ABSTRACT
Furqan Muqri, MD
Vascular Surgery Fellow
Division of Vascular Surgery, New York University Langone Medical Center
new York, New York, United States
Endovenous ablation is the standard of care for patients with symptomatic superficial venous reflux. For patients with a history of deep venous thrombosis (DVT), there is concern that there may be a higher rate of complications. In this present study we aim to evaluate the safety and efficacy of endovenous ablation in patients with a history of DVT to guide treatment for this cohort of patients.
Methods:
Utilizing the national Varicose Vein Vascular Quality Initiative (VQI) database, patients with a history of DVT were compared to patients without a history of DVT. Demographics and procedural characteristics were compared per procedure performed. Technical success rate was based on successful ablation with the absence of reflux post procedure. The primary safety endpoints were the rates of new DVT and endothermal heat induced thrombosis (EHIT).
Results:
In 34429 procedures performed in 28969 individual patients ages 13-90 from January 2014- July 2021, 2091 (7.2%) patients were found to have a history of DVT. Baseline characteristics are as delineated in Table 1. Technical success was achieved in 1881/2118 (88.8%) procedures performed with a history of DVT, as compared to the 28201/32129 (87.8%) without a history of DVT (P=0.0394). New post-procedural DVT was found in 55/2091 (2.6%) procedures with a history of DVT, as compared to 155/27099 (0.6%) without a history of DVT (P < 0.01). Post-procedural EHIT was found in 43/2091 (2.1%) of procedures with a history of DVT, as compared to 239/27099 (1.2%) without a history of DVT(P < 0.01). Of the patients with a history of DVT, 164 stopped taking anticoagulation prior to the procedure while 644 continued taking anticoagulation. 5/164 (3.0%) patients who stopped their anticoagulation developed a post-procedural DVT, whereas 16/644 (2.5%) who were on anticoagulation developed a DVT. From the same cohorts, 2/164 (1.2%) patients developed a post-procedural EHIT, whereas 6/644 (0.9%) who were on anticoagulation developed an EHIT. These did not reach statistical significance.
Conclusions:
Procedures performed in patients with a history of DVT achieve technical success equivalent to those without a history of DVT, and anticoagulation status does not change that outcome. The rates of new DVT and EHIT were higher in patients with a history of DVT, and these rates were equivalent whether they were on or off anticoagulation. Appropriate patient counseling regarding ongoing venous thromboembolic risk is critical for this patient cohort, and the decision to continue or to hold anticoagulation in the periprocedural period may be tailored to the individual patient.