Impact of Postoperative Duplex Surveillance after Radiofrequency Ablation of the Greater Saphenous Vein

Abstract

Purpose Radiofrequency ablation (RFA) is an effective therapeutic option for the treatment of greater saphenous vein (GSV) insufficiency; however, recent reports have begun to document an associated incidence of postprocedural deep venous thrombosis (DVT) of up to 16%. We evaluated our incidence of DVT after RFA and the role of venous duplex ultrasonography (VUS) in the assessment and treatment of GSV reflux. Methods During a 17-month period, 62 lower extremities with symptomatic GSV reflux were evaluated by VUS in 51 patients (74% women; mean age 51 years, range 25–83 yrs). Clinical history and examination focusing on risk factors for venous insufficiency and DVT were obtained along with a complete preoperative bilateral lower-extremity VUS in all patients. All procedures were completed by performing an intraoperative VUS to confirm patency of the GSV and common femoral veins before and after RFA. All patients received outpatient complete lower-extremity VUS within 5 days of the procedure to assess technical success of the procedure and superficial and deep venous patency. Results Fifty (98%) of patients completed RFA, with one patient undergoing high ligation of the GSV because of our inability to pass a guidewire and catheter into the proximal GSV. Duplex ultrasound confirmed successful RFA of the GSV in all limbs treated. Stab phlebectomy was performed in 33 (53%) limbs for associated clusters of large varicose veins. Two postoperative DVTs occurred (2/62,3.2%), both of which were identified as a floating thrombus in the common femoral vein and which subsequently were treated with percutaneous catheter-directed suction thrombectomy without the need for extended anticoagulation therapy. Conclusion Duplex venous scanning is an important component in the diagnosis and treatment of GSV insufficiency. VUS not only is necessary to direct the success of these catheter-based ablative procedures but is mandatory to confirm the absence of extended DVT after the procedure is completed. Our series has recorded a relatively low incidence of DVT and demonstrates that early recognition and aggressive treatment of nonocclusive common femoral DVT after RFA can obviate the need for long-term anticoagulation and potentially the sequelae of deep venous thrombosis.