Division of Vascular and Endovascular Surgery, Gonda Venous Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
Division of Vascular and Endovascular Surgery, Gonda Venous Center, David Geffen School of Medicine at UCLA, Los Angeles, CA.
J Vasc Surg Venous Lymphat Disord. 2024 May;12(3):101815. doi: 10.1016/j.jvsv.2024.101815. Epub 2024 Jan 11.
Polidocanol endovenous microfoam ablation (MFA) is approved by the US Food and Drug Administration for great saphenous vein (GSV) closure, yet there are few published data on the subsequent risk of ablation-related thrombus extension (ARTE). Recent societal practice guidelines recommend against routine postprocedure duplex ultrasound (DU) examination after thermal ablation of the GSV in asymptomatic patients. At present, limited data do not allow this recommendation to extend to MFA. Our aim is to identify characteristics and outcomes associated with ARTE following MFA vs radiofrequency ablation (RFA).
A retrospective review of a prospectively maintained database was conducted of patients who underwent MFA and RFA closure of incompetent above-knee GSVs. Patients treated for isolated tributary vein treatment or did not have a postprocedure DU examination within 48 to 72 hours were not included. Patients were classified into two groups: ARTE and no ARTE. Demographic data, Clinical, Etiologic, Anatomic and Pathophysiologic class, Venous Clinical Severity Score, operative details, postprocedure (48-72 hours) DU findings, and adverse events were analyzed. Variables that were significant on univariate analysis were evaluated using multivariate logistic regression with the primary outcome being development of ARTE.
Between June 2018 and February 2023, 800 limbs were treated with either MFA (n = 224) or RFA (n = 576). Ninety-six GSVs treated with MFA met the study criteria. One hundred fifty successive GSVs treated with RFA during the same period were included as a comparison group. There was no statistically significant difference in baseline demographics between the two groups. Six patients (2.4%) demonstrated ARTE on postoperative DU examination at 48 to 72 hours (MFA, n = 5 [5.2%]; RFA, n = 1 [0.7%]; P = .02). Saphenous vein ablation with MFA (P = .045) and a vein diameter of >10 mm (P = .017) were associated with ARTE on both univariable and multivariable analysis. All patients who developed ARTE were treated with oral anticoagulants (mean, 15.6 days). Body mass index, Clinical, Etiologic, Anatomic and Pathophysiologic class, Venous Clinical Severity Score, microfoam volume, operative time, and prior deep venous thrombosis were not predictive of ARTE.
ARTE after above-knee GSV closure occurred more frequently after MFA. Our results suggest that a saphenous vein diameter of >10 mm may be associated with ARTE. Despite this finding, all patients with ARTE were treated with short-term anticoagulation with no related complications. Until larger studies with high-risk subgroups have been studied after MFA, DU examination should be performed routinely after this procedure and patients with ARTE anticoagulated until the thrombus retracts caudal to the saphenofemoral junction or is no longer present on DU examination. Current societal guidelines recommending against routine post-thermal ablation DU examination should not be applied to similar patients after saphenous nonthermal MFA ablation.
聚多卡醇静脉内微泡消融（MFA）已获得美国食品和药物管理局批准，用于大隐静脉（GSV）闭合，但关于消融相关血栓延伸（ARTE）的后续风险，发表的数据很少。最近的社会实践指南建议，对于无症状患者，在 GSV 热消融后不常规进行术后双功能超声（DU）检查。目前，有限的数据不允许将这一建议扩展到 MFA。我们的目的是确定 MFA 与射频消融（RFA）后发生 ARTE 的特征和结果。
对前瞻性维护的数据库进行了回顾性分析，纳入了接受 MFA 和 RFA 治疗的功能不全的膝上 GSV 患者。仅治疗孤立的属支静脉或术后 48 至 72 小时内未行 DU 检查的患者不包括在内。患者分为两组：ARTE 和无 ARTE。分析了人口统计学数据、临床、病因、解剖和病理生理分类、静脉临床严重程度评分、手术细节、术后（48-72 小时）DU 结果和不良事件。单变量分析中具有统计学意义的变量采用多元逻辑回归进行评估，主要结局为 ARTE 的发生。
2018 年 6 月至 2023 年 2 月，800 条肢体接受了 MFA（n=224）或 RFA（n=576）治疗。224 条 MFA 治疗的 GSV 中有 96 条符合研究标准。同期接受 RFA 治疗的 150 条连续 GSV 被纳入对照组。两组患者的基线人口统计学数据无统计学差异。48 至 72 小时的术后 DU 检查发现 6 例（2.4%）发生 ARTE（MFA，n=5 [5.2%]；RFA，n=1 [0.7%]；P=0.02）。MFA 消融（P=0.045）和静脉直径>10mm（P=0.017）与单变量和多变量分析中的 ARTE 相关。所有发生 ARTE 的患者均接受口服抗凝治疗（平均 15.6 天）。体重指数、临床、病因、解剖和病理生理分类、静脉临床严重程度评分、微泡体积、手术时间和既往深静脉血栓形成与 ARTE 无关。
膝上 GSV 闭合后，MFA 后 ARTE 更常见。我们的结果表明，静脉直径>10mm 可能与 ARTE 有关。尽管存在这种情况，但所有发生 ARTE 的患者均接受短期抗凝治疗，无相关并发症。在 MFA 后对高风险亚组进行更大规模的研究之前，应常规进行 DU 检查，所有发生 ARTE 的患者应接受抗凝治疗，直到血栓退缩至股隐静脉交界处以下或 DU 检查不再存在血栓。目前建议对热消融后不常规进行术后 DU 检查的社会指南，不应用于类似的接受 saphenous 非热 MFA 消融的患者。
