Evaluation of the efficacy and ulcer recurrence risk of endovenous radiofrequency ablation in elderly patients with lower extremity varicose veins

doi:10.11958/20260219

Abstract

Abstract:

Objective To investigate the clinical efficacy of endovenous radiofrequency ablation (RFA) in elderly patients with lower extremity varicose veins, and to analyze the independent risk factors for venous leg ulcer (VLU) recurrence and establish a predictive nomogram. Methods Clinical data of 211 elderly patients with lower extremity varicose veins complicated by venous leg ulcer (VLU) who underwent RFA from January 2020 to January 2022 were retrospectively analyzed. Operative parameters, perioperative complications and long-term follow-up data were recorded. Univariate analysis and multivariate Logistic regression models were used to screen independent risk factors for ulcer recurrence. A recurrence risk prediction nomogram was constructed based on the identified independent risk factors and internally validated using the Bootstrap resampling method. Results The technical success rate of the procedure was 100% for all patients. The venous clinical severity score (VCSS) showed a significant decrease during the postoperative follow-up (P<0.01). The perioperative complication rate was 8.06% (17/211). Among the 211 patients, 79 experienced recurrence (recurrence group), and the remaining 132 cases were included in the non-recurrence group. Univariate analysis and multivariate Logistic regression analysis revealed that age, body mass index (BMI), history of diabetes, ulcer area, poor compliance with compression stocking therapy postoperatively and deep venous reflux were independent risk factors for venous ulcer recurrence in elderly patients (P<0.05). The nomogram constructed based on these factors had a predictive C-index of 0.832 (95%CI: 0.781-0.887). The Bootstrap-corrected C-index was 0.814. The calibration curve showed good agreement with the ideal curve, and the decision curve analysis indicated high clinical utility of the model. Conclusion RFA treatment for elderly patients with lower limb varicose veins has the characteristics of minimal trauma, fast recovery, definite long-term efficacy and high safety. Age, BMI, history of diabetes, ulcer area, poor postoperative compression stocking compliance and deep venous reflux are key risk factors for ulcer recurrence.

Key words: aged, radiofrequency ablation, lower extremity varicose veins, venous leg ulcer, recurrence

CLC Number:

