下肢静脉射频和激光消融术后深静脉血栓形成的发生率及危险因素
Incidence and Risk Factors for Deep Vein Thrombosis after Radiofrequency and Laser Ablation of the Lower Extremity Veins.
作者信息
Itoga Nathan K, Rothenberg Kara A, Deslarzes-Dubuis Celine, George Elizabeth L, Chandra Venita, Harris E John
机构信息
Division of Vascular Surgery, Stanford University, Stanford, CA.
Division of Vascular Surgery, Stanford University, Stanford, CA; Department of Surgery, University of California San Francisco-East Bay, Oakland, CA.
出版信息
Ann Vasc Surg. 2020 Jan;62:45-50.e2. doi: 10.1016/j.avsg.2019.04.008. Epub 2019 Jun 13.
BACKGROUND
The rates of thromboembolic complications such as deep vein thrombosis (DVT) after venous ablation procedures for symptomatic superficial venous insufficiency are controversial. We sought to describe the risk factors for and incidence of DVT after radiofrequency ablation (RFA) and laser ablation (LA).
METHODS
We queried the Truven Health Marketscan Database from 2007-16 for patients who underwent RFA or LA and had a follow-up duplex ultrasound within 30 days of the ablation procedure. The primary outcome was DVT at 7 and 30 days identified by International Classification of Diseases-9 and International Classification of Diseases-10 codes. Multivariable regression was used to evaluate the patient and procedural variables associated with a DVT at 30 days, expressed as odds ratios (ORs) with a 95% confidence interval (95% CI). Patients and procedures with a previous DVT diagnosis were excluded.
RESULTS
A total of 256,999 patients underwent 433,286 ablation procedures: 192,195 (44.4%) RFA and 241,091 LA. Of these, 8,203 (1.9%) had a newly diagnosed DVT within 7 days and 13,347 (3.1%) within 30 days of the procedure. The incidence of DVT decreased over the study period. LA (2.8%) demonstrated a lower incidence of DVT at 30 days compared with RFA (3.4%), P < 0.001. On multivariable regression, LA (OR, 0.82; 95% CI 0.80-0.85) was again associated with a decreased risk for 30-day DVT, as was female gender (OR, 0.74; 95% CI, 0.71-0.77), and sclerotherapy performed on the same day (OR, 0.91; 95% CI, 0.85-0.98). A diagnosis of peripheral artery disease (OR, 1.23; 95% CI, 1.16-1.31) and concomitant stab phlebectomy (OR, 1.43; 95% CI, 1.37-1.49) was associated with an increased risk of DVT within 30 days.
CONCLUSIONS
The incidence of newly diagnosed DVT within 30 days of an ablation procedure was 3.2%. The risk for DVT decreased in recent years, and LA was associated with an 18% decreased risk compared with RFA.
背景
对于有症状的浅静脉功能不全患者，在静脉消融术后发生深静脉血栓形成（DVT）等血栓栓塞性并发症的发生率存在争议。我们旨在描述射频消融（RFA）和激光消融（LA）术后DVT的危险因素及发生率。
方法
我们查询了2007年至2016年的Truven Health Marketscan数据库，以获取接受RFA或LA治疗且在消融术后30天内进行了随访双功超声检查的患者。主要结局是通过国际疾病分类第9版和第10版编码确定的7天和30天时的DVT。采用多变量回归分析评估与30天时DVT相关的患者和手术变量，以比值比（OR）及95%置信区间（95%CI）表示。排除既往有DVT诊断的患者和手术。
结果
共有256,999例患者接受了433,286次消融手术：192,195例（44.4%）RFA和241,091例LA。其中，8203例（1.9%）在术后7天内新诊断为DVT，13,347例（3.1%）在术后30天内新诊断为DVT。在研究期间，DVT的发生率有所下降。LA组（2.8%）在30天时DVT的发生率低于RFA组（3.4%），P<0.001。多变量回归分析显示，LA（OR，0.82；95%CI 0.80 - 0.85）再次与30天时DVT风险降低相关，女性（OR，0.74；95%CI，0.71 - 0.77）以及同日进行硬化治疗（OR，0.91；95%CI，0.85 - 0.98）也与DVT风险降低相关。外周动脉疾病诊断（OR, 1.23；95%CI, 1.16 - 1.31）和同期进行的小切口静脉切除术（OR, 1.43；9%CI, 1.37 - 1.49）与30天内DVT风险增加相关。
结论
消融术后30天内新诊断DVT发生率为3.2%。近年来DVT风险降低，与RFA相比，LA与DVT风险降低18%相关。
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