The possibility of using local remedies to reduce the frequency of the “string” symptom after radiofrequency obliteration of the trunk of the large saphenous vein
AbstractIntroduction. Endovascular thermal ablation techniques, such as endovascular laser or radiofrequency ablation (RFA), have become the standard of care for treating varicose veins. However, some patients may experience unpleasant sensations, such as a “tourniquet” or “string”, in the area where the subcutaneous artery is obliterated. One way to reduce these adverse events is through the use of topical treatments, such as sodium heparin gel (1000 IU) and a combined preparation containing escin, heparin, and essential phospholipids.
The aim of this study was to evaluate the clinical symptoms, frequency, and severity of the “string” sensation in patients with varicose veins who underwent large saphenous vein ablation (LSVA), and to assess whether sodium heparin (1000 UI) or the combined preparation could alleviate these symptoms.
Material and methods. An open, randomized, prospective cohort study was conducted on 180 female patients aged 18–72 years (mean age 41.2±7.5 years) diagnosed with varicose veins of the lower extremities. The patients were divided into three groups: Group 1 underwent IVF without any additional conservative therapy; Group 2 received topical heparin (1000 IU) applied twice daily for two weeks after endovenous thermal ablation (EPR); and Group 3 received a topical medication containing escin, heparin, and essential phospholipids applied twice daily after EPO for two weeks.
Results. In the initial class of chronic venous disease, grade 3 according to the CEAR classification, a decrease in edema was recorded at the end of treatment in group 1 in 72.7% of cases, in group 2 – in 76.9% of cases and in group 3 – 91.7%, respectively. The differences between groups 3 (patients receiving a combination topical agent) and the other two were statistically significant (p<0.05). For grade 4 chronic venous diseases, a reduction in dermatitis symptoms was noted in group 3 in 83.3% patients compared to 50% and 57.1%, respectively, for groups 1 and 2. A decrease in induration of tissue was observed in 66.7% of patients in group three compared to 40%, in both group 1 and group 2. Healed ulcerative defects were noted in 60% of group 3 patients versus 33% and 25% in groups 1 and 2, respectively. Using a combination of topical agents, the number of “string” symptoms decreased from 50.6% to 93.5%.
Conclusion. The symptom of “string” after acute renal failure may occur 2 months after surgery in about 3–4% of patients on average. The use of topical agents containing a combination of venoactive drugs (escin), heparin, and essential phospholipids can help reduce the severity of this symptom.
Keywords: varicose veins of the lower extremities; chronic venous disease; radiofrequency ablation; large subcutaneous vein; local remedies
Funding. The article was published with the support of Servier, which had no influence on the results obtained in the study.
Conflict of interest. The authors declare no conflict of interest.
Authors’ contribution. Study conception and design – Kuznetsov M.R.; data collection and handling – Kuznetsov M.R., Bogachev V.Yu., Sapelkin S.V., Yasnopolskaya N.V., Shapoval A.S.; processing of the material – Pirogova L.A.; draft manuscript preparation – Kuznetsov M.R., Bogachev V.Yu., Sapelkin S.V., Yasnopolskaya N.V.; manuscript revision – Kuznetsov M.R., Bogachev V.Yu., Sapelkin S.V.
For citation: Kuznetsov M.R., Bogachev V.Yu., Sapelkin S.V., Yasnopolskaya N.V., Shapoval A.S., Pirogova L.A. The possibility of using local remedies to reduce the frequency of the “string” symptom after radiofrequency obliteration of the trunk of the large saphenous vein. Angiology and Vascular Surgery. Journal named after Academician A.V. Pokrovsky. 2025; 31 (4): 110–7. DOI: https://doi.org/10.33029/1027-6661-2025-31-4-110-117
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