COMPARISON OF THERMAL METHODS OF TREATMENT OF PATIENTS WITH VARICOSE DISEASE OF THE LOWER LIMBS AND TYPE 2 DIABETES

Abstract

Objective. To compare endovenous laser ablation (EVLA) using a 1470 nm wavelength with radiofrequency ablation (RFA) in the treatment of patients with chronic venous disease (CVD) and type 2 diabetes mellitus (T2DM).

Materials and Methods. The study included 121 patients who presented to the Department of Vascular Surgery at the Lviv Regional Clinical Hospital and the private medical center “Korona” between 2022 and 2024 with CVD and T2DM, without prior surgical treatment for this condition. Patients were divided into two main groups (Group I – CVD, Group II – CVD + T2DM), each comprising two subgroups (EVLA-I, RFA-I; EVLA-II, RFA-II). Follow-up examinations were conducted before treatment (Visit 1), on day 3 (Visit 2), and one month after treatment (Visit 3). During these visits, duplex ultrasonography of the lower limb superficial veins was performed to assess the diameter of the great saphenous vein (GSV), presence or absence of recanalization, and deep vein thrombosis. Clinical evaluation included the Varicose Clinical Severity Score (VCSS), the Visual Analogue Scale (VAS) for pain, and a patient-reported symptom questionnaire. Statistical analysis was performed using parametric statistical methods using Microsoft Excel and STATISTICA 6.0 software (Statsoft, USA) and determining the Student's t-test.

Results. At the one-month follow-up (Visit 3), a significant difference was observed in GSV diameter at the saphenofemoral junction between EVLA-I and RFA-I subgroups (8.5 ± 0.18 mm vs 7.3 ± 0.25 mm, p < 0.05), and between EVLA-II and RFA-II subgroups (8.2 ± 0.11 mm vs 7.7 ± 0.11 mm, p < 0.05), with a trend toward significance in GSV diameters at mid-thigh and knee levels.
VCSS scores significantly (p < 0.05) decreased in all subgroups after one month of treatment, indicating clinical improvement with both thermal ablation modalities (from 17.7 ± 1.12 to 13.3 ± 1.04 in EVLA-I; 17.6 ± 1.10 to 12.2 ± 0.47 in RFA-I; 19.9 ± 1.27 to 16.1 ± 0.66 in EVLA-II; and 19.8 ± 1.13 to 15.5 ± 0.69 in RFA-II). VAS pain scores differed significantly (p < 0.05) between EVLA and RFA groups at Visits 1 and 2, showing higher pain intensity following EVLA regardless of group (CVD or CVD + T2DM): 4.5 ± 0.41 vs 2.9 ± 0.27 for EVLA-I, 4.4 ± 0.36 vs 2.8 ± 0.19 for RFA-I; and 3.4 ± 0.24 vs 2.2 ± 0.18 for EVLA-II, 3.1 ± 0.27 vs 2.1 ± 0.20 for RFA-II.

Conclusions. It was determined that one month after treatment with radiofrequency ablation, there was a significantly more pronounced improvement compared to endovenous laser ablation in terms of diameter at the mouth of the great saphenous vein in patients regardless of the presence of diabetes mellitus. A trend towards improvement in the diameter of the great saphenous vein in the middle of the thigh and at the knee level was shown one month after treatment with radiofrequency ablation in both groups. The total VCSS score significantly decreased in both study groups one month after treatment, regardless of the choice of thermal ablation method. More advantages have been shown in favor of radiofrequency ablation in patients with varicose veins and type 2 diabetes mellitus regarding the diameter of the great saphenous vein in different locations, a lower incidence of side effects (numbness, tingling), and pain during and after treatment.