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Endovenous laser ablation: venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency.
J Vasc Surg. 2008 Dec; 48(6):1538-45.JV

Abstract

OBJECTIVE

We hypothesize that endovenous laser ablation (EVA) therapy is equally successful in improving venous insufficiency symptoms in patients with or without deep venous insufficiency (DVI).

METHODS

From January 2005 through August 2007, EVA of the great saphenous vein (GSV) was attempted in 364 patients (460 limbs) with symptomatic GSV reflux. The GSV was successfully cannulated and obliterated in all but 17 limbs. EVA was performed alone in 308 limbs (69.5%) and with phlebectomy or perforator ligation (EVAP) in 135 limbs (30.5%). Venous clinical severity scores (VCSS) were recorded preoperatively and at 30, 90, 180, and 360 days postoperatively. Patients were classified as those with or without DVI based on duplex imaging valve closure times at the common femoral vein (CFV) and popliteal vein (PV). In a subset of 181 patients undergoing EVA therapy in the operating room, perioperative thrombosis prophylaxis was administered based on a risk-stratification protocol. Patients were assessed with direct end points (VCSS) and indirect end points (vein occlusion rates).

RESULTS

Successful performance of EVA led to complete saphenous vein ablation in 99.8% at 1 month and 95.9% at 1 year. Median VCSS preoperatively was 6 (interquartile range, 5-8), generally decreasing over all time points to 4 (interquartile range, 2-5) beyond 360 days (P < .001). Male gender was independently associated with greater improvement in scores with time (P = .019). Changes in VCSS and duration of vessel occlusion were equivalent regardless of DVI for both isolated EVA and EVAP. For EVAP, the true deep venous thrombosis (DVT) rate was 2.2%, whereas for isolated EVA, the rate was 0% (P = .028); the rate of saphenofemoral thrombus extension was 5.9% for EVAP vs 7.8% for isolated EVA (P = .554). The use of risk-adjusted heparin prophylaxis in patients undergoing EVAP did not have a significant effect on thrombotic complications. There were no differences in true DVT, thrombus extension, or superficial thrombophlebitis between patients with or without DVI. Performance of concomitant phlebectomy, DVI, gender, and age had no effect on the duration of vessel occlusion.

CONCLUSION

EVA produces successful ablation and is associated with sustained improvement in VCSS. These outcomes are independent of the presence of DVI. Finally, the use of a risk-adjusted thrombosis prevention protocol had no effect on the rate of superficial thrombus extension from EVA or EVAP in patients undergoing general anesthesia.

Authors+Show Affiliations

Section of Vascular Surgery, University of Michigan, Ann Arbor, Michigan, USA. bknipp@med.umich.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

18829223

Citation

Knipp, Brian S., et al. "Endovenous Laser Ablation: Venous Outcomes and Thrombotic Complications Are Independent of the Presence of Deep Venous Insufficiency." Journal of Vascular Surgery, vol. 48, no. 6, 2008, pp. 1538-45.
Knipp BS, Blackburn SA, Bloom JR, et al. Endovenous laser ablation: venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. J Vasc Surg. 2008;48(6):1538-45.
Knipp, B. S., Blackburn, S. A., Bloom, J. R., Fellows, E., Laforge, W., Pfeifer, J. R., Williams, D. M., & Wakefield, T. W. (2008). Endovenous laser ablation: venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. Journal of Vascular Surgery, 48(6), 1538-45. https://doi.org/10.1016/j.jvs.2008.07.052
Knipp BS, et al. Endovenous Laser Ablation: Venous Outcomes and Thrombotic Complications Are Independent of the Presence of Deep Venous Insufficiency. J Vasc Surg. 2008;48(6):1538-45. PubMed PMID: 18829223.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Endovenous laser ablation: venous outcomes and thrombotic complications are independent of the presence of deep venous insufficiency. AU - Knipp,Brian S, AU - Blackburn,Susan A, AU - Bloom,Jess R, AU - Fellows,Elaine, AU - Laforge,William, AU - Pfeifer,John R, AU - Williams,David M, AU - Wakefield,Thomas W, AU - ,, Y1 - 2008/10/01/ PY - 2008/03/19/received PY - 2008/07/09/revised PY - 2008/07/11/accepted PY - 2008/10/3/pubmed PY - 2009/1/23/medline PY - 2008/10/3/entrez SP - 1538 EP - 45 JF - Journal of vascular surgery JO - J Vasc Surg VL - 48 IS - 6 N2 - OBJECTIVE: We hypothesize that endovenous laser ablation (EVA) therapy is equally successful in improving venous insufficiency symptoms in patients with or without deep venous insufficiency (DVI). METHODS: From January 2005 through August 2007, EVA of the great saphenous vein (GSV) was attempted in 364 patients (460 limbs) with symptomatic GSV reflux. The GSV was successfully cannulated and obliterated in all but 17 limbs. EVA was performed alone in 308 limbs (69.5%) and with phlebectomy or perforator ligation (EVAP) in 135 limbs (30.5%). Venous clinical severity scores (VCSS) were recorded preoperatively and at 30, 90, 180, and 360 days postoperatively. Patients were classified as those with or without DVI based on duplex imaging valve closure times at the common femoral vein (CFV) and popliteal vein (PV). In a subset of 181 patients undergoing EVA therapy in the operating room, perioperative thrombosis prophylaxis was administered based on a risk-stratification protocol. Patients were assessed with direct end points (VCSS) and indirect end points (vein occlusion rates). RESULTS: Successful performance of EVA led to complete saphenous vein ablation in 99.8% at 1 month and 95.9% at 1 year. Median VCSS preoperatively was 6 (interquartile range, 5-8), generally decreasing over all time points to 4 (interquartile range, 2-5) beyond 360 days (P < .001). Male gender was independently associated with greater improvement in scores with time (P = .019). Changes in VCSS and duration of vessel occlusion were equivalent regardless of DVI for both isolated EVA and EVAP. For EVAP, the true deep venous thrombosis (DVT) rate was 2.2%, whereas for isolated EVA, the rate was 0% (P = .028); the rate of saphenofemoral thrombus extension was 5.9% for EVAP vs 7.8% for isolated EVA (P = .554). The use of risk-adjusted heparin prophylaxis in patients undergoing EVAP did not have a significant effect on thrombotic complications. There were no differences in true DVT, thrombus extension, or superficial thrombophlebitis between patients with or without DVI. Performance of concomitant phlebectomy, DVI, gender, and age had no effect on the duration of vessel occlusion. CONCLUSION: EVA produces successful ablation and is associated with sustained improvement in VCSS. These outcomes are independent of the presence of DVI. Finally, the use of a risk-adjusted thrombosis prevention protocol had no effect on the rate of superficial thrombus extension from EVA or EVAP in patients undergoing general anesthesia. SN - 1097-6809 UR - https://www.unboundmedicine.com/medline/citation/18829223/Endovenous_laser_ablation:_venous_outcomes_and_thrombotic_complications_are_independent_of_the_presence_of_deep_venous_insufficiency_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0741-5214(08)01189-0 DB - PRIME DP - Unbound Medicine ER -