In total, the investigators recruited 100 consecutive patients—51 to group A and 49 to group B—classified as clinical class C2–C6 of the Clinical-Etiological-Anatomical-Pathophysiological (CEAP) classification.

Onwudike and colleagues write in EJVES that, at 12 weeks, the occlusion rate of the target vein was similar in both groups at 98% (n=47) and 98% (n=45), respectively (p=1).

They also report that here was no statistically significant different in mean AVSS 6 vs. 5 (mean difference -1, 95% confidence interval [CI] -2–3, p=0.57) and mean RVCSS 3 vs. 4 (mean difference 1, 95% CI -1–2, p=0.46) scores at 12 weeks.

Finally, they observed comparable patient satisfaction scores (p=0.72) and pain score 2 vs. 2 (p=0.92) were achieved in both groups. Two patients in each group developed deep vein thrombosis at two-week follow-up (p=1 for above the knee and p=1 for below the knee).

In the discussion of their findings, Onwudike et al remark that the method of randomisation and the fact that both the chief investigator and the statistician were blinded to the allocated group reduced the risk of bias. In addition, the low dropout rate reduced the risk of type 2 error.

However, they also note some limitations. Firstly, Onwudike and colleagues recognise that the study is from a single centre and it only reports short-term results. “Long-term follow-up analysis may give further insight into differences in success rates based on compression therapy use,” they write.

Overall, while the authors “accept that the place or duration of compression post-RFA is far from settled,” they expect that this study will “contribute to development of the body of knowledge on the subject”.

Onwudike et al elaborate that, while earlier studies concentrated on the duration of compression, the present study and that of Ayo et al have moved the discussion on to answering the question of whether compression is required at all following RFA in situations where phlebectomies have not been performed. “This is consistent with a publication by the UK National Institute for Health and Care Excellent (NICE), which highlighted the knowledge gap in the role of compression following endothermal ablation,” they remark.

Furthermore, they note that this study is also a partial response to the European Society for Vascular Surgery (ESVS) guidelines, which recommend the need for further studies in this area. Onwudike and colleagues state that, if the present findings are confirmed by larger studies, “it is likely that the current recommendation of post-procedural compression for all cases of open surgery and endovenous superficial vein procedures will be revised”.

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John Mathews
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Journal of Phlebology and Lymphology
Email: phlebology@eclinicalsci.com