Comparative analysis of outcomes of radiofrequency ablation for incompetent great saphenous varicose vein using F-care (monopolar) and ClosureFast (segmental) systems and a method to improve outcomes in the monopolar system

ObjectiveEndovenous thermal ablation (EVTA) is the preferred treatment for symptomatic incompetent truncal varicose veins. Radiofrequency ablation (RFA) and laser ablation are commonly used. RFA devices can be either monopolar (F-Care) or bipolar/segmental (ClosureFast). Limited data is available on the comparison between these two modalities of treatment, which suggest that the Great saphenous vein (GSV) ablation is incomplete with the monopolar system. This study compares the results of RFA with the two systems (monopolar and bipolar) with regard to early outcomes of treatment and vein closure rates at 1 year and describes a method that could improve results with monopolar system.MethodsA prospective audit of 66 limbs (52 patients) undergoing RFA, either monopolar (33limbs) or bipolar (33 limbs) was carried out.ResultsCEAP C4 was the most common clinical stage (41.5% in ClosureFast group and 60.6% in F-Care group). Preoperative VCSS ranged from 3 to 21 (mean 7.48 ± 3.53) in both groups. All patients underwent adjuvant treatment with either foam sclerotherapy (FS) or a combination of FS with concomitant phlebectomy. Procedural complications were infrequent in both treatment groups. Primary outcome at 1 year showed one subject (3.0%) in each group had complete failure. Three subjects (9.1%) in the F-Care group and one subject (3.0%) in the ClosureFast group were found to have partial failure. GSV occlusion rate at 1 year was 97%. Overall, VCSS had significantly improved in both the groups from preoperative values.ConclusionMonopolar and bipolar RFA had similar primary closure rates for truncal veins at 1 year. Both are safe and had the same effect with minimal complications. However, F-Care system requires catheter removal, cleaning and reintroduction to achieve similar ablation.