Recurrent Recanalization After Endovenous Thermal Ablation for Recanalized Varicose Veins
Journal of Vascular Surgery
Background: Endovenous thermal ablation (ETA) in the form of radiofrequency ablation (RFA) or endovenous laser ablation (EVLA) are being used more frequently in the treatment of venous insufficiency. Studies capturing rates of thrombotic complications and recanalization rates can be found in the literature. However, data are lacking regarding recanalization risk after ETA, and further treatment options available. We hereby present our data of subsequent recanalization after repair of recanalized insufficient lower limb veins.
Methods: Re-canalized patient from 2012 to 2022 treated in our practice were collected for retrospective analysis. Recanalized patients undergoing further ETA operations were analyzed after reintervention. Data was collected from follow-up visit within 1 week of procedure, every 3 months for the first year, and every 6 months thereafter. Flow of >500 ms of greater saphenous vein, short saphenous vein, and accessory saphenous vein was considered as recanalization. Flow of >350 ms in the perforator vein was considered as re-canalization. Correlations were made in the data for age, gender, laterality, presenting symptoms and treated targeted vein.
Results: We captured 13,335 procedures, of those 203 patients undergoing 240 redo procedures; 145 were female, 117 were performed on the left lower extremity and 123 on the right lower extremity. The median body mass index was 32.2 kg/m2 (interquartile range [IQR], 9.7 kg/m2). The median age was 61.5 years (IQR, 19.25 years). The Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) class was C2, C3, C4, C5, and C6 for 2, 76, 111, 6, and 45 patients, respectively. Of the 240 procedures, 73 were performed using EVLA and 167 were performed using RFA. The initial technical success was 97.6% (13,020/13,335), and the subsequent success rate was 95.4% (229/240). Of the veins operated on, 138 were greater saphenous vein, 52 perforator vein, 34 short saphenous vein, and 16 accessory saphenous vein. No correlation was found between successful obliteration with the repeat procedures and gender, CEAP class, laterality, or EVLA vs RFA.
Conclusions: The rate of successful closure with initial procedures was higher than the subsequent recurrent recanalization success rate. Lower limb vein insufficiency can be operated on with acceptable success rate by ETA. Further data need to validate our finding. Patients should be informed of the decreased success rate after subsequent intervention.
varicosis, vein insufficiency, body mass, hemispheric dominance, laser surgery, radiofrequency ablation, recanalization, saphenous vein, thermal ablation
Ali A, Santos T, Khan H, Singh N, Kibrik P, Chait J, Arustamyan M, Marks N, Ascher E, Hingorani A. Recurrent Recanalization After Endovenous Thermal Ablation for Recanalized Varicose Veins. Journal of Vascular Surgery. 2023; 78(4). doi: 10.1016/j.jvs.2023.08.044.