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

Abstract

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.)

Pre-operative Color Doppler Ultrasonography Predicts Endovenous Heat Induced Thrombosis after Endovenous Radiofrequency Ablation

“…14 The follow up protocol enabled identification of the highest number of EHIT possible, which otherwise, with a less meticulous follow up would have been lost. 18 Thromboprophylaxis of EHIT is described with variability in randomised trials and single centre studies. Although EHIT occurred despite the systematic use of LWMH during the peri-operative period, it remained asymptomatic and dissolved in the weeks after the procedure.…”

Endovenous Laser Ablation Combined with Stripping Technique for Large Saphenous Varicose Veins: The Selection of Operation Technique

“…Furthermore, EHIT cases were resolved within 2-4 weeks in most patients. 3) EVLA with a 980 nm diode laser fiber (ELVeS) was reported to be a minimally invasive procedure with improved recovery of postoperative venous function compared with air plethysmography and is similar to stripping. 4) Furthermore, the 1470 nm EVLA reduced the postoperative recovery time, wound-related complications, and the incidence of skin disorders, such as ecchymosis and bruising, which was significantly lower than that with a 980 nm diode laser fiber (ELVeS).…”

Mid-Term Report on the Safety and Effectiveness of Endovenous Radiofrequency Ablation for Varicose Veins

“… 13 – 16 ) Marsh et al 14 ) reported a low incidence of EHIT post-EVLA, with no differences from RFA. Kurihara et al 17 ) reported that EHITs caused by RFA were mainly class 1 according to the Kabnick classification. All EHITs in our study were class 1 and disappeared without antithrombotic therapy.…”