IP261. Radiofrequency Ablation Increases the Incidence of Endothermal Heat-Induced Thrombosis

Abstract

Endovenous thermal ablation has become the procedure of choice in the treatment of superficial venous reflux disease. The current armamentarium of devices and techniques aimed at the elimination of saphenous reflux offers surgeons and interventionalists a variety of treatment options; however, there is a lack of data comparing the safety of these products. The most concerning complication after endovenous thermal ablation is endothermal heat-induced thrombosis (EHIT) because of the risk of progression to deep venous thrombosis. This study aimed to compare the incidence rate of EHIT between radiofrequency ablation (RFA) and endovenous laser therapy (EVLT). This was a single-center, office-based, retrospective study during the course of 5 years, in which 3218 consecutive patients underwent 10,029 endovenous saphenous ablations. The patient cohort was 66.2% female, with an average age of 61.9 years. At the time of each individual intervention, 24, 212, 3620, 4806, 200, and 1167 patients had Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class 1, class 2, class 3, class 4, class 5, and class 6 disease, respectively. There was a total of 3983 EVLT and 6091 RFA procedures. The most common vessel treated was the great saphenous vein, 63.6% of the time, followed by the small saphenous vein (25.6%), accessory saphenous vein (6.1%), and perforator vein (4.6%). There were 186 cases of EHIT, with 137 (73.6%) identified as class 1 per the Kabnick classification. Endovenous ablation performed by RFA resulted in significantly more cases of EHIT compared with EVLT (109 vs 77; P = .034; odds ratio, 1.52), which was confirmed by multivariate analysis. In the largest single-center study of endovenous saphenous ablations to date, RFA was shown to pose a significantly higher risk of EHIT compared with EVLT.