Safety of Great Saphenous Vein Ablation in Patients with Recent Superficial Venous Thrombosis: A Propensity-Matched Cohort Analysis.

BACKGROUND

Endovenous ablation of the great saphenous vein (GSV) has traditionally been approached with caution or even delayed in patients with a recent history of superficial venous thrombosis (SVT) due to concern for postprocedural complications. Scant literature has substantiated this theoretical concern. The objective of this study was to characterize the safety of GSV ablation in patients with a recent history of SVT.

METHODS

This single-center retrospective cohort study included patients who underwent a GSV ablation with or without concomitant microphlebectomy from March 2016 to December 2023 at an institutional accredited outpatient vein center. Patients were grouped into 2 cohorts: (1) no history of ipsilateral SVT and (2) a recent history of ipsilateral SVT, defined as a clinical diagnosis within 3 months of GSV ablation. Patients with no history of SVT were propensity-score-matched 1:1 to those with a recent history of ipsilateral SVT using nearest-neighbor matching based on the following covariates: age, sex, race, insurance status, history of deep venous thrombosis (DVT), and use of preoperative anticoagulation. The primary end point was postprocedural acute DVT. Secondary end points included new or worsening SVT, endovenous heat-induced thrombosis (EHIT), and the time interval between the office visit recommending intervention and the procedural date.

RESULTS

Seventy-nine patients with no history of SVT and 79 patients with a recent history of SVT were included. Among the 158 total patients, 46.2% of patients underwent isolated GSV ablation, 45.6% underwent GSV ablation with concomitant microphlebectomy, and 8.2% underwent GSV ablation with staged microphlebectomy. There was no difference in the preoperative Venous Clinical Severity Score between the 2 cohorts (6.4 vs. 7.3, P = 0.09). Patients without SVT had the longer waiting period from the office visit that planned the procedure to the intervention date (52 vs. 35 days, P = 0.005). Postoperatively, those with a recent SVT were more likely to have thrombosed superficial tributaries (30.4% vs. 59.5%, P < 0.001). There were no significant differences in other postoperative outcomes including acute DVT (P = 0.65), endothermal heat-induced thrombosis (EHIT) (P = 0.17), or SVT (P = 0.32).

CONCLUSION

New or worsening SVT was rare (1/158, 0.6%) and did not differ between cohorts (P = 0.32); accordingly, intervention in these patients should not be delayed. Moreover, our findings show that there were no differences in procedural outcomes between patients with recent SVT and patients without SVT.