Occurrence and risk factors for endothermal heat induced thrombosis after endovenous varicose vein ablation
Al Adas Z, Lin JC, Weaver MR, Kennedy N, Ahsan S, Shepard A, and Kabbani L. Occurrence and risk factors for endothermal heat induced thrombosis after endovenous varicose vein ablation. J Vasc Surg 2018; 67(6):e231.
Journal of Vascular Surgery
Objectives: Radiofrequency ablation (RFA) and endovascular laser ablation (EVLA) have become popular techniques for treating varicose veins. Endothermal heat induced thrombosis (EHIT) is a complication unique to endovenous ablation. It reflects the extension of the thrombus from the ablated saphenous vein into deep venous system. Using national data, we want to determine patient factors and operative parameters associated with a higher incidence of EHIT. Methods: We performed a retrospective analysis of the national Vascular Quality Initiative (VQI) Varicose Vein Registry for all varicose vein procedures by RFA and EVLA performed between March 2014 and May 2017. To accurately detect all EHIT cases, we only included ablations that had a follow-up between 2 and 28 days. EHIT was classified according to the Kabnick criteria into low grade (class 1 and 2) and high grade (class 3 and 4) as per the VQI. Variables collected included patients demographics, comorbidities, procedural details and complications. After stratifying by the type of vein ablated (great saphenous vs small saphenous), univariate followed by multivariate logistic regression was performed to determine the significant risk factors for EHIT. Results: During the study period, 11,041 vein ablations were recorded in the national registry; of these 2353 met the inclusion criteria. The average age was 56 years and 70% were female. Fifty-five percent of procedures were RFA and the rest were EVLA. Ninety percent of procedures were performed to ablate the great saphenous vein. Fortyone patients (1.6%) developed EHIT during the follow-up period; 90% belonged to Kabnick class 1 and 2. The only significant risk factor for EHIT using multivariate logistic regression was increasing diameter of the great saphenous (OR, 1.014 for every 1 mm increase in vein diameter; P = .001).Type of ablation energy used (RFA vs EVLA), concomitant stab phlebectomy, and preoperative anticoagulation were not associated with EHIT occurrence. Conclusions: EHIT is a rare complication after endovenous varicose vein ablation, and it is not affected by the type of vein ablation. Increasing great saphenous vein diameter was the only significant risk factor for EHIT.