Thrombus Extension After Great Saphenous Vein Mechanochemical Ablation.

Abstract

OBJECTIVE\nTo examine factors associated with thrombus extension after early experience with mechanochemical ablation, which combines mechanical damage to the venous endothelium with infusion of a sclerosant.\n\n\nMETHODS\nA retrospective review was performed of patients who underwent mechanochemical ablation to treat saphenous vein insufficiency in the thigh including the saphenofemoral junction. Data abstracted included patient demographics, procedural details, and post-procedural outcomes. Thrombus extension was determined by post-procedural duplex ultrasound and classified as flush closure with the femoral vein and any extension of thrombus into the femoral vein.\n\n\nRESULTS\n73 patients met inclusion criteria. The mean age of the population was 60, 17.8% were female, and the mean BMI was 30.7. Seven (9.6%) patients who underwent mechanochemical ablation experienced saphenous vein closure flush with the femoral vein. Eleven (15%) patients experience extension of thrombus to less than 50% of the diameter of the femoral vein and one patient experienced complete thrombosis of the femoral vein. There was no significant difference in age, sex, or comprehensive classification system for chronic venous disorders (CEAP) between the group with thrombus extension and the group without, with the exception of body mass index (BMI). The mean BMI in the group with thrombus extension was 26.8 vs 32 in the group without (p=0.02). There was no significant difference between the two groups in sclerosant volume used, distance between catheter tip and SFJ, and mean diameter of GSV in the thigh.\n\n\nCONCLUSIONS\nIn this cohort, the incidence of thrombus extension into the femoral vein with mechanochemical ablation was high relative to rates of thrombus extension associated with reported rates of thermal ablation. Further investigation with larger cohorts, and standardized reporting is required to characterize the true rate of thrombus extension after mechanochemical ablation and identify maneuvers which may prevent thrombus extension.