Type 2 Diabetes Mellitus in Patients Undergoing Treatment with Different Thermal Ablation Techniques

Aim. To compare endovenous laser ablation (EVLA, 1470 nm wavelength) and radiofrequency ablation (RFA) in the treatment of patients with varicose vein disease (VVD) and type 2 diabetes mellitus (T2DM) based on individual and standardized questionnaires. Materials and Methods. The study included 98 patients who presented to the Department of Vascular Surgery of the Lviv Regional Clinical Hospital and the private medical center “Korona” between 2022 and 2024 with VVD and T2DM, without a history of prior surgical treatment for these conditions. Patients were divided into two groups (Group I – VVD; Group II – VVD+T2DM), each comprising two subgroups (EVLA-I, RFA-I and EVLA-II, RFA-II). Follow-up examinations were conducted before treatment (Visit 1), on day 3 (Visit 2), and one month after treatment (Visit 3). During each visit, patients were evaluated using the VCSS (Varicose Clinical Severity Score), VAS (Visual Analogue Scale), and an individual self-administered questionnaire (SAQ). Results. VCSS scores decreased significantly (p<0.05) after one month of treatment in all subgroups of both the VVD and VVD+T2DM groups, indicating the efficacy of both thermal ablation techniques (from 17.7 ± 1.12 to 13.3±1.04 in EVLA-I; from 17.6±1.1 to 12.2±0.47 in RFA-I; from 19.9±1.27 to 16.1±0.66 in EVLA-II; and from 19.8±1.13 to 15.5±0.69 in RFA-II). Comparing pain intensity by the VAS scale between EVLA-I vs. RFA-I and EVLA-II vs. RFA-II revealed a statistically significant difference (p<0.05) at Visit 1 (4.5±0.41 vs. 2.9±0.27 for EVLA-I; 4.4±0.36 vs. 2.8±0.19 for and RFA-I) and Visit 2 (3.4±0.24 vs. 2.2±0.18 for EVLA-II; 3.1±0.27 vs. 2.1±0.2 for RFA-II), suggesting higher pain intensity following EVLA regardless of patient group. At Visit 1, 47 % of patients in EVLA-I and 55 % in RFA-I reported no complaints; after one month (Visit 3), these rates increased to 91 % and 97 %, respectively. The choice of thermal technique did not significantly influence the “no complaints” rate between Visits 1 and 3. In the VVD+T2DM group, the increase in the “no complaints” parameter was less pronounced, suggesting that carbohydrate metabolism disorders affect postoperative recovery. This was reflected in the higher incidence and duration of neurological symptoms (numbness, tingling). Conclusions. Total VCSS scores significantly decreased after one month in both study groups, regardless of the chosen thermal ablation method. RFA was associated with less pain compared to EVLA during and three days after treatment in both groups. Based on the self-administered questionnaire, RFA demonstrated fewer complications such as numbness and tingling after one month, while these paresthetic symptoms were more pronounced in patients with VVD+T2DM regardless of the ablation method.