Vascular Institute Central Switzerland, Aarau, Switzerland; Department of Angiology, University Hospital and University of Basel, Basel, Switzerland.
Vascular Institute Central Switzerland, Aarau, Switzerland.
J Vasc Surg Venous Lymphat Disord. 2021 Jul;9(4):916-924. doi: 10.1016/j.jvsv.2020.10.007. Epub 2020 Oct 22.
The use of endovenous thermal ablation (ETA) for the treatment of truncal varicose veins has been increasing worldwide; however, uncertainty remains regarding the need for thromboprophylaxis and follow-up of patients undergoing this minimally invasive procedure. A nationwide survey of among physicians performing ETA was conducted to assess the thromboprophylaxis practice and follow-up protocols after ETA in Switzerland.
A questionnaire was sent to all ETA-certified physicians (n = 193) in Switzerland. The survey covered procedure type, thromboprophylaxis (including pharmacologic and compression therapy), duplex ultrasound follow-up examinations, and the management of endovenous heat-induced thrombosis (EHIT).
Overall, 121 responses were received, for a response rate of 62.7%. Of the 121 respondents, 71 were vascular medicine specialists (58.7%) and 46 were general or vascular surgeons (38.0%), representing the two largest groups of specialists, followed by 2 dermatologists (1.7%) and 2 interventional radiologists (1.7%). Pharmacologic thromboprophylaxis after ETA was always used by 86 physicians (71.1%), nearly always by 8 (6.6%), frequently used by 5 (4.1%), rarely used by 21 (17.4%), and never by 1 physician (0.8%). A direct oral anticoagulant drug was the preferred type of thromboprophylaxis used by 92 physicians (77.3%). The first dose of thromboprophylaxis was mostly administered immediately after intervention by 53 physicians (53.7%). The duration of postablation thromboprophylaxis ranged from 1 to 21 days, with 7 to 10 days used by 57 physicians. Compression therapy was used by all physicians, with large variation in duration ranging from 1 to 42 days after a single ETA session and after ETA with concomitant phlebectomy. Postablation duplex ultrasonography was performed routinely by 120 respondents (99.2%), and 84 respondents (69.4%) performed two to three duplex ultrasound scans. Management of EHIT depended on the EHIT class and differed widely among the physicians.
Our nationwide survey on thromboprophylaxis practices after ETA of truncal varicose veins in Switzerland showed that most physicians use pharmacologic thromboprophylaxis, with a direct oral anticoagulant drug the preferred agent. However, the timing of the first dose and the duration of thromboprophylaxis varied widely among the respondents, reflecting the uncertainty in this domain owing to the absence of high-quality evidence-based guidelines.
静脉内热消融术（ETA）在全球范围内用于治疗主干静脉曲张的应用越来越多；然而，对于接受这种微创治疗的患者是否需要进行血栓预防和随访，仍存在不确定性。对瑞士开展 ETA 的医生进行了一项全国性调查，以评估瑞士 ETA 术后的血栓预防措施和随访方案。
向瑞士所有 ETA 认证医生（n=193）发送问卷。该调查涵盖了手术类型、血栓预防（包括药物和压迫治疗）、双功能超声随访检查以及静脉内热诱导血栓形成（EHIT）的管理。
共收到 121 份回复，回复率为 62.7%。在 121 名受访者中，71 名为血管医学专家（58.7%），46 名为普通或血管外科医生（38.0%），这两个群体是最大的专家群体，其次是 2 名皮肤科医生（1.7%）和 2 名介入放射科医生（1.7%）。86 名医生（71.1%）始终在 ETA 后使用药物性血栓预防，8 名医生（6.6%）几乎始终使用，5 名医生（4.1%）经常使用，21 名医生（17.4%）很少使用，1 名医生（0.8%）从未使用。92 名医生（77.3%）首选直接口服抗凝药物进行血栓预防。53 名医生（53.7%）在干预后立即给予第一剂血栓预防药物。消融后抗栓治疗的持续时间为 1-21 天，57 名医生使用 7-10 天。所有医生均使用压迫治疗，单次 ETA 治疗后和 ETA 联合静脉切除术治疗后，压迫治疗的持续时间差异很大，范围为 1-42 天。120 名受访者（99.2%）常规进行术后双功能超声检查，84 名受访者（69.4%）进行 2-3 次双功能超声检查。EHIT 的管理取决于 EHIT 分级，且在医生之间差异很大。
我们对瑞士主干静脉曲张 ETA 术后血栓预防措施的全国性调查显示，大多数医生使用药物性血栓预防，首选直接口服抗凝药物。然而，受访者之间的首次剂量时间和抗栓治疗持续时间差异很大，这反映了由于缺乏高质量的循证指南，该领域存在不确定性。
