Practice patterns of endovenous ablation therapy for the treatment of venous reflux disease

The purpose of this study was to assess practice patterns of endovenous ablation therapy for the treatment of venous reflux disease among the vein specialist members of the American Venous Forum (AVF).

An online survey was conducted of AVF members designed to identify demographics, treatment practices, and clinical variables in the selection of vein ablation devices.

The survey was distributed to 798 practicing physicians, of whom 129 (16%) responded. The specialty distribution of respondents was as follows: vascular surgeons, 54%; phlebologists, 14%; general surgeons, 11%; interventional radiologists, 9%; and other specialties, 6%. The majority (81%) were from the United States, and 65% were self-employed. Almost half (47%) were in practice for >20 years, with 33% of all respondents performing three to five saphenous vein ablations per week. Three-quarters (79%) of respondents preferred radiofrequency ablation (RFA), with 47% believing that it was more cost-effective and more than half (57%) reporting improved patient satisfaction with this technique. Most of them (63%) responded that previous capital investment played a significant role in their choice of vein ablation device along with the associated cost of disposable equipment. A large majority (77%) of physicians responded that they had a significant role in choosing the treatment device, whereas only 17% thought that patients' choice played a major role in device choice. The capital investment affected choice of modality more significantly in newer practices (P < .0.5).

The majority of AVF vein specialists prefer an RFA technique to laser, believing that RFA is associated with improved patient outcomes and is more cost-effective. Advances in technology, device costs, and reimbursement levels may have an impact on such preferences in the future.