Preliminary study on the fine management of overweight and obese patients undergoing day surgery of ultrasound-guided radiofrequency ablation of the great saphenous vein_West China Medical Journal

Authors：

CHEN Xin ¹ ,  YU Zhengya ¹ , NI Ruyang ²

1. Department of Vascular Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P. R. China;
2. Department of Medical Management, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, P. R. China;

Corresponding?author：

YU Zhengya, Email: zhengyayu_tr@126.com

Keywords：

Day surgery; Ultrasound-guided varicose vein radiofrequency ablation closure; Body mass index

DOI：

10.7507/1002-0179.201911297

Video：

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Objective To explore the outcome of ultrasound-guided radiofrequency ablation in the treatment of overweight and obesity patients, and develop a more reasonable day-to-day surgical procedure.Methods A retrospective analysis of the patients undergoing day surgery of ultrasound-guided radiofrequency ablation of the great saphenous vein under fine management from July 1st, 2017 to June 30th, 2019 was performed. According to the body mass index (BMI), the patients were divided into normal group (18.5 kg/m²≤BMI<24 kg/m²), overweight group (24 kg/m²≤BMI<28 kg/m²), and obese group (BMI≥28 kg/m²). The observation items during and after surgery of each group were compared and analyzed. The quantitative data were presented as median (lower quartile, upper quartile), and the qualitative data were presented as frequency and/or percentage.Results A total of 189 patients were included, including 65 in the normal group [BMI: 22.6 (21.3, 23.4) kg/m²], 77 in the overweight group [BMI: 26.1 (25.3, 27.0) kg/m²], and 47 in the obese group [BMI: 29.7 (28.4, 31.2) kg/m²]. Radiofrequency ablation time in the obese group [195 (185, 215) s] was significantly longer than that in the normal group [185 (175, 195) s] and the overweight group [185 (177.5, 198) s] (P<0.05). The numerical rating scale score of postoperative 24-hour pain in the radiofrequency ablation area in the obese group [1 (1, 2)] was significantly higher than that in the normal group [1 (1, 1)] and the overweight group [1 (1, 1)] (P<0.05). The postoperative 1-month residual vein length in the normal group [1.0 (0.8, 1.3) cm] was significantly shorter than that in the overweight group [1.2 (0.9, 1.8) cm] and the obese group [1.3 (0.9, 1.8) cm] (P<0.05). The incidence of postoperative 1-month radiofrequency ablation area induration in the obese group (66.0%) was significantly higher than that in the normal group (10.8%) and the overweight group (20.8%) (P<0.05). The postoperative 3-month residual vein length in the obese group [1.2 (1.1, 1.4) cm] was significantly longer than that in the normal group [1.0 (0.9, 1.2) cm] and the overweight group [1.1 (1.0, 1.2) cm] (P<0.05).Conclusion Patients with BMI≥24 kg/m² undergoing day surgery of ultrasound-guided radiofrequency ablation of the great saphenous vein require longer radiofrequency ablation time, as well as more postoperative pain assessment and outpatient follow-up.

Citation： CHEN Xin, YU Zhengya, NI Ruyang. Preliminary study on the fine management of overweight and obese patients undergoing day surgery of ultrasound-guided radiofrequency ablation of the great saphenous vein. West China Medical Journal, 2020, 35(2): 165-169. doi: 10.7507/1002-0179.201911297 Copy

1.	林夏, 馬洪升, 王琪, 等. 提升我國日間手術管理水平的思考與建議. 中國醫院管理, 2017, 37(7): 41-42.
2.	Balint R, Farics A, Parti K, et al. Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review. Vascular, 2016, 24(6): 649-657.
3.	Roshan B, Sarah O, Tristan RAL, et al. Varicose veins and their management. Surgery (Oxford), 2016, 34(4): 165-171.
4.	Gibson K, Khilnani N, Schul M, et al. American college of phlebology guidelines-treatment of refluxing accessory saphenous veins. Phlebology, 2016, 32(7): 448-452.
5.	Goodyear SJ, Nyamekye IK. Radiofrequency ablation of varicose veins: best practice techniques and evidence. Phlebology, 2015, 30(Suppl 2): 9-17.
6.	Coughlin PA, Berridge DC. Is there a continuing role for traditional surgery?. Phlebology, 2015, 30(Suppl 2): 29-35.
7.	Ekl?f B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Sur, 2004, 40(6): 1248-1252.
8.	中國肥胖問題工作組數據匯總分析協作組. 我國成人體重指數和腰圍對相關疾病危險因素異常的預測價值: 適宜體重指數和腰圍切點的研究. 中華流行病學雜志, 2002, 23(1): 5-10.
9.	Bailey CR, Ahuja M, Bartholomew K, et al. Guidelines for day-case surgery 2019. Anaesthesia, 2019, 74: 778-792.
10.	Davies HO, Popplewell M, Singhal R, et al. Obesity and lower limb venous disease-the epidemic of phlebesity. Phlebology, 2017, 3(4): 227-233.
11.	Habash RWY. Bioeffects and therapeutic applications of electromagnetic energy. Florida CRC Press, Taylor & Francis Group, LLC, 2019.
12.	Segura S, Requena L. Anatomy and histology of normal subcutaneous fat, necrosis of adipocytes, and classification of the panniculitides. Dermatol Clin, 2008, 26(4): 419-424.
13.	Alster TS, Lupton JR. Nonablative cutaneous remodeling using radiofrequency devices. Clin Dermatol, 2007, 25(5): 487-491.
14.	Jiménez-Lozano J, Vacas-Jacques P, Anderson RR, et al. Selective and localized radiofrequency heating of skin and fat by controlling surface distributions of the applied voltage: analytical study. Phys Med Biol, 2012, 57(22): 7555-7578.
15.	Bunnell AP, Zaidi S, Eidson JL 3rd, et al. Factors associated with saphenous vein recanalization after endothermal ablation. Ann Vasc Surg, 2015, 29(2): 322-327.
16.	Van der Velden SK, Lawaetz M, De Maeseneer MG, et al. Predictors of recanalization of the great saphenous vein in randomized controlled trials 1 year after endovenous thermal ablation. Eur J Vasc Endovasc Surg, 2016, 52(2): 234-241.
17.	Bakker NA, Schieven LW, Bruins RM, et al. Compression stockings after endovenous laser ablation of the great saphenous vein: a prospective randomized controlled trial. Eur J Vasc Endovasc Surg, 2013, 46(5): 588-592.

