# Minimally invasive management of chronic venous insufficiency: A case report on combined radiofrequency ablation and sclerotherapy in an obese patient

## TL;DR

This case report shows that combining radiofrequency ablation and sclerotherapy is effective for treating chronic venous insufficiency in obese patients.

## Contribution

The paper presents a successful case of minimally invasive treatment for CVI in an obese patient with multiple comorbidities.

## Key findings

- Combined radiofrequency ablation and sclerotherapy successfully treated venous insufficiency in an obese patient.
- The procedure resulted in no postoperative complications and effective vein obliteration.
- The approach is suitable for high-risk patients due to reduced invasiveness and quicker recovery.

## Abstract

Chronic venous insufficiency (CVI) affects a significant portion of the population, particularly impacting those with obesity. This condition leads to various symptoms, including leg discomfort and edema, contributing to work absenteeism. Traditional surgical procedures, like saphenous vein stripping and phebectomy, are increasingly supplanted by minimally invasive techniques, such as radiofrequency ablation (RFA) and sclerotherapy, which reduce invasiveness and associated complications, particularly beneficial for high-risk patients, including those with obesity.

A 22-year-old male patient with a BMI of 41, suffering from severe varicose veins, hypertension, diabetes, and obstructive sleep apnea. The patient underwent simultaneous RFA and sclerotherapy after imaging confirmed significant venous incompetence but ruled out deep vein thrombosis. The procedure, performed under spinal anesthesia, resulted in successful obliteration of the great saphenous vein, with no postoperative complications.

The literature highlights the advantages of endovascular techniques over traditional open surgery, particularly for patients with comorbidities that elevate surgical risks. Studies support the efficacy of combining RFA with sclerotherapy, showing improved outcomes and reduced recurrence rates. This combined approach minimizes complications and provides a quicker recovery, making it a suitable option for high-risk patients.

Our experience and the findings of literature suggest that radiofrequency ablation paired with sclerotherapy is an effective treatment modality for managing CVI, particularly in patients with obesity.

•The treatment of varicose veins with not invasive techniques improves the outcome.•The combination of radiofrequency and sclerotherapy is well-documented in literature.•Obesity is a significant risk factor for recurrences of venous treatments.•A combined approach improves the treatment outcomes for venous patients with obesity.•The combined approach reduces operational risks for obese patients.

The treatment of varicose veins with not invasive techniques improves the outcome.

The combination of radiofrequency and sclerotherapy is well-documented in literature.

Obesity is a significant risk factor for recurrences of venous treatments.

A combined approach improves the treatment outcomes for venous patients with obesity.

The combined approach reduces operational risks for obese patients.