Thrombotic complications of superficial endovenous ablation: a contemporary review of thermal and non-thermal techniques. [Review]

MedStar author(s):
Citation: Journal of Cardiovascular Surgery. 62(5):420-426, 2021 Oct.PMID: 33890755Institution: MedStar Washington Hospital CenterDepartment: Surgery/Vascular SurgeryForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Ablation Techniques/ae [Adverse Effects] | *Endovascular Procedures/ae [Adverse Effects] | *Ischemic Stroke/et [Etiology] | *Saphenous Vein/su [Surgery] | *Varicose Ulcer/su [Surgery] | *Venous Insufficiency/su [Surgery] | *Venous Thrombosis/et [Etiology] | Anticoagulants/tu [Therapeutic Use] | Humans | Ischemic Stroke/dg [Diagnostic Imaging] | Ischemic Stroke/dt [Drug Therapy] | Male | Middle Aged | Risk Assessment | Risk Factors | Saphenous Vein/dg [Diagnostic Imaging] | Saphenous Vein/pp [Physiopathology] | Treatment Outcome | Varicose Ulcer/dg [Diagnostic Imaging] | Varicose Ulcer/pp [Physiopathology] | Venous Insufficiency/dg [Diagnostic Imaging] | Venous Insufficiency/pp [Physiopathology] | Venous Thrombosis/dg [Diagnostic Imaging] | Venous Thrombosis/dt [Drug Therapy]Year: 2021ISSN:
  • 0021-9509
Name of journal: The Journal of cardiovascular surgeryAbstract: Endovenous ablation has become the preferred means to treat superficial venous insufficiency. Ablative technologies have evolved to include a variety of both thermal and nonthermal techniques. The reported thrombotic complications of endovenous heat induced thrombosis (EHIT) and deep venous thrombosis (DVT) associated with thermal techniques are low (<2% overall). However, the limited data on newer non-thermal technologies suggest these modalities may have thrombotic complication rates upwards of 6%. Additionally, the pathophysiology of thrombotic events related to mechanochemical ablative techniques may differ from EHIT, and thus, may have different implications for management. Described is a case report of a stroke after cyanoacrylate ablation of the great saphenous vein, and a review of the current literature reporting the thrombotic complications associated with current thermal and non-thermal techniques. There exists a need for high volume studies on newer ablative techniques to fully understand their associated thrombotic complications. This review highlights the need for a comprehensive classification system and standard treatment algorithm encompassing of thrombotic complications associated with both thermal and non-thermal ablative techniques.All authors: Dirks RC, Kiguchi MM, Kochubey MS, O'Banion LA, Siada SS, Tenet MOriginally published: Journal of Cardiovascular Surgery. 2021 Apr 23Fiscal year: FY2022Fiscal year of original publication: FY2021Digital Object Identifier: Date added to catalog: 2021-06-07
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Journal Article MedStar Authors Catalog Article 33890755 Available 33890755

Endovenous ablation has become the preferred means to treat superficial venous insufficiency. Ablative technologies have evolved to include a variety of both thermal and nonthermal techniques. The reported thrombotic complications of endovenous heat induced thrombosis (EHIT) and deep venous thrombosis (DVT) associated with thermal techniques are low (<2% overall). However, the limited data on newer non-thermal technologies suggest these modalities may have thrombotic complication rates upwards of 6%. Additionally, the pathophysiology of thrombotic events related to mechanochemical ablative techniques may differ from EHIT, and thus, may have different implications for management. Described is a case report of a stroke after cyanoacrylate ablation of the great saphenous vein, and a review of the current literature reporting the thrombotic complications associated with current thermal and non-thermal techniques. There exists a need for high volume studies on newer ablative techniques to fully understand their associated thrombotic complications. This review highlights the need for a comprehensive classification system and standard treatment algorithm encompassing of thrombotic complications associated with both thermal and non-thermal ablative techniques.

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