Quickshot: Strategies to Reduce Rates of Severe Endothermal Heat-induced Thrombosis Following Radiofrequency Ablation: A Single Center Experience

Endothermal heat-induced thrombosis (EHIT) is a potential complication of radiofrequency ablation (RFA). Data on effective prophylaxis of EHIT is limited. In 2018, our institution implemented strategies to decrease the incidence of EHIT. The study objective was to evaluate the impact of these institutional changes on thrombotic complication rates after RFA.

Methods:

A retrospective cohort control study was conducted for patients in our institution who underwent RFA with a great saphenous vein (GSV) diameter ≥8mm or sapheno-femoral junction (SFJ) diameter ≥10mm from January 2015-July 2022. Institutional changes to reduce rates of EHIT (implemented in 2018) included a single dose of peri-procedural Enoxaparin (40 mg) for patients with large GSV (≥8mm) and limiting treatment to one vein per procedure. The primary outcome was incidence of thrombotic complications (thrombophlebitis, EHIT or DVT), while the secondary endpoint was bleeding complications. Patient demographic and procedural variables were included in the analysis and significant variables after univariable logistic regression were included in a multiple-variable logistic regression.

Results:

2074 patients underwent RFA procedures during our study period. Post-policy change, the overall Vein Center EHIT rate decreased from 2.59% to 1.52% with a trend toward significance (p = 0.10). The inclusion criteria of GSV diameter ≥8mm or SFJ diameter ≥10mm yielded 845 patients, of which 298 were treated prior to the policy change and 547 were treated after.

There was a significant reduction in rates of EHIT classified as level 3 or greater (2.34 vs 0.37, p = 0.02) following the institutional changes (Table I). Treatment of two or more veins and increased vein diameter were associated with increased risk of EHIT (p = 0.05, p < 0.05), though the association of multiple veins was lost when a per limb analysis was performed (p = 0.85). There was no significant association between peri-procedural anticoagulation and all-cause thrombotic complications (p = 0.56) or EHIT (p = 0.89).

Conclusions:

The institutional policy changes have led to lower rates of EHIT, with a reduction in severe EHIT in patients with GSV diameter ≥8mm or SFJ ≥ 10mm treated with RFA. Of the changes implemented, restricting treatment to one vein is associated with a reduction in severe EHIT. Our study shows no reduction with peri-procedural Enoxaparin use.