Retrospective Study Of Postoperative Complications In Patients Who Received Endovenous Ablation Therapy With Prior History Of Diseased Iliac Veins
Jai Ganesh Shahani, BA1, Pavel Kibrik, DO2, Hala Kalaji, MD3, Hason Khan, MS4, Aleha Syed5, Ikpechukwu Obayi, BA6, Keahan Mokhtari, BA7, Natalie Marks, MD8, Enrico Ascher, MD8, Anil Hingorani, MD2.
1New Jersey Medical School, Newark, NJ, USA, 2NYU Langone Hospital, Brooklyn, NY, USA, 3Royal College of Surgeons, Dublin, Ireland, 4Kansas City University, Kansas City, MO, USA, 5New Explorations into Science, Math, and Technology, New York City, NY, USA, 6CUNY School of Medicine, New York City, NY, USA, 7St. George's University, St. George, Grenada, 8NYU Grossman School of Medicine, New York City, NY, USA.
OBJECTIVES: Current treatment protocols according to the Society for Interventional Radiologists suggest against endovenous ablations (EVAs) in patients with a history of iliac vein chronic disease. Our experience suggested that these patients did not suffer major complications, postoperatively. This study attempts to investigate the results of performing infrainguinal EVAs in the setting of diseased iliac veins.
A retrospective analysis of 5,620 ablation procedures in 1,688 patients with a history of EVA from 2012 to 2020 was performed. Iliac vein duplex ultrasounds (DUS) were performed preoperatively to screen for iliac vein disease, then within 3 to 7 days postoperatively. Follow ups were scheduled every 3 to 6 months for the first year, then every 6 to 12 months thereafter. Successful obliteration of the vein was defined as a lack of color flow using postoperative iliac vein DUS. Patients with confirmed iliac vein disease were screened for treatment complications and EHITs, then characterized by clinical signs (C) of the CEAP classification, age, race, gender, BMI, and procedure method.
RESULTS: 5,620 EVAs and 4,006 pre-procedure iliac vein DUS screenings were performed in 1,688 patients. Of those screened, 16 patients (55.2%) were found to have an iliac vein occlusion prior to EVA and 13 cases (44.8%) had stenotic iliac vein stents. 15 (51.7%) patients were females. 11 patients (37.9%) were White, 8 (27.6%) were Hispanic, 7 (24.1%) were Black, and 3 (10.3%) were Asian. 12 patients (41.4%) had a BMI above 30 and 17 patients (58.6%) were above the age of 65. 18 patients (62.0%) had a radiofrequency ablation and 11 (37.9%) had a laser procedure. One patient (3.4%) had a clinical sign classification of 2, ten (34.5%) had a score of 3, seven (24.1%) had a score of 4, and eleven (37.9%) had a score of 6. Two (6.90%) patients suffered symptomatic venous recanalization and the average time to follow-up was 2 months. One patient (3.4%) developed an EHIT within 11 days post-EVA, and none developed acute iliofemoral deep vein thromboses.
CONCLUSIONS: As per our experience, EVA procedures appeared to be safe in the presence of chronically diseased iliac veins. Further studies should examine whether patients who undergo EVA have sustained symptomatic relief from venous reflux.
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