Systematic review on the incidence and management of endovenous heat-induced thrombosis following endovenous thermal ablation of the great saphenous vein

Healy, Donagh; Twyford, Mark; Moloney, Tony; Kavanagh, Eamon G.

doi:10.1016/j.jvsv.2021.02.006

Cited by 10 publications

(5 citation statements)

References 82 publications

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“…6 According to the literature, the overall reported EHIT prevalence is 1.27% (regarding the clinically relevant stages of the condition) with GSV diameter, male sex, history of venous thromboembolism, and concomitant phlebectomy being identified among potential risk factors. 2,29 Concerning GSV diameter, several studies have identified various cut-offs ranging from 7.5 mm to 10 mm as predictors for EHIT occurrence. [30][31][32] In our review, though the regression analysis of the whole dataset revealed a statistically significant association between diameter and EHIT occurrence, both the comparative analysis (GSV > 12 mm versus GSV < 12 mm) and regression analysis including only GSV > 12 mm failed to reach statistical significance.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…Ultimately, if one takes into account the minimal reported DVT estimates following EVTA of under 1%, the nonidentification of GSV diameter as a risk factor for the development of DVT is rather expected. 29 Paresthesia is one of the most commonly anticipated complications following EVTA. The reported paresthesia outcomes vary widely and range from 3% to 12%, though they heavily depend on multiple parameters, such as the treatment modality, or the specific device parameters.…”

Section: Discussionmentioning

confidence: 99%

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Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: A systematic review meta-analysis and meta-regression

Bontinis

Koutsoumpelis

et al. 2023

Vasc Med

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Background: We sought to assess the safety and efficacy of endovenous thermal ablation (EVTA) in treating large great saphenous veins (GSV) > 12 mm in diameter. Methods: We performed a systematic review according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2020 for comparative and noncomparative studies depicting EVTA in the treatment of GSV > 12 mm. Primary endpoints included GSV occlusion, technical success, deep vein thrombosis (DVT), and endovenous heat-induced thrombosis (EHIT). We conducted a comparative analysis between GSV > 12 mm and < 12 mm and a meta-regression analysis for two sets of studies, one including the whole dataset, containing treatment arms of comparative studies with GSV < 12 mm and one exclusively for GSV > 12 mm. Results: Seven studies, including 2564 GSV, depicting radiofrequency (RFA) and endovenous laser ablation (EVLA) were included. GSV > 12 mm occlusion, technical success, DVT, and EHIT estimates were 95.9% (95% CI: 93.6–97.8), 99.9% (95% CI: 98.9–100.0), 0.04% (95% CI: 0.0–3.4), and 1.6% (95% CI: 0.3–3.5). Meta-regression revealed a negative association between GSV diameter and occlusion for both the whole dataset ( p < 0.01) and the > 12 mm groups ( p = 0.04), GSV diameter and technical success for both groups ( p < 0.01), ( p = 0.016), and GSV diameter and EHIT only for the whole dataset ( p = 0.02). The comparative analysis between GSV < 12 mm and GSV > 12 mm displayed an occlusion estimate of OR 1.79 (95% CI: 1.25–2.56) favoring small GSV. Conclusion: Whereas we have displayed excellent occlusion and technical success results for the EVTA of GSV > 12 mm, our analysis has illustrated the unfavorable impact of GSV diameter on occlusion, technical success, and EHIT outcomes regardless of the 12 mm threshold. Potential parameter or device adjustments in a diameter-oriented fashion could further enhance outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: A systematic review meta-analysis and meta-regression

Bontinis

Koutsoumpelis

et al. 2023

Vasc Med

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“…Notably, the European Society for Vascular Surgery does not make such a recommendation [6]. The routine use of duplex surveillance has led to the recognition of a new form of localized post-operative DVT which is termed endovenous heat induced thrombosis (EHIT), referring to the extension of thrombus from the ablated superficial vein into the deep vein [7]. EHIT rates reported in the literature vary widely from 0% to 8%, with no consensus on its management [8].…”

Section: Introductionmentioning

confidence: 99%

“…EHIT rates reported in the literature vary widely from 0% to 8%, with no consensus on its management [8]. Given the substantial volume of EVTA procedures performed globally and the potential for severe complications, it is imperative for healthcare providers to have a clear understanding of the true incidence of VTE complications [7, 8]. Such insights can aid in individual patient decision-making and facilitate research on VTE prevention strategies [9, 10].…”

Section: Introductionmentioning

confidence: 99%

An artificial-intelligence interpretable tool to predict risk of deep vein thrombosis after endovenous thermal ablation

Tabari,

Ma,

Alfonso

et al. 2024

Preprint

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IntroductionEndovenous thermal ablation (EVTA) stands as one of the primary treatments for superficial venous insufficiency. Concern exists about the potential for thromboembolic complications following this procedure. Although rare, those complications can be severe, necessitating early identification of patients prone to increased thrombotic risks. This study aims to leverage AI-based algorithms to forecast patients’ likelihood of developing deep vein thrombosis (DVT) within 30 days following EVTA.Materials and MethodsFrom 2007 to 2017, all patients who underwent EVTA were identified using the American College of Surgeons National Surgical Quality Improvement Program database. We developed and validated 4 machine learning models using demographics, comorbidities, and laboratory values to predict the risk of postoperative deep vein thrombosis: Classification and Regression Trees (CART), Optimal Classification Trees (OCT), Random Forests, and Extreme Gradient Boosting (XGBoost). The models were trained using all the available variables. SHAP analysis was adopted to interpret model outcomes and offer medical insights into feature importance and interactions.ResultsA total of 21,549 patients were included (mean age of 54 ± SD years, 67% female). In this cohort, 1.59% developed DVT. The XGBoost model had good discriminative power for predicting DVT risk with AUC of 0.711 in the hold-out test set for all-variable model. Stratification of the test set by age, BMI, preoperative white blood cell and platelet count shows that the model performs equally well across these groups.ConclusionWe developed and validated an interpretable model that enables physicians to predict which patients with superficial venous insufficiency has higher risk of developing deep vein thrombosis within 30 days following endovenous thermal ablation.

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Endovenöse thermische Therapie der Stammveneninsuffizienz

Schmedt¹,

Noppeney

Schmitz‐Rixen

2022

Gefässchirurgie

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Systematic review on the incidence and management of endovenous heat-induced thrombosis following endovenous thermal ablation of the great saphenous vein

Cited by 10 publications

References 82 publications

Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: A systematic review meta-analysis and meta-regression

Endovenous thermal ablation in the treatment of large great saphenous veins of diameters > 12 mm: A systematic review meta-analysis and meta-regression

An artificial-intelligence interpretable tool to predict risk of deep vein thrombosis after endovenous thermal ablation

Endovenöse thermische Therapie der Stammveneninsuffizienz

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