation for lower limb primary varicosity in day hospital setting.

AIM: The traditional surgical treatment for lower limb primary varicosity has been for a long time high ligation of sapheno-femoral junction and stripping of great saphenous vein. Surgery, however, has been frustrated by postoperative pains and discomfort and recurrences so that it has been challenged by minimally invasive endovenous techniques such as laser treatment and radiofrequency ablation. The aim of the article is to assess the feasibility, in a day hospital setting, of a combined approach to greater saphenous vein reflux: high ligation of sapheno-femoral junction and thermal treatment of the great sapenous vein.

METHODS

A retrospective analysis on 95 patients treated with high ligation and thermal ablation at our institution from January 2009 to July 2017 was performed, assessing duration of surgery, post-operative pain and analgesics requirements, early complications and resumption of activities.

RESULTS

Two patients (2.74%), in the laser group experienced skin burns in the course of the GSV. Moderate ecchymosis, by laser fibre-induced perforation of the vein wall, were observed in another two patients (2.74%). Four limbs (5.48%) in the EVLT group developed transient paraesthesias. Analgesic requirement on POD 3 was nil for RFA group; conversely half of the EVLT patients did take analgesics, either 2 or 3 tabs were required. On POD 7, the patients of RFA group continued to not ask for any analgesics, but the same half of the patients in EVLT group still needed 1-2 tabs to carry out their normal activities smoothly. On POD 15, no patient did require analgesics. Resumption of routine activities was earlier for RFA group patients than for those in the EVLT group. The RFA group resumed their activities within 3 days, whereas EVLT group in 8-9 days. High ligation of the SFJ didn't add too much time or morbidities.

CONCLUSION

Catheter delivery of thermal energies for saphenous ablation, even when combined with high ligation of saphenous femoral arc, demonstrated to be minimally invasive, easy to learn and easy to perform in day hospital setting, with early return to normal activity. EVLT achieved similar results to RFA and both techniques were considered equally effective and safe; the results we obtained were not statistically significant but RFA showed less pain, ecchymosis and haematomas, as well as provided better short-term quality of life.

KEY WORDS: Day Hospital setting, Endovenous laser treatment, High ligation ablation of the saphenous vein, Radiofrequency ablation.