R543.1

Figures/Tables 5

References 21

[1]	Gloviczki P, Lawrence P F, Wasan S M, et al. The 2023 Society for Vascular Surgery,American Venous Forum,and American Vein and Lymphatic Society clinical practice guidelines for the management of varicose veins of the lower extremities. Part Ⅱ:endorsed by the society of interventional radiology and the society for vascular medicine[J]. J Vasc Surg Venous Lymphat Disord,2024, 12(1):101670. doi:10.1016/j.jvsv.2023.08.011.
[2]	Mayrovitz H N, Aoki K C, Colon J. Chronic venous insufficiency with emphasis on the geriatric population[J]. Cureus, 2023, 15(6):e40687. doi:10.7759/cureus.40687.
[3]	Horiuchi K, Fogel J, Sarmiento J. Endovenous radiofrequency ablation of great saphenous vein complicated by pulmonary embolism in an elderly patient[J]. BMJ Case Rep, 2023, 16(7):e255543. doi:10.1136/bcr-2023-255543.
[4]	Nyamekye I K, Pullen B J, Kelly N, et al. Six year extension study of patients from a randomised clinical trial comparing venefit,radiofrequency induced thermal therapy,and endovenous radiofrequency ablation for treatment of incompetent great saphenous veins[J]. Eur J Vasc Endovasc Surg, 2023, 66(1):94-101. doi:10.1016/j.ejvs.2023.03.021.
[5]	Puggina J, Sincos I R, Campos W, et al. A randomized clinical trial of the effects of saphenous and perforating veins radiofrequency ablation on venous ulcer healing (VUERT trial)[J]. Phlebology, 2021, 36(3):194-202. doi:10.1177/0268355520951697.
[6]	Korepta L, Ward M, Blecha M, et al. A contemporary comparison of cyanoacrylate, radiofrequency, and endovenous laser ablation on healing of active venous ulceration[J]. Ann Vasc Surg, 2022, 87:237-244. doi:10.1016/j.avsg.2022.04.031.
[7]	Lurie F, Passman M, Meisner M, et al. The 2020 update of the CEAP classification system and reporting standards[J]. J Vasc Surg Venous Lymphat Disord, 2020, 8(3):342-352. doi:10.1016/j.jvsv.2019.12.075.
[8]	Kusagawa H. Clinical results 5 years after radiofrequency ablation of saphenous veins[J]. Ann Vasc Dis, 2025, 18(1):25-00097. doi:10.3400/avd.oa.25-00097.
[9]	Cong L, Sun J, Wang L, et al. Hybrid endovenous laser ablation reduces the recurrence of varicose veins below the knee compared with radiofrequency ablation:a real-world study[J]. Arch Med Sci, 2023, 19(6):1739-1746. doi:10.5114/aoms/163449.
[10]	Vlachovský R, Novotný T, Staffa R, et al. Endovenous ablation of varicose veins current status and overview of methods[J]. Rozhl Chir, 2022, 101(5):200-210. doi:10.33699/PIS.2022.101.5.200-210.
[11]	El Kilic H, Bektas N, Bitargil M, et al. Long-term outcomes of endovenous laser ablation, n-butyl cyanoacrylate,and radiofrequency ablation for treatment of chronic venous insufficiency[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(4):865-871. doi:10.1016/j.jvsv.2021.10.009.
[12]	Baccellieri D, Ardita V, Pannone A, et al. Factors influencing recurrent varicose vein formation after radiofrequency thermal ablation for truncal reflux performed in two high-volume venous centers[J]. J Vasc Surg Venous Lymphat Disord, 2024, 12(2):101675. doi:10.1016/j.jvsv.2023.08.014.
[13]	Mo H, Jung I M. Long-term results of radiofrequency ablation for unilateral great saphenous vein insufficiency and hemodynamic changes in the contralateral leg[J]. Ann Vasc Surg, 2025, 120:103-107. doi:10.1016/j.avsg.2025.05.003.
[14]	Jiang W, Liang Y, Long Z, et al. Endovenous radiofrequency ablation vs laser ablation in patients with lower extremity varicose veins:A meta-analysis[J]. J Vasc Surg Venous Lymphat Disord, 2024, 12(5):101842. doi:10.1016/j.jvsv.2024.101842.
[15]	张妍, 李威, 满文玲, 等. 对比腔内微波消融与大隐静脉高位结扎及剥脱术治疗下肢静脉曲张效果[J]. 中国介入影像与治疗学, 2023, 20(1):48-52.
	Zhang Y, Li W, Man W L, et al. Comparison on efficacy of endovenous microwave ablation and high ligation plus stripping of great saphenous vein for lower extremity varicose veins[J]. Chin J Interv Imaging Ther, 2023, 20(1):48-52. doi:10.13929/j.issn.1672-8475.2023.01.012.
[16]	Hong K P. Midterm results of radiofrequency ablation with multiple heat cycles for incompetent saphenous veins[J]. J Vasc Surg Venous Lymphat Disord, 2023, 11(3):483-487. doi:10.1016/j.jvsv.2022.12.004.
[17]	Andercou O, Stancu B, Coman H F, et al. Radiofrequency thermal ablation for the treatment of chronic insufficiency of the saphenous vein-A comparative retrospective study[J]. Int J Environ Res Public Health, 2023, 20(4):3308. doi:10.3390/ijerph20043308.
[18]	张晶, 于立娜, 孙思翘, 等. 对比分析不同手术方式对老年原发性大隐静脉曲张的疗效[J]. 中国老年学杂志, 2024, 44(15):3643-3646.
	Zhang J, Yu L N, Sun S Q, et al. Comparative analysis of the efficacy of different surgical approaches for primary great saphenous varicose veins in the elderly[J]. Chinese Journal of Gerontology, 2024, 44(15):3643-3646. doi:10.3969/j.issn.1005-9202.2024.15.016.
[19]	Rocha M, Serna Gonzalez C V, Borges E L, et al. Incidence of recurrent venous ulcer in patients treated at an outpatient clinic:historical cohort[J]. Int J Low Extrem Wounds, 2024, 23(3):455-463. doi:10.1177/15347346211065929.
[20]	O'banion L A, Reynolds K B, Kochubey M, et al. A comparison of cyanoacrylate glue and radiofrequency ablation techniques in the treatment of superficial venous reflux in CEAP 6 patients[J]. J Vasc Surg Venous Lymphat Disord, 2021, 9(5):1215-1221. doi:10.1016/j.jvsv.2020.12.082.
[21]	Pihlaja T, Vanttila L M, Ohtonen P, et al. Factors associated with delayed venous ulcer healing after endovenous intervention for superficial venous insufficiency[J]. J Vasc Surg Venous Lymphat Disord, 2022, 10(6):1238-1244. doi:10.1016/j.jvsv.2022.07.008.

