The Incidence and Outcome of DVT after Endovenous Laser Ablation
William P Shutze, Sr., Katherine Kane, Taylor Hicks, John Kedora, Steve Hohmann, Toby Dunn, Brad Grimsley, Dennis Gable, Greg Pearl, Bertram Smith
Baylor University Medical Center, Dallas, TX
Background: Endovenous ablation of the saphenous vein (EVLT) has become the preferred treatment for treating saphenous reflux which results in symptomatic lower extremity venous insufficiency or varicose veins. This office based ambulatory procedure was noted during initial FDA trials to have a low incidence of postoperative deep vein thrombosis (DVT). Later clinical experience suggested that the actual incidence of DVT may be much higher .
Methods: We reviewed the office records and the pre and post treatment ultrasounds of patients undergoing EVLT in our office from 2005 -2010 to determine the frequency of postoperative DVT in patients we had treated and then graded them according to a previously published classification.
Results: There were 528 veins treated in 192 males and 336 females. The CEAP class for these patients was 1(0), 2(291), 3(65), 4(104), 5(26) and 6(40). The greater saphenous vein was treated in 496, the lesser saphenous vein (LSV) in 22 and both were treated in 10. DVT occurred in 27 of legs treated for an incidence of 5.1%. The DVTs in the femoral vein were of level 3 (3), 4 (7), 5(12) and 6 (3). Two patients developed DVT in the popliteal vein after EVLT of the LSV. Treatment for the postop DVT consisted of observation (13), anticoagulation (9), antiplatelet therapy (2), and nonsteroidal anti-inflammatory agents (1). Duration of therapy was usually one week but 7 patients were treated for periods ranging from 1 to 7 weeks. No pulmonary emboli occurred in any of these patients. The DVTs resolved completely in all patients.
Conclusion: The incidence of DVT after EVLT is higher than previously reported but is not associated with PE and mainly consists of low risk level 3, 4 and 5 DVT. The DVT typically resolves after one week and can be treated with a short course of antiplatelet or anticoagulation therapy although observation appears to be sufficient as well.
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