Document Detail


Classification of proximal endovenous closure levels and treatment algorithm.
MedLine Citation:
PMID:  20646894     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVES: Endovenous closure is a common method to treat saphenous vein incompetence. Despite attempts to prevent it, some patients have extension of thrombus above the ideal site of closure immediately below the epigastric vein. We have developed a classification system for the level of saphenous vein closure to guide further therapy after endovenous treatment.
METHODS: A six-tier classification system was developed, based on thrombus proximity to the epigastric or femoral vein, and an algorithm for treatment, based on level of closure was applied to all patients.
RESULTS: Five hundred consecutive patients underwent radio-frequency ablation of the saphenous vein; it was successfully closed in 498 (99.6%) patients. Thirteen patients (2.6%) experienced thrombus bulging into the femoral vein or adherent to its wall, which was treated with anticoagulation. All of these patients had thrombus retraction to the level of the saphenofemoral junction (SFJ) in an average of 16 days with concurrent anticoagulation. No femoral deep venous thrombosis (DVT) occurred in the series. There was a significantly higher rate of proximal thrombus extension in those patients with a history of DVT and those with a great saphenous vein (GSV) diameter of >8 mm (P < .02).
CONCLUSIONS: A classification system for saphenous endovenous closure which extends above the epigastric vein has been helpful in guiding management. A GSV diameter at the SFJ of >8 mm and a history of DVT results in significantly higher rates of proximal thrombus extension into the femoral vein. A short course of LMWH, until clot retracts back into the saphenous vein, is therapeutic. Management of the patients with thrombus flush with the femoral vein wall still needs to be defined, but the outcome from these patients is generally benign.
Authors:
Peter F Lawrence; Ankur Chandra; Michael Wu; David Rigberg; Brian DeRubertis; Hugh Gelabert; Juan Carlos Jimenez; Vicki Carter
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Publication Detail:
Type:  Journal Article     Date:  2010-06-19
Journal Detail:
Title:  Journal of vascular surgery     Volume:  52     ISSN:  1097-6809     ISO Abbreviation:  J. Vasc. Surg.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-08-31     Revised Date:  2012-10-03    
Medline Journal Info:
Nlm Unique ID:  8407742     Medline TA:  J Vasc Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  388-93     Citation Subset:  IM    
Copyright Information:
Copyright (c) 2010 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.
Affiliation:
Division of Vascular Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif 90095-6908, USA. pflawrence@mednet.ucla.edu
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Algorithms*
Anticoagulants / therapeutic use*
Catheter Ablation* / adverse effects
Critical Pathways*
Humans
Middle Aged
Risk Assessment
Risk Factors
Saphenous Vein / surgery*,  ultrasonography
Time Factors
Treatment Outcome
Ultrasonography, Doppler, Duplex
Vascular Surgical Procedures* / adverse effects
Venous Insufficiency / surgery*,  ultrasonography
Venous Thrombosis / etiology,  prevention & control*,  ultrasonography
Chemical
Reg. No./Substance:
0/Anticoagulants

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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