Incidence, treatment variation and outcomes of Rollercoaster reflux

Objective: Paradoxical reflux, which is most commonly seen in the Giacomini vein, is also referred to as Rollercoaster reflux (RCR). RCR is a rare phenomenon, infrequently reported in literature and lacking standardized treatments. The aim of this study was to describe the incidence, treatment variation, and outcomes of RCR in a high-volume centre, specialized in skin and venous disease. Methods: All patients suspected of venous incompetence who presented at Skin and Vein Clinic Oosterwal between July 2022 and July 2023 were retrospectively screened to determine if they had RCR. All eligible patients were invited to participate in the cohort study, regardless of treatment or treatment type (ultrasound-guided foam sclerotherapy [UGFS], endovenous thermal ablation [EVTA], or compression therapy). A duplex-ultrasound was performed and the VEINES-QoL/Sym questionnaire was completed. The primary outcomes were RCR incidence and type of RCR. Secondary outcomes were assessed at 1-year follow-up and included anatomical success rates, complications, quality of life (QoL) and patient-satisfaction scores. Results: The incidence of RCR was 1.1% (62/5.718 patients). Fifty-one limbs of 50 patients were included. Anatomical success after 1 year was 73.3% for limbs treated with UGFS and 96.6% for limbs treated with EVTA. The most common complication for UGFS was hyperpigmentation (40.0%) and for EVTA was nerve injury (10.3%). QoL improved across all treatment groups and there were no significant differences in patient satisfaction scores. Conclusion: RCR is a rare phenomenon occurring in only 1.1% of patients suspected of venous incompetence. Although EVTA had a higher anatomical success rate compared to UGFS for the treatment of RCR, QoL improved across all treatment groups.