December 12, 2008

Short Saphenous Vein Radiofrequency Ablation: Is There An Increased Risk of DVT?

Stephen M. Bauer, MD¹, Caron Rockman, MD¹, Jonathon Zagzag, BA², Lowell Kabnick, MD¹, Mark A. Adelman, MD¹.
¹New York University Medical Center, New York, NY, USA, ²New York University School of Medicine, New York, NY, USA.

Background: There is a paucity of literature regarding radiofrequency ablation (RFA) treatment of the short saphenous vein (SSV). We report our institutional experience with SSV ablation.
Methods: A retrospective chart review was performed. Duplex ultrasound (DUS) was performed at the completion of the procedure, and within the first week. Patients were assessed for successful ablation, and deep venous thrombosis (DVT).
Results: 970 RFA cases were performed of which 61 were in the SSV (6.3%). The mean age of the SSV patients was 49.3 years, and 69% were female. Presenting symptoms included varicosities (100%), pain (34.7%), and pruritis (2.0). Most patients were CEAP class 2 (80%). All procedures were initially successful. One-week follow-up DUS demonstrated successful ablation in all cases. There were five asymptomatic DVT’s (8.2%) demonstrated on the one-week DUS. Two were non-occlusive extensions of SSV thrombus into the adjacent popliteal vein, and three were in non-contiguous tibial veins. Treatment of DVT was at the surgeon’s discretion, and was expectant in 2 cases, low-molecular weight heparin in 2 cases, and warfarin in 1 case. Resolution of all DVT’s occurred at a mean of 28.3 days with or without anticoagulation. There was a trend towards an increased incidence of DVT using the Closure Fast system (VNUS Medical Technologies Inc., San Jose, Ca.) as opposed to the original Closure system (10.8% versus 4.2%); this was not statistically significant. There were no other serious complications related to the procedure.
Conclusion: RFA of the SSV is safe and initially successful. The incidence of DVT in the SSV as compared to reported results of RFA treatment of the greater saphenous vein might be higher; however, they appear to be of minor clinical significance, and may not require anticoagulation. The newer generation RFA system may be associated with an increased risk of DVT when compared to the earlier generation catheters. We recommend careful technique to ensure an adequate treatment distance from the sapheno-popliteal junction, as well as mandatory postoperative DUS screening.

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