Challenging conventions: Reconsidering the indication for endovenous ablation in CEAP 2 patients

Area of Science:

• Vascular Medicine
• Phlebology
• Medical Interventions

Background:

• Chronic venous insufficiency (CVI) affects many patients, often leading to recommendations for endovenous ablation.
• However, the necessity of endovenous ablation for all CVI patients with an ablation indication is questioned.
• This study focuses on patients with CEAP C2 classification of CVI.

Purpose of the Study:

• To compare the efficacy of conservative treatment (compression stockings and Daflon®) versus endovenous laser ablation in CVI patients.
• To determine if hemodynamic assessment can identify patients suitable for less invasive CVI management.
• To evaluate outcomes in CVI patients based on venous hemodynamics.

Main Methods:

• 137 patients with CVI and an ablation indication underwent plethysmographical hemodynamic testing.
• Group 1 (normal hemodynamics) received compression stockings and Daflon®.
• Group 2 (abnormal hemodynamics) underwent endovenous laser ablation. Outcomes were assessed after 6 months.

Main Results:

• No statistically significant difference in outcomes was observed between the two groups at the 6-month follow-up.
• This suggests that conservative management can yield comparable results to ablation in selected CVI patients.
• Hemodynamic assessment is key to patient stratification.

Conclusions:

• Endovenous ablation should not be universally recommended for all CVI patients with an ablation indication.
• Evaluating lower extremity venous hemodynamics is essential for tailoring CVI treatment plans.
• Conservative treatments like compression stockings and Daflon® offer a viable alternative for specific patient cohorts.