Analysis of a New Ultrasound Classification System following Ablation of the Great Saphenous Vein

Abstract

Ablation of truncal vein reflux, whether by thermal or nonthermal techniques, may be associated with thrombus extension into the deep system and deep venous thrombosis (DVT) in a small number of patients. To assess for this, most patients undergo a follow-up ultrasound examination within 24 to 72 hours after the procedure. Two prior classification systems for describing thrombus extension and managing postprocedure anticoagulation therapy have been widely used. Recently, a new classification system, arteriovenous fistula (AVF) consensus, was published that combined the two in an effort to establish one universal system. In this study, our objective was to use all three classifications in a cohort of patients to determine the impact of consolidating systems in the management of patients with different levels of great saphenous vein (GSV) closure. We performed a retrospective cohort review of consecutive patients who underwent GSV ablation with mechanochemical or thermal techniques at two associated medical centers during years 2015-2017 and 2018-2019. Only patients who underwent postprocedure duplex ultrasound at 24 to 72 hours were included. Ultrasounds were independently assigned to each of the classification systems based on the level of closure (Table). Patient charts were also reviewed to identify treatment. A total of 223 patients were analyzed (150 underwent radiofrequency ablation and 73 ClariVein ablation). The mean age was 58.5 with 49% females and 51% males. Of the patients, 52% underwent concomitant phlebectomies. Two patients required anticoagulation post treatment. Another two underwent a follow-up ultrasound examination with one patient who had unchanged findings and one with improvement of the level of closure. The rest did not require any further follow-up. This was consistent with recommendations by all three classifications. GSV ablation at a level that requires anticoagulation or repeat ultrasound examination is rare, occurring in <1% of patients. The previous systems and AVF consensus system are similar enough that applying either one for the purpose of postprocedure management results in no change in treatment. Based on this data, the AVF classification system may be applied when clinically indicated in the postablation period, to standardize the reporting of this infrequent but important complication.TableNumber of patients by level of closureKabnick class (n = 223)Lawrence class (n = 223)AVF consensus class (n = 223)I (210)I (195)Ia (195)II (12)II (5)Ib (15)III (0)III (10)II (12)Iv (1)IV (11)III (0)V (1)IV (1)VI (1) Open table in a new tab