title: Increasing ablation distance peripheral to the saphenofemoral junction may result in a diminished rate of endothermal heat-induced thrombosis.
abstract: OBJECTIVE
  The treatment of venous insufficiency using endovenous laser ablation or radiofrequency ablation may result in endothermal heat-induced thrombosis (EHIT), a form of deep venous thrombosis. This study sought to assess whether increasing the ablation distance peripheral to the deep venous junction would result in a reduction in the incidence of EHIT II.
  
  
  METHODS
  This study was a retrospective review of a prospectively maintained database from April 2007 to December 2011. Consecutive patients undergoing great saphenous vein (GSV) or small saphenous vein (SSV) ablation were evaluated. Previous to February 2011, all venous ablations were performed 2 cm peripheral to the saphenofemoral or saphenopopliteal junction (group I). Subsequent to February 2011, ablations were performed greater than or equal to 2.5 cm peripheral to the respective deep system junction (group II). The primary outcome was the development of EHIT II or greater (ie, thrombus protruding into the deep venous system but comprising less than 50% of the deep vein lumen). Secondary outcomes included procedure-site complications such as thrombophlebitis and hematomas. χ(2) tests were performed for all discrete variables, and unpaired Student's t-tests were performed for all continuous variables. P < .05 was considered statistically significant.
  
  
  RESULTS
  A total of 4223 procedures were performed among group I (n = 3239) and group II (n = 984). Patient demographics were similar between the two groups; however, the CEAP classification was higher by a small margin in group II, and the result was significant (group I: 2.6% ± 0.9% vs group II: 2.8% ± 1.0%; P = .006). The incidence of EHIT II was 76 in group I and 13 in group II. This represented a trend toward diminished frequency in group II as compared with group I (group I: 2.3% vs group II: 1.3%; P = .066). There were no reported cases of EHIT III or IV in this patient cohort. Patients who developed an EHIT II in group I were treated using anticoagulation 54% of the time, and patients who developed an EHIT II in group II were treated using anticoagulation 100% of the time.
  
  
  CONCLUSIONS
  This study suggests that changing the treatment distance from 2 cm to greater than or equal to 2.5 cm peripheral to the deep venous junction may result in a diminished incidence of EHIT II. Ongoing evaluation is required to validate these results and to affirm the long-term durability of this technique.
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Mikel
authors.initials: M
authors.lastname: Sadek
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY. Electronic address: lowell.kabnick@nyumc.com.
authors.forename: Lowell S
authors.initials: LS
authors.lastname: Kabnick
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Caron B
authors.initials: CB
authors.lastname: Rockman
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Todd L
authors.initials: TL
authors.lastname: Berland
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Di
authors.initials: D
authors.lastname: Zhou
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Cara
authors.initials: C
authors.lastname: Chasin
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Glenn R
authors.initials: GR
authors.lastname: Jacobowitz
authors.affiliation: Division of Vascular and Endovascular Surgery, New York University Langone Medical Center, New York, NY.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Adelman