Deep Venous Thrombosis After Saphenous Endovenous Radiofrequency Ablation: Is It Predictable?

Abstract

Endovenous radiofrequency ablation (RFA) is a safe and effective treatment for varicose veins secondary to saphenous reflux. Deep venous thrombosis (DVT) is a known complication of this procedure. The purpose of this study is to describe the frequency of DVT after RFA and associated predisposing factors. We performed a retrospective data analysis from December 2008 to December 2011, during which 277 consecutive office-based RFA were performed in our institution using the VNUS ClosureFast catheter. Duplex scans were completed 2 weeks postprocedure in all patients to confirm saphenous vein obliteration and evaluate the deep venous system for thrombosis. Risk factors assessed for development of DVT included greater vs lesser saphenous, side treated, number of cycles used, hypercoagulable state, history of DVT, tobacco use, medications (oral contraceptives, aspirin, warfarin, clopidogrel), and vein diameter at the junction of the superficial and deep systems. Seventy percent of the patients were female, 56% were right side, and 86% were performed on the greater saphenous vein. Mean age was 54 ± 14 (range, 23-88 years). 3% of patients had a diagnosis of hypercoagulable state and 8% had a history of DVT. Follow-up ultrasound imaging showed thrombus protrusion into the deep system without occlusion was present in 11 patients (4%). DVT, as defined by thrombus protrusion with complete occlusion of the femoral or popliteal vein, developed in two patients (0.7%). Previous DVT was the only factor associated with DVT (P = .018). Although not statistically significant, there was a trend toward higher risk of DVT in LSV patients. Factors associated with protrusion into the deep system were lesser saphenous vein (P = .035), and factor V Leiden (P = .026). The use of RFA to treat patients with saphenous reflux involves a small but definite risk of DVT. This study demonstrates that the risk of DVT or any thrombus protrusion in to the deep system is greater in patients with previous DVT, factor V Leiden, and treatment of the lesser saphenous vein. Periprocedural anticoagulation should be considered in this subset to reduce the risk of complication after RFA.