title: Pretreatment elevated D-dimer levels without systemic inflammatory response are associated with thrombotic complications of thermal ablation of the great saphenous vein.
abstract: OBJECTIVE
  To examine possible association of plasma levels of biomarkers of inflammation and hemostatic activation with the incidence of thrombotic complications after thermal ablation of the great saphenous vein (GSV).
  
  
  METHODS
  This was a prospective cohort study of 120 patients with primary chronic venous disease and reflux limited to the GSV and its tributaries, who were to undergo treatment with radiofrequency ablation of the GSV. Plasma concentration of C-reactive protein (high-sensitivity CRP) and D-dimer were measured immediately prior to the ablation procedure, and in 64 patients, at 20 to 36 hours, 1 week, and 1 month after the treatment. A complete bilateral duplex ultrasound scan was performed prior to treatment, within the first 36 hours and at 1 month after treatment. Incidence of thrombotic complications was based on findings of duplex ultrasound scans.
  
  
  RESULTS
  Sixteen patients developed thrombotic complications. These included seven endovenous heat-induced thromboses, seven thromboses of untreated superficial veins, one thrombosis of the posterior tibial vein, and one gastrocnemius vein thrombosis. In two patients, endovenous heat-induced thromboses coincided with superficial phlebitis. Multivariate analysis showed that patients who had a combination of normal baseline levels of CRP and elevated levels of D-dimer were more than seven times more likely to develop thrombotic complications compared with all other patients (odds ratio, 7.3; 95% confidence interval, 2.2-23.9; P = .002). Both CRP and D-dimer levels significantly increased at 24 to 36 hours and returned to the baseline values at 1 month after the treatment. The D-dimer levels were significantly higher in patients with thrombotic complications at the baseline, 24 to 36 hours and 1 week after the treatment but became not statistically significant a month after the treatment.
  
  
  CONCLUSIONS
  These findings suggest that preoperative activation of the hemostatic system plays an important role in the development of thrombotic complications after thermal ablation of the GSV and that such activation can be detected by commonly used clinical practice laboratory tests.
authors.affiliation: Kistner Vein Clinic and the John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii. Electronic address: flurie@hawaii.edu.
authors.forename: Fedor
authors.initials: F
authors.lastname: Lurie
authors.affiliation: Kistner Vein Clinic and the John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Kistner