The safety of radiofrequency ablation of the great saphenous vein in patients with previous venous thrombosis

Puggioni, Alessandra; Marks, Natalie; Hingorani, Anil; Shiferson, Alexander; Alhalbouni, Saadi; Ascher, Enrico

doi:10.1016/j.jvs.2008.12.016

Cited by 51 publications

(35 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A history of DVT was a statistically significant risk factor for the need for anticoagulation (P ϭ .029). 5 The mean preoperative diameter of the saphenous vein in all patients who underwent RFA was 7.34 Ϯ 2.99 mm (Fig 2, A) Those who had closure at a level 1, 2, or 3 and did not require anticoagulation had a mean diameter of 7.29 Ϯ 2.93 mm, while those with a level 4 or 5 closure had a mean diameter of 10.46 Ϯ 3.61 mm. (Fig 2, B and C) Patients with a saphenous vein diameter greater than 8 mm had a significantly higher risk of closing their vein at a level that required anticoagulation (level 4-5) (P Ͻ .02, Table II).…”

Section: Resultsmentioning

confidence: 98%

Classification of proximal endovenous closure levels and treatment algorithm

Lawrence

Chandra

et al. 2010

Journal of Vascular Surgery

109

View full text Add to dashboard Cite

A classification system for saphenous endovenous closure which extends above the epigastric vein has been helpful in guiding management. A GSV diameter at the SFJ of >8 mm and a history of DVT results in significantly higher rates of proximal thrombus extension into the femoral vein. A short course of LMWH, until clot retracts back into the saphenous vein, is therapeutic. Management of the patients with thrombus flush with the femoral vein wall still needs to be defined, but the outcome from these patients is generally benign.

show abstract

Section: Resultsmentioning

confidence: 98%

Classification of proximal endovenous closure levels and treatment algorithm

Lawrence

Chandra

et al. 2010

Journal of Vascular Surgery

109

View full text Add to dashboard Cite

show abstract

“…[251][252][253] Experience with RF rapidly accumulated, 8,195,246,[254][255][256][257][258][259] although the first-generation device was somewhat cumbersome to use. The current ClosureFast RF catheter (VNUS Medical Technologies, San Jose, Calif), introduced in 2007, is more user-friendly, and treatment with it is faster than with the first-generation device.…”

Section: Endovenous Thermal Ablationsmentioning

confidence: 99%

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Gloviczki

Comerota²,

Dalsing

et al. 2011

Journal of Vascular Surgery

1,263

952

View full text Add to dashboard Cite

The Society for Vascular Surgery (SVS) and the American Venous Forum (AVF) have developed clinical practice guidelines for the care of patients with varicose veins of the lower limbs and pelvis. The document also includes recommendations on the management of superficial and perforating vein incompetence in patients with associated, more advanced chronic venous diseases (CVDs), including edema, skin changes, or venous ulcers. Recommendations of the Venous Guideline Committee are based on the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system as strong (GRADE 1) if the benefits clearly outweigh the risks, burden, and costs. The suggestions are weak (GRADE 2) if the benefits are closely balanced with risks and burden. The level of available evidence to support the evaluation or treatment can be of high (A), medium (B), or low or very low (C) quality. The key recommendations of these guidelines are: We recommend that in patients with varicose veins or more severe CVD, a complete history and detailed physical examination are complemented by duplex ultrasound scanning of the deep and superficial veins (GRADE 1A). We recommend that the CEAP classification is used for patients with CVD (GRADE 1A) and that the revised Venous Clinical Severity Score is used to assess treatment outcome (GRADE 1B). We suggest compression therapy for patients with symptomatic varicose veins (GRADE 2C) but recommend against compression therapy as the primary treatment if the patient is a candidate for saphenous vein ablation (GRADE 1B). We recommend compression therapy as the primary treatment to aid healing of venous ulceration (GRADE 1B). To decrease the recurrence of venous ulcers, we recommend ablation of the incompetent superficial veins in addition to compression therapy (GRADE 1A). For treatment of the incompetent great saphenous vein (GSV), we recommend endovenous thermal ablation (radiofrequency or laser) rather than high ligation and inversion stripping of the saphenous vein to the level of the knee (GRADE 1B). We recommend phlebectomy or sclerotherapy to treat varicose tributaries (GRADE 1B) and suggest foam sclerotherapy as an option for the treatment of the incompetent saphenous vein (GRADE 2C). We recommend against selective treatment of perforating vein incompetence in patients with simple varicose veins (CEAP class C(2); GRADE 1B), but we suggest treatment of pathologic perforating veins (outward flow duration ≥500 ms, vein diameter ≥3.5 mm) located underneath healed or active ulcers (CEAP class C(5)-C(6); GRADE 2B). We suggest treatment of pelvic congestion syndrome and pelvic varices with coil embolization, plugs, or transcatheter sclerotherapy, used alone or together (GRADE 2B).

show abstract

“…Thirteen trials reported baseline and follow-up scores for the VCSS (see Table 15); 44,45,53,80,86,87,90,97,102,117,127 the data reported by Figueiredo et al 85 and Rasmussen et al 95 were not appropriate for analysis because they did not report mean and SDs, or figures to enable the calculation of these data.…”

Section: Venous Clinical Severity Scorementioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

Carroll

Hummel²,

Leaviss³

et al. 2013

Health Technology Assessment

View full text Add to dashboard Cite

The safety of radiofrequency ablation of the great saphenous vein in patients with previous venous thrombosis

Abstract: RFA of the GSV in patients with previous venous thromboembolic events is safe and should be offered as an alternative to surgical procedures. These data demonstrate that AT events increase when larger-diameter GSVs are treated.

Cited by 51 publications

References 39 publications

Classification of proximal endovenous closure levels and treatment algorithm

Classification of proximal endovenous closure levels and treatment algorithm

The care of patients with varicose veins and associated chronic venous diseases: Clinical practice guidelines of the Society for Vascular Surgery and the American Venous Forum

Clinical effectiveness and cost-effectiveness of minimally invasive techniques to manage varicose veins: a systematic review and economic evaluation

Contact Info

Product

Resources

About