Increasing ablation distance peripheral to the saphenofemoral junction may result in a diminished rate of endothermal heat-induced thrombosis

Sadek, Mikel; Kabnick, Lowell S.; Rockman, Caron; Berland, Todd; Zhou, Di; Chasin, Cara; Jacobowitz, Glenn R.; Adelman, Mark A.

doi:10.1016/j.jvsv.2013.01.002

Cited by 58 publications

(47 citation statements)

References 14 publications

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“…As preventive procedures, previous studies recommended that a starting point of ablation should be established on the distal side 1 to 2 cm from the deep vein-saphenous vein junction, that branches at the junction should be preserved to maintain venous blood flow from the branches, and that the proximal side should be compressed to prevent influx of steam bubbles (heated/boiled blood bubbles). 9,10) The results of this study suggest the influence of steam bubbles on the development of C2 in patients who underwent EVLA. In particular, on EVLA, a large volume of steam bubbles is generated in comparison with RFA.…”

Section: Discussionmentioning

confidence: 66%

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

Kurihara

Hirokawa

Yamamoto

2016

Annals of Vascular Diseases

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Objective: Endovenous laser ablation (EVLA) and radiofrequency ablation (RFA) are safe and effective treatments for varicose veins caused by saphenous reflux. Deep venous thrombosis (DVT) and endovenous heat-induced thrombosis (EHIT) are known complications of these procedures. The purpose of this article is to investigate the incidence of postoperative DVT and EHIT in patients undergoing EVLA and RFA. Methods: The patients were assessed by clinical examination and venous duplex ultrasonography before operation and at 24-72 hours, 1 month, and 1 year follow-up after operation. Endovenous ablation (EVA) had been treated for 1026 limbs (835 patients) using an RFA; 1174 limbs (954 patients) using a 1470-nm wavelength diode laser with radial two-ring fiber (1470R); and 6118 limbs (5513 patients) using a 980-nm wavelength diode laser with bare-tip fiber (980B). Results: DVT was detected in 3 legs (0.3%) of RFA, 5 legs (0.4%) of 1470R, and 27 legs (0.4%) of 980B. One patient in three symptomatic DVT treated with 980B developed asymptomatic pulmonary embolus. In all, 31 of the 35 DVTs were confined to the calf veins. The incidence of EHIT classes 2 and 3 was 2.7% following RFA procedure, 6.7% after 1470R, and 7.5% after 980B. Conclusion: The incidence of EHIT following EVA was low, especially the RFA procedure. EHIT resolves within 2-4 weeks in most patients. DVT rates after EVA were compared with those published for saphenous vein stripping. (This is a translation of J Jpn Coll Angiol 2015; 55: 153-161.)

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Section: Discussionmentioning

confidence: 66%

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

Kurihara

Hirokawa

Yamamoto

2016

Annals of Vascular Diseases

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“…However, the extent to which these factors represent "risk factors" for the development of EHIT remains controversial. Factors related to the procedure include: the use of general or epidural anaesthesia, the incorrect positioning of the radiofrequency catheter or laser fibre at the saphenous femoral junction, and adjunctive phlebectomies of collaterals (8,(11)(12)(13)(14)(15).…”

Section: Discussionmentioning

confidence: 99%

“…Another important technical detail implicated in EHIT development is the catheter tip position from the saphenous femoral or saphenous popliteal junction (6,15,19). Both for laser and radiofrequency treatment the current recommendations of use from the manufacturer suggest catheter tip position 2 cm from the saphenous femoral or popliteal junction.…”

