Abstract：
OBJECTIVE: Polidocanol endovenous microfoam ablation (MFA) is approved by the US Food and Drug Administration for great saphenous vein (GSV) closure, yet there are few published data on the subsequent risk of ablation-related thrombus extension (ARTE). Recent societal practice guidelines recommend against routine postprocedure duplex ultrasound (DU) examination after thermal ablation of the GSV in asymptomatic patients. At present, limited data do not allow this recommendation to extend to MFA. Our aim is to identify characteristics and outcomes associated with ARTE following MFA vs radiofrequency ablation (RFA).
METHODS: A retrospective review of a prospectively maintained database was conducted of patients who underwent MFA and RFA closure of incompetent above-knee GSVs. Patients treated for isolated tributary vein treatment or did not have a postprocedure DU examination within 48 to 72 hours were not included. Patients were classified into two groups: ARTE and no ARTE. Demographic data, Clinical, Etiologic, Anatomic and Pathophysiologic class, Venous Clinical Severity Score, operative details, postprocedure (48-72 hours) DU findings, and adverse events were analyzed. Variables that were significant on univariate analysis were evaluated using multivariate logistic regression with the primary outcome being development of ARTE.
RESULTS: Between June 2018 and February 2023, 800 limbs were treated with either MFA (n = 224) or RFA (n = 576). Ninety-six GSVs treated with MFA met the study criteria. One hundred fifty successive GSVs treated with RFA during the same period were included as a comparison group. There was no statistically significant difference in baseline demographics between the two groups. Six patients (2.4%) demonstrated ARTE on postoperative DU examination at 48 to 72 hours (MFA, n = 5 [5.2%]; RFA, n = 1 [0.7%]; P = .02). Saphenous vein ablation with MFA (P = .045) and a vein diameter of >10 mm (P = .017) were associated with ARTE on both univariable and multivariable analysis. All patients who developed ARTE were treated with oral anticoagulants (mean, 15.6 days). Body mass index, Clinical, Etiologic, Anatomic and Pathophysiologic class, Venous Clinical Severity Score, microfoam volume, operative time, and prior deep venous thrombosis were not predictive of ARTE.
CONCLUSIONS: ARTE after above-knee GSV closure occurred more frequently after MFA. Our results suggest that a saphenous vein diameter of >10 mm may be associated with ARTE. Despite this finding, all patients with ARTE were treated with short-term anticoagulation with no related complications. Until larger studies with high-risk subgroups have been studied after MFA, DU examination should be performed routinely after this procedure and patients with ARTE anticoagulated until the thrombus retracts caudal to the saphenofemoral junction or is no longer present on DU examination. Current societal guidelines recommending against routine post-thermal ablation DU examination should not be applied to similar patients after saphenous nonthermal MFA ablation.
METHODS: A retrospective review of a prospectively maintained database was conducted of patients who underwent MFA and RFA closure of incompetent above-knee GSVs. Patients treated for isolated tributary vein treatment or did not have a postprocedure DU examination within 48 to 72 hours were not included. Patients were classified into two groups: ARTE and no ARTE. Demographic data, Clinical, Etiologic, Anatomic and Pathophysiologic class, Venous Clinical Severity Score, operative details, postprocedure (48-72 hours) DU findings, and adverse events were analyzed. Variables that were significant on univariate analysis were evaluated using multivariate logistic regression with the primary outcome being development of ARTE.
RESULTS: Between June 2018 and February 2023, 800 limbs were treated with either MFA (n = 224) or RFA (n = 576). Ninety-six GSVs treated with MFA met the study criteria. One hundred fifty successive GSVs treated with RFA during the same period were included as a comparison group. There was no statistically significant difference in baseline demographics between the two groups. Six patients (2.4%) demonstrated ARTE on postoperative DU examination at 48 to 72 hours (MFA, n = 5 [5.2%]; RFA, n = 1 [0.7%]; P = .02). Saphenous vein ablation with MFA (P = .045) and a vein diameter of >10 mm (P = .017) were associated with ARTE on both univariable and multivariable analysis. All patients who developed ARTE were treated with oral anticoagulants (mean, 15.6 days). Body mass index, Clinical, Etiologic, Anatomic and Pathophysiologic class, Venous Clinical Severity Score, microfoam volume, operative time, and prior deep venous thrombosis were not predictive of ARTE.
