Presence Of Popliteal Vein Reflux Increases The Rate Of EHIT After Small Saphenous Vein Closure
C. Y. Maximilian Png, MD, David Schneider, Kathryn Nuzzulo, Sherry Scovell, MD, Julianne Stoughton, MD.
Massachusetts General Hospital, Boston, MA, USA.
OBJECTIVES: Venous insufficiency in the small saphenous vein (SSV) is significantly less common than venous insufficiency in the great saphenous vein; the impact of popliteal vein reflux on SSV closure procedural outcomes has yet to be studied. METHODS: A retrospective analysis was performed on 169 consecutive patients who underwent SSV closure procedures from 2015 to 2019. Preoperative demographic analysis was performed, following which chi-squared analysis was performed for postoperative occlusion rates and complication rates including endovenous heat induced thrombus (EHIT), superficial venous thrombosis and deep vein thrombosis. RESULTS: The cohort had a mean age of 58 years, and 127 (77%) were female. 58 patients had C2 disease, 83 had C3 disease, 16 had C4 disease, 2 had C5 disease and 4 had C6 disease. 31 (18.6%) patients were noted to have popliteal vein reflux on their initial venous insufficiency ultrasound study, compared to 135 (81.3%) who did not. Treatment modalities included 85 (50.3%) radiofrequency ablations, 49 (28.9%) foam sclerotherapy, 29 (17.1%) laser ablation and 6 (3.5%) mechanochemical ablation. When comparing patients with popliteal vein reflux to those without, there was no significant difference in occlusion rates at their immediate postoperative visit (99.2% vs 96.4%) or at their 6-month postoperative visit (87.3% vs 80.6%). EHIT was noted in 5 of the patients with popliteal vein reflux compared to 5 of the patients without popliteal vein reflux (17.8% vs. 3.7%, P < 0.01). There were no significant differences in any of the other complications analyzed.
CONCLUSIONS: The presence of popliteal vein reflux has no impact on postoperative occlusion rates, however it is associated with almost a fivefold increase rate in EHIT. Patients should be counseled on this increased risk should they undergo SSV treatment with known popliteal vein reflux.
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