Role of Sonography and Color Doppler in the Candidate Selection for Endovenous Ablation and Management of Varicose Veins

Objective: Reflux, diameter, and tortuosity of the great saphenous vein (GSV) are related to the choice for its access in the endovascular treatment of varicose veins. The aim of this was to examine the relation between the GSV reflux, diameter, tortuosity, and the optimal clinical management procedure. Materials and Methods: Data from 70 patients (e.g., 109 lower limbs) were evaluated in relation to their clinical features of chronic venous insufficiency. Diameter measurements were performed using sonography, and reflux was evaluated by the demonstration of reverse flow with color and spectral Doppler. The GSVs of each patient were examined, and the diameters were recorded at different levels, including the mid-thigh 15.0 cm below the saphenofemoral junction (SFJ), lower-thigh just above medial aspect knee by 5.0 cm, and below the knee by 5.0 cm. Patients with a dilated, straight GSV that exceeded 6.0 mm in diameter and associated reflux were treated with radiofrequency (i.e., endovenous thermal) ablation (RFA), and patients with tortuous, relatively dilated, refluxing veins were managed with sclerotherapy. Results: The use of RFA was the frequent treatment technique used for patients with varicose veins (28.6%). The primary occlusion rate in this cohort was 94.5%. The RFA had a lower overall complication rate, and a shorter hospital stay that averaged 14 ± 3.6 hours. Sonography-guided sclerotherapy was provided for 27.1%, while 14.3% of patients were advised to have subsequent follow-up visits. Moreover, 11.4% had sclerotherapy as a cosmetic solution. Surgical ligation and medical treatment with sonographic surveillance were advised for 7.1% of patients. Conclusion: Diameter, reflux, and tortuosity of the GSV were a major determining factor in the selection of the best choice of treatment for primary varicose veins. In this cohort, the GSV occlusion was achieved efficiently in 94.5% using RFA, with minimal complications.