CONCLUSIONS: ARTE after above-knee GSV closure occurred more frequently after MFA. Our results suggest that a saphenous vein diameter of >10 mm may be associated with ARTE. Despite this finding, all patients with ARTE were treated with short-term anticoagulation with no related complications. Until larger studies with high-risk subgroups have been studied after MFA, DU examination should be performed routinely after this procedure and patients with ARTE anticoagulated until the thrombus retracts caudal to the saphenofemoral junction or is no longer present on DU examination. Current societal guidelines recommending against routine post-thermal ablation DU examination should not be applied to similar patients after saphenous nonthermal MFA ablation.
摘要：
目的：Polidocanol静脉内微泡沫（MFA）已被美国食品和药物管理局批准用于大隐静脉（GSV）闭合，然而,关于消融相关血栓扩展(ARTE)的后续风险的公开数据很少.最近的社会实践指南建议对无症状患者进行GSV热消融后的常规术后双工超声（DU）。目前,有限的数据不允许将此建议扩展到MFA。我们的目的是确定MFA与射频消融（RFA）后与ARTE相关的特征和结果。
方法：对接受MFA和RFA闭合的膝关节上无功能GSV患者进行前瞻性维护的数据库进行回顾性回顾。不包括接受孤立支流静脉治疗或在48-72小时内没有术后DU的患者。患者分为两组：ARTE和无ARTE。人口统计数据,CEAP类，静脉临床严重程度评分（VCSS），操作细节,分析术后(48~72小时)DU发现和不良事件.使用多变量逻辑回归评估在单变量分析中有意义的变量，主要结果是ARTE的发展。
结果：在2018年6月至2023年2月之间，800条肢体接受了MFA（n=224）或RFA（n=576）治疗。接受MFA治疗的96例GSV符合研究标准。在同一时期接受RFA治疗的一百五十例连续GSV作为对照组。两组之间的基线人口统计学差异无统计学意义。6例患者（2.4%）在术后48-72小时显示出ARTE（MFA：n=5（5.2%），RFA:n=1(0.7%);p=0.02)。在单变量和多变量分析中，MFA（p=0.045）和静脉直径>10mm（p=0.017）的大隐静脉消融与ARTE相关。所有发生ARTE的患者均接受口服抗凝剂治疗（平均值=15.6天）。身体质量指数,CEAP类，VCSS,微泡沫体积，手术时间,和既往DVT不能预测ARTE。
结论：MFA后，膝上GSV闭合后消融相关的血栓扩展更频繁。我们的结果表明，隐静脉直径大于10mm可能与ARTE有关。尽管有这个发现,所有ARTE患者均接受短期抗凝治疗,无相关并发症.直到在MFA之后对高风险亚组进行了更大的研究，术后应常规进行DU，并对ARTE患者进行抗凝治疗，直到血栓回缩至隐股部或不再存在于双链体。目前的社会指南建议反对常规热消融术后DU，不应适用于隐非热MFA消融术后的类似患者。
方法：对接受MFA和RFA闭合的膝关节上无功能GSV患者进行前瞻性维护的数据库进行回顾性回顾。不包括接受孤立支流静脉治疗或在48-72小时内没有术后DU的患者。患者分为两组：ARTE和无ARTE。人口统计数据,CEAP类，静脉临床严重程度评分（VCSS），操作细节,分析术后(48~72小时)DU发现和不良事件.使用多变量逻辑回归评估在单变量分析中有意义的变量，主要结果是ARTE的发展。
结果：在2018年6月至2023年2月之间，800条肢体接受了MFA（n=224）或RFA（n=576）治疗。接受MFA治疗的96例GSV符合研究标准。在同一时期接受RFA治疗的一百五十例连续GSV作为对照组。两组之间的基线人口统计学差异无统计学意义。6例患者（2.4%）在术后48-72小时显示出ARTE（MFA：n=5（5.2%），RFA:n=1(0.7%);p=0.02)。在单变量和多变量分析中，MFA（p=0.045）和静脉直径>10mm（p=0.017）的大隐静脉消融与ARTE相关。所有发生ARTE的患者均接受口服抗凝剂治疗（平均值=15.6天）。身体质量指数,CEAP类，VCSS,微泡沫体积，手术时间,和既往DVT不能预测ARTE。
结论：MFA后，膝上GSV闭合后消融相关的血栓扩展更频繁。我们的结果表明，隐静脉直径大于10mm可能与ARTE有关。尽管有这个发现,所有ARTE患者均接受短期抗凝治疗,无相关并发症.直到在MFA之后对高风险亚组进行了更大的研究，术后应常规进行DU，并对ARTE患者进行抗凝治疗，直到血栓回缩至隐股部或不再存在于双链体。目前的社会指南建议反对常规热消融术后DU，不应适用于隐非热MFA消融术后的类似患者。
