Complex long-segment and bilateral iliac occlusions can be safely treated via endovascular means with high rates of symptom resolution. Initial technical success, low morbidity, and mid-term durability are comparable to results with open reconstruction. A liberal posture to open femoral artery reconstruction extends the ability to treat diffuse TASC-C and -D lesions via endovascular means.
Objectives: The incidence of endovenous heat-induced thrombus (EHIT) and deep vein thrombosis (DVT) after endovenous laser treatment (EVLT) or radiofrequency ablation (VNUS) of truncal vein is low. However, the consequence may be lethal. We investigate the value of vein mapping prior to vein ablation for predicting the risk of thrombus formation.Methods: 355 consecutive vein mappings were prospectively collected and analyzed. Excluded were 29 patients who did not complete the EVLT or VNUS procedure. All symptomatic patients underwent venous duplex ultrasound to assess for valvular incompetence. Preoperative venous reflux is defined as Ͼ0.5 second. Vein mapping of refluxing truncal veins was done at least the day prior and the diameter of the great saphenous vein (GSV) or small saphenous vein (SSV) measured. Post-operative duplex were performed between 5-7 days after the procedure. Bivariate analysis of independent variables by outcomes was performed using Student's t-test for continuous variable, chi-square test for categorical variables, and logistic regression to estimate the odds ratio (OR). Multivariate logistic models were used to adjust for diameter and refluxing vein.Results: Among the 355 studies in 330 patients, the average age of the patients was 55.2 years; 96 male (29.1%) and 231 female (70.9%); 312 were GSV (95.7%) and 14 SSV (4.3%); 169 right leg (51.4%) and 157 left leg (48.2%). Among 326 veins, 169 were treated with VNUS (51.8%) and 157 EVLT (48.2%). The immediate post-procedure closure was seen in 319 veins (97.9%). Among the 312 GSV ablation procedures, 10 (3.2%) developed EHIT or DVT. When comparing the group of patients who developed EHIT versus no EHIT, the mean GSV diameter was 12.75 Ϯ 5.76 mm versus 8.5 Ϯ 3.44 mm (OR 1.23, P ϭ .001), the presence of valvular incompetence at the saphenofemoral junction was 8.33% vs. 0.44% (OR 20.64, pϭ.001), and 3.09% in VNUS vs. 2% in EVLT (OR 0.64, P ϭ .54) Conclusions: Patients with valvular insufficiency of the saphenofemoral junction and a large proximal GSV diameter had significantly higher risk of developing heat-induced thrombus formation after endovenous catheter ablation. There was no difference in the occurrence of EHIT with EVLT or VNUS procedures in our series.
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