Neovascularization after great saphenous vein ablation

Area of Science:

• Vascular Surgery
• Interventional Radiology
• Medical Imaging

Background:

• Endovenous ablation techniques like endovenous laser ablation (EVLT) and radiofrequency ablation (RFA) are common for treating great saphenous vein (GSV) insufficiency.
• Recurrence or incomplete obliteration of treated veins can occur, necessitating investigation into underlying mechanisms.

Purpose of the Study:

• To investigate the prevalence, distribution, and flow characteristics of intraluminal neovascularization following GSV endovenous ablation.
• To determine if this neovascularization contributes to treatment failure.

Main Methods:

• Duplex ultrasound (DU) was used to assess patients before, during, and after EVLT or RFA procedures.
• Flow characteristics, including vessel diameter and resistivity index (RI), were analyzed for any identified new vessels.
• Follow-up included assessment for deep venous thrombosis and vein obliteration.

Main Results:

• Arteriovenous fistulae (AVF) were identified in 5% of the 102 treated GSV segments (46 RFA, 56 EVLT).
• These AVFs involved multiple small vessels adjacent to the treated vein, with a mean channel diameter of 2.2mm and mean RI of 0.42.
• Feeding arteries showed enhanced flow with a significantly higher RI (0.63). No patients reported symptoms related to the AVF.

Conclusions:

• Intraluminal neovascularization forming small AVFs within ablated GSVs is a notable finding after endovenous ablation.
• The presence of these AVFs may be a significant factor contributing to vein recanalization or recurrence after these procedures.