组别		n		年龄/岁			性别（男/女）		BMI/（kg/m²）				病程/年
未复发组		132		68.61±4.99			58/74		24.61±2.82				7.93±2.21
复发组		79		71.81±4.89			45/34		26.69±3.06				8.56±2.85
t或χ²				4.543^＊＊			3.354		5.019^＊＊				1.793
组别	吸烟				饮酒			高血压		糖尿病史		冠心病史
未复发组	37（28.03）				24（18.18）			49（37.12）		41（31.06）		33（25.00）
复发组	29（36.71）				22（27.85）			36（45.57）		38（48.10）		29（36.71）
t或χ²	1.732				2.709			1.466		6.127^＊		3.265
组别			溃疡面积/cm²			术后弹力袜使用依从性差					深静脉反流
未复发组			5.29±2.52			28（21.21）					67（50.76）
复发组			8.75±3.13			36（45.57）					57（72.15）
t或χ²			8.792^＊＊			13.876^＊＊					9.336^＊＊

组别		n		年龄/岁			性别（男/女）		BMI/（kg/m²）				病程/年
未复发组		132		68.61±4.99			58/74		24.61±2.82				7.93±2.21
复发组		79		71.81±4.89			45/34		26.69±3.06				8.56±2.85
t或χ²				4.543^＊＊			3.354		5.019^＊＊				1.793
组别	吸烟				饮酒			高血压		糖尿病史		冠心病史
未复发组	37（28.03）				24（18.18）			49（37.12）		41（31.06）		33（25.00）
复发组	29（36.71）				22（27.85）			36（45.57）		38（48.10）		29（36.71）
t或χ²	1.732				2.709			1.466		6.127^＊		3.265
组别			溃疡面积/cm²			术后弹力袜使用依从性差					深静脉反流
未复发组			5.29±2.52			28（21.21）					67（50.76）
复发组			8.75±3.13			36（45.57）					57（72.15）
t或χ²			8.792^＊＊			13.876^＊＊					9.336^＊＊

因素	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.140	0.045	9.679	0.002	1.150（1.053~1.256）
深静脉反流	0.215	0.071	9.170	0.002	1.240（1.079~1.425）
糖尿病史	0.293	0.091	10.367	0.001	1.340（1.121~1.602）
BMI	0.341	0.075	10.326	0.001	1.273（1.099~1.474）
溃疡面积	0.118	0.057	4.286	0.038	1.125（1.006~1.258）
术后弹力袜使用依从性	0.137	0.069	3.942	0.047	1.147（1.002~1.313）
常数项	-3.852	0.521	54.470	<0.001	<0.001

因素	β	SE	Wald χ²	P	OR（95%CI）
年龄	0.140	0.045	9.679	0.002	1.150（1.053~1.256）
深静脉反流	0.215	0.071	9.170	0.002	1.240（1.079~1.425）
糖尿病史	0.293	0.091	10.367	0.001	1.340（1.121~1.602）
BMI	0.341	0.075	10.326	0.001	1.273（1.099~1.474）
溃疡面积	0.118	0.057	4.286	0.038	1.125（1.006~1.258）
术后弹力袜使用依从性	0.137	0.069	3.942	0.047	1.147（1.002~1.313）
常数项	-3.852	0.521	54.470	<0.001	<0.001