1. 林夏, 馬洪升, 王琪, 等. 提升我國日間手術管理水平的思考與建議. 中國醫院管理, 2017, 37(7): 41-42.
2. Balint R, Farics A, Parti K, et al. Which endovenous ablation method does offer a better long-term technical success in the treatment of the incompetent great saphenous vein? Review. Vascular, 2016, 24(6): 649-657.
3. Roshan B, Sarah O, Tristan RAL, et al. Varicose veins and their management. Surgery (Oxford), 2016, 34(4): 165-171.
4. Gibson K, Khilnani N, Schul M, et al. American college of phlebology guidelines-treatment of refluxing accessory saphenous veins. Phlebology, 2016, 32(7): 448-452.
5. Goodyear SJ, Nyamekye IK. Radiofrequency ablation of varicose veins: best practice techniques and evidence. Phlebology, 2015, 30(Suppl 2): 9-17.
6. Coughlin PA, Berridge DC. Is there a continuing role for traditional surgery?. Phlebology, 2015, 30(Suppl 2): 29-35.
7. Ekl?f B, Rutherford RB, Bergan JJ, et al. Revision of the CEAP classification for chronic venous disorders: consensus statement. J Vasc Sur, 2004, 40(6): 1248-1252.
8. 中國肥胖問題工作組數據匯總分析協作組. 我國成人體重指數和腰圍對相關疾病危險因素異常的預測價值: 適宜體重指數和腰圍切點的研究. 中華流行病學雜志, 2002, 23(1): 5-10.
9. Bailey CR, Ahuja M, Bartholomew K, et al. Guidelines for day-case surgery 2019. Anaesthesia, 2019, 74: 778-792.
10. Davies HO, Popplewell M, Singhal R, et al. Obesity and lower limb venous disease-the epidemic of phlebesity. Phlebology, 2017, 3(4): 227-233.
11. Habash RWY. Bioeffects and therapeutic applications of electromagnetic energy. Florida CRC Press, Taylor & Francis Group, LLC, 2019.
12. Segura S, Requena L. Anatomy and histology of normal subcutaneous fat, necrosis of adipocytes, and classification of the panniculitides. Dermatol Clin, 2008, 26(4): 419-424.
13. Alster TS, Lupton JR. Nonablative cutaneous remodeling using radiofrequency devices. Clin Dermatol, 2007, 25(5): 487-491.
14. Jiménez-Lozano J, Vacas-Jacques P, Anderson RR, et al. Selective and localized radiofrequency heating of skin and fat by controlling surface distributions of the applied voltage: analytical study. Phys Med Biol, 2012, 57(22): 7555-7578.
15. Bunnell AP, Zaidi S, Eidson JL 3rd, et al. Factors associated with saphenous vein recanalization after endothermal ablation. Ann Vasc Surg, 2015, 29(2): 322-327.
16. Van der Velden SK, Lawaetz M, De Maeseneer MG, et al. Predictors of recanalization of the great saphenous vein in randomized controlled trials 1 year after endovenous thermal ablation. Eur J Vasc Endovasc Surg, 2016, 52(2): 234-241.
17. Bakker NA, Schieven LW, Bruins RM, et al. Compression stockings after endovenous laser ablation of the great saphenous vein: a prospective randomized controlled trial. Eur J Vasc Endovasc Surg, 2013, 46(5): 588-592.

West China Medical Journal

Preliminary study on the fine management of overweight and obese patients undergoing day surgery of ultrasound-guided radiofrequency ablation of the great saphenous vein

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