Thromboembolic complications of endovenous thermal ablation and foam sclerotherapy in the treatment of great saphenous vein insufficiency.
OBJECTIVE
We assessed the incidence of venous thromboembolism following treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy using meta-analysis of published randomized controlled trials and case series.


METHODS
Medline, Embase, Cochrane, and Clinical Trials Registry databases were searched from January 2000 through January 2013 for randomized controlled trials and large case series employing endovenous thermal ablation or foam sclerotherapy as a single modality for the treatment of great saphenous insufficiency, with concomitant postoperative duplex scanning. Pooled (stratified) incidence of venous thromboembolism with 95% confidence intervals was estimated using the DerSimonian–Laird procedure for random effects meta-analysis. A bootstrap analysis was performed to examine between-modality differences.


RESULTS
Twelve randomized controlled trials and 19 case series investigating endovenous thermal ablation (radio frequency ablation with VNUS/Covidien ClosureFAST™ catheter only, endovenous laser ablation, or both) were included. Data from 12 randomized controlled trials and 6 case series investigating nonproprietary foam preparations were analyzed. Estimated incidence of venous thromboembolism was low (mostly <1%) and similar across treatment modalities and study types.


CONCLUSIONS
Treatment of great saphenous insufficiency by endovenous thermal ablation or foam sclerotherapy is a common vascular intervention. The stratified incidence of venous thromboembolism appears to be low as reported in both randomized controlled trials and case series investigating these modalities. Although duplex scans were obtained postoperatively, a minority of studies specified protocols for venous thromboembolism detection.
Cardiovascular Center, Tufts Medical Center, USA meghandermody@gmail.com.
Meghan
M
Dermody
Lafayette Regional Vein and Laser Center, IN, USA.
Marlin W
MW
Schul
Cardiovascular Center, Tufts Medical Center, USA.
Thomas F
TF
O'Donnell
D017115:Catheter Ablation / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006979:Hyperthermia, Induced / Q000009:adverse effects*; D053685:Laser Therapy / Q000009:adverse effects*; D016239:MEDLINE; D008297:Male; D016032:Randomized Controlled Trials as Topic; D012501:Saphenous Vein; D015911:Sclerotherapy / Q000009:adverse effects*; D014689:Venous Insufficiency / Q000628:therapy*; D054556:Venous Thromboembolism / Q000209:etiology* / Q000517:prevention & control
Venous thromboembolism; endovenous laser; endovenous thermal ablation; foam sclerotherapy; radiofrequency ablation; treatment