Classification of proximal endovenous closure levels and treatment algorithm

Area of Science:

• Vascular Surgery
• Phlebology
• Interventional Radiology

Background:

• Endovenous closure is a standard treatment for saphenous vein incompetence.
• Thrombus extension above the closure site, near the epigastric or femoral vein, can occur.
• A standardized system is needed to guide management of such events.

Purpose of the Study:

• To introduce a novel six-tier classification system for saphenous endovenous closure.
• To establish an algorithm for patient management based on the classification.
• To evaluate the system's utility in guiding therapy after endovenous treatment.

Main Methods:

• A six-tier classification system was developed based on thrombus proximity to the epigastric or femoral vein.
• An algorithm for treatment was applied to all patients undergoing radio-frequency ablation.
• Data from 500 consecutive patients were analyzed.

Main Results:

• Radio-frequency ablation achieved successful closure in 99.6% of patients.
• Thirteen patients (2.6%) experienced thrombus bulging into the femoral vein, treated with anticoagulation.
• Anticoagulation led to thrombus retraction in all cases within an average of 16 days, with no instances of femoral deep venous thrombosis (DVT).
• Higher rates of proximal thrombus extension were observed in patients with a history of DVT and great saphenous vein (GSV) diameter >8 mm.

Conclusions:

• The developed classification system aids in managing saphenous endovenous closure complications.
• GSV diameter >8 mm and a history of DVT are significant risk factors for proximal thrombus extension.
• A short course of low-molecular-weight heparin (LMWH) is effective for thrombus retraction.
• Management of thrombus flush with the femoral vein wall requires further definition but generally has a benign outcome.