Section: Discussionmentioning

confidence: 99%

EHIT after thermoablation

Mitri¹,

Leo²,

Romano³

2017

Phlebologie

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SummaryAim: After 10 years of experience, we evaluated the incidence and management of endothermal heat-induced-thrombosis (EHIT), i.e. saphenous vein thrombosis following endothermic treatment of saphenous vein re-flux.Methods: From 2006 to 2016 data were retrospectively collected on 840 patients undergoing saphenous vein treatment by laser and radiofrequency technique. All patients were treated with tumescent local anaesthesia in an ambulatory setting to promote early mobilization. Class II compression stockings and heparin were recommended for 5 days post-operatively.Results: EHIT was observed in 15 patients from a total of 992 saphenous veins which were evaluated (1,5 %). 14 patients treated by EVLA had EHIT 1, one patient by RFA had EHIT 2, complicated by pulmonary embolism. All EHIT patients were treated by low weight molecular heparin. 980 nm laser and bare-tip fibres had been used in EVLA-EHIT patients. EHIT was not observed in patients treated by 1470 nm laser and radial fibres.Conclusions: Latest generation technology, the ambulatory setting and local anaesthesia probably contributed to the low incidence of EHIT reported. Further studies are necessary for a better acquaintance of these complications and to facilitate the development of specific guidelines.

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“…It appears to be more likely following treatment of the small saphenous veins, in large veins, and in patients with an underlying thombophilia 26,27. EHIT also appears to occur if the distance between the deep vein and the most proximal point of treatment is less than 2.5 cm 28. The problem normally presents as a finding on posttreatment duplex scans and can resolve without any anticoagulation treatment.…”

Section: Findings From Literature Searchmentioning

confidence: 99%

“…The problem normally presents as a finding on posttreatment duplex scans and can resolve without any anticoagulation treatment. A four-level classification system and management strategies have been suggested for EHIT 28,29. Patients with complete occlusion of the deep vein by EHIT should be treated with anticoagulation while partial occlusion may be left to the clinician’s discretion, although debate continues on the matter.…”

Section: Findings From Literature Searchmentioning

confidence: 99%

Clinical utility of the Covidien Closure Fast™ Endovenous Radiofrequency Ablation Catheter

Braithwaite¹,

Braithwaite²

2014

MDER

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The Closure Fast™ Endovenous Radiofrequency Ablation Catheter is the latest version of a minimally invasive system for the treatment of patients with superficial venous disease. The Closure Fast™ catheter heats the vein wall to 120°C, causing denaturation of the collagen of the vein wall and contraction of the vessel such that no blood can flow through it. Nearly one million systems have been sold since the product was launched. Many, if not all, patients can be treated under local anesthesia with the Closure Fast™ catheter. Duplex ultrasound reports occlusion rates for the treated vein of 94%–98% at 1 year and 85%–93% at 3 years. The system produces average postoperative pain scores of less than 2 out of 10 on a visual analog score. In the first postoperative week, 76% of patients do not require analgesia. Some 45% of patients return to normal activity on the first postoperative day. Serious complications appear to be rare following the Closure Fast™ procedure. Transient paresthesia occurs in 0.2% of cases, thrombophlebitis in 1%–10%, and thromboembolic events in up to 1.4%, mainly heat-induced thrombosis. Closure Fast™ adds significant costs to treating superficial venous disease but studies have shown it to be cost-effective when used in an office setting.

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Increasing ablation distance peripheral to the saphenofemoral junction may result in a diminished rate of endothermal heat-induced thrombosis

Cited by 58 publications

References 14 publications

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

EHIT after thermoablation

Clinical utility of the Covidien Closure Fast™ Endovenous Radiofrequency Ablation Catheter

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Increasing ablation distance peripheral to the saphenofemoral junction may result in a diminished rate of endothermal heat-induced thrombosis

Cited by 58 publications

References 14 publications

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

Postoperative Venous Thromboembolism in Patients Undergoing Endovenous Laser and Radiofrequency Ablation of the Saphenous Vein

EHIT after thermoablation

Clinical utility of the Covidien Closure Fast&trade; Endovenous Radiofrequency Ablation Catheter

Contact Info

Product

Resources

About

Clinical utility of the Covidien Closure Fast™ Endovenous Radiofrequency Ablation Catheter