Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: A word of caution

Hingorani, Anil; Ascher, Enrico; Markevich, Natalia; Schutzer, Richard; Kallakuri, Sreedhar; Hou, Alexander; Nahata, Suresh; Yorkovich, William; Jacob, Theresa

doi:10.1016/j.jvs.2004.04.032

Cited by 202 publications

(135 citation statements)

References 24 publications

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“…The DVT rates were reported to be 0% to 1% in most series that have been published. In one series [15], DVT was detected in 12 of 73 limbs (16.4%), which is felt to be an aberrancy from the experiences of others [16,17].…”

Section: Radiofrequency Ablation Safetymentioning

confidence: 92%

Endovenous Radiofrequency Ablation of Superficial and Perforator Veins

Roth¹

2007

Surgical Clinics of North America

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Section: Radiofrequency Ablation Safetymentioning

confidence: 92%

Endovenous Radiofrequency Ablation of Superficial and Perforator Veins

Roth¹

2007

Surgical Clinics of North America

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“…72 Although radiofrequency ablation is less invasive than surgical stripping, potential complications include saphenous nerve injury, mandating only treating a specific segment of the great saphenous vein, and DVT in up to 16% of limbs, requiring the use of duplex ultrasound surveillance. 73 Laser treatment with either an 810-nm or a 940-nm diode has provided excellent results; saphenous vein obliteration occurred in 93% at 2 years and there was no case of DVT. 74 Both radiofrequency and laser treatment are performed with tumescent anesthesia to prevent skin burns and reduce pain with earlier return to normal activities.…”

Section: Eberhardt and Raffetto Chronic Venous Insufficiency 2405mentioning

confidence: 99%

Chronic Venous Insufficiency

2005

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C hronic venous disease is often overlooked by primary and cardiovascular care providers because of an underappreciation of the magnitude and impact of the problem. The importance of chronic venous disease is related to the number of people with the disease and the socioeconomic impact of its more severe manifestations. Unfortunately, the literature concerning the prevalence and incidence of chronic venous disease has varied greatly because of differences in the methods of evaluation, criteria for definition, and the geographic regions analyzed. The most common manifestations of chronic venous disease are dilated cutaneous veins, such as telangiectases and reticular veins, and varicose veins. The term chronic venous insufficiency (CVI) describes a condition that affects the venous system of the lower extremities with venous hypertension causing various pathologies including pain, swelling, edema, skin changes, and ulcerations. Although the term CVI is often used to exclude uncomplicated varicose veins, varicose veins have incompetent valves with increased venous pressure leading to progressive dilation and tortuosity. We will use the term CVI to represent the full spectrum of manifestations of chronic venous disease.Varicose veins have an estimated prevalence between 5% to 30% in the adult population, with a female to male predominance of 3 to 1, although a more recent study supports a higher male prevalence. 1 The Edinburgh Vein Study screened 1566 subjects with duplex ultrasound for reflux finding CVI in 9.4% of men and 6.6% of women, after age adjustment, which rose significantly with age (21.2% in men Ͼ50 years old, and 12.0% in women Ͼ50 years old). 2 The San Valentino Vascular Screening Project found among the 30 000 subjects evaluated by clinical assessment and duplex ultrasound a prevalence of 7% for varicose veins and 0.86% for "symptomatic" CVI. 3 As in previous studies, CVI was more common with increasing age, but there was no significant sex difference. The rate of varicose vein development may be estimated from the Framingham Heart Study, which found an annual incidence of 2.6% in women and 1.9% in men. 4 Risk factors found to be associated with CVI include age, sex, a family history of varicose veins, obesity, pregnancy, phlebitis, and previous leg injury. 5,6 There also may be environmental or behavioral factors associated with CVI such as prolonged standing and perhaps a sitting posture at work. 6,7 Varicose veins have a significant impact on healthcare resources, with millions of people seeking medical attention for their cosmetic appearance annually. Although often minimized, the cosmetic consequences may adversely affect an individual's quality of life and are associated with other manifestations.The more serious consequences of CVI such as venous ulcers have an estimated prevalence of Ϸ0.3%, although active or healed ulcers are seen in Ϸ1% of the adult population. 8 It has been estimated that Ϸ2.5 million people have CVI in the United States, and of those, Ϸ20% develop venous ulcers. 9 The ov...

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“…A range of DVT incidences have been reported according to the type of venous procedure: 0.4 %-5.3 %, following saphenofemoral junction (SFJ) ligation and great saphenous vein (GSV) stripping [2][3][4]; 0.7-16 % following radiofrequency ablation (RFA) [5][6][7]; 1 % following endovenous laser ablation (EVLA) [5,8]; and 1-3 % following foam sclerotherapy [9].…”

Section: Introductionmentioning

confidence: 99%

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

Barker

Evison

Benson

et al. 2017

Vasa

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Summary:Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson's Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15-0.35 % at 30 days, 0.26-0.50 % at 90 days, and 0.46-0.58 % at one year. At 30 days there was a signifi cantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other signifi cant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments. Keywords: Varicose veins, vascular surgical procedures, thrombosis, embolusThe wide range of reported incidences may be accounted for by the varying length of follow-ups in the studies and by whether routine duplex scanning was performed postoperatively or it was relied upon the development of clinical features of a DVT. The signifi cance of duplex identifi ed DVTs in the absence of clinical signs is uncertain; however, one series examining this problem reported no instances of a patients with early positive duplex fi ndings developing a clinical DVT on long term follow-up [3].The relative risk of DVT following diff erent VV procedures is currently unknown. NICE guidelines have highlighted the lack of large cohorts and high quality evidence, investigating this phenomenon, as the available evidence is limited to comparisons between two procedure types, with relatively small cohorts leading to identifi cation of sporadic events, which preclude in-depth statistical analysis. Currently the only reported comparisons are the ones between RFA and EVLA, which demonstrate no signifi cant diff erence in the incidence of DVT between these two procedures [5,10].

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Deep venous thrombosis after radiofrequency ablation of greater saphenous vein: A word of caution

Abstract: Patients who underwent combined GSV RFA and varicose vein excision did not demonstrate a higher occurrence of postoperative DVT compared with patients who underwent RFA alone. Early postoperative duplex scans are essential, and should be mandatory in all patients undergoing RFA of the GSV.

Cited by 202 publications

References 24 publications

Endovenous Radiofrequency Ablation of Superficial and Perforator Veins

Endovenous Radiofrequency Ablation of Superficial and Perforator Veins

Chronic Venous Insufficiency

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

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