The safety of radiofrequency ablation of the great saphenous vein in patients with previous venous thrombosis

Alessandra Puggioni, Natalie Marks, Anil Hingorani, Alexander Shiferson, Saadi Alhalbouni, Enrico Ascher
Journal of Vascular Surgery 2009, 49 (5): 1248-55

BACKGROUND: The safety of radiofrequency ablation (RFA) of the great saphenous vein (GSV) in patients with previous history of deep venous thrombosis (DVT) has not been determined.

METHODS: From April 2003 to June 2006, 274 patients (68% women; mean age, 60 years +/- 15 years) underwent 293 consecutive RFA procedures. In the first 15 months, the temperature probe was maintained at 85 degrees C, with a pullback rate of 2 cm/min (85 limbs, 30%); we subsequently changed the protocol to 90 degrees C and a pullback rate of 2 to 3 cm/min (205 limbs, 70%). We identified 29 patients (10%) with a history of DVT or duplex scan evidence of post-thrombotic venous disease; these were compared with the remaining 264 (90%). Postprocedural acute thrombotic (AT) events were analyzed. By the CEAP classification, 204 limbs (70%) were C(2) to C(4), and 89 (30%) were C(5) to C(6). Thirty-seven patients (13%) had a history of superficial thrombophlebitis (SVT). Proximal mean GSV diameter was 0.95 +/- 0.29 cm (range, 0.4-2.3 cm). Concomitant procedures included avulsion phlebectomy in 88 limbs (30%) and perforator vein surgery in 4 (1%).

RESULTS: AT events after RFA were detected in 38 limbs (13%), including thrombus protrusion into the sapheno-femoral junction (SFJ) in 24 (8%), common femoral vein in 7 (2.5%), and calf vein DVT in 7 (2.5%). Overall incidence of AT events in limbs with and without evidence of previous DVT was 7% (2 of 29) and 14% (36 of 264), respectively (P = .36). Variables significantly associated with AT events were previous SVT (10 of 37 [27%] vs 28 of 256 [11%], P = .01), a larger GSV diameter (mean 1.1 +/- .39 vs 0.93 +/- 0.27, P < .01), and first protocol (catheter temperature of 85 degrees C with a slower pullback rate in 18 of 88 [20%] vs 20 of 205 [9.7%], P = .02). Concomitant venous operations were associated with an increase in AT events (23% vs 9%; P < .002). By multivariate analysis, larger proximal GSV diameter and previous SVT remained independently statistically significant (P = .049 and P = .0135, respectively). All AT patients were successfully treated with standard anticoagulation. No pulmonary emboli occurred.

CONCLUSION: RFA of the GSV in patients with previous venous thromboembolic events is safe and should be offered as an alternative to surgical procedures. These data demonstrate that AT events increase when larger-diameter GSVs are